CARDIOVASCULAR NCLEX CORRECT FINAL EXAM
QUESTIONS AND ANSWERS SURE A+
✔✔Older clients experiencing anginal pain with complaints of fatigue or weakness
usually are medicated with which of the following types of medication?
Sublingual nitroglycerin
Cardiac glycosides
HMG-CoA reductase inhibitors
Morphine sulfate - ✔✔Sublingual nitroglycerin
Rationale: Angina frequently is managed with sublingual nitroglycerin, which causes
vasodilation and increases blood flow to the coronary arteries. Cardiac glycosides are
used to treat heart failure, and morphine is used to treat myocardial infarction. The
HMG-CoA reductase inhibitors are used for patients with type 2 diabetes mellitus.
✔✔Which of the following diagnostic studies most likely would confirm a myocardial
infarction?
Serum myoglobin level
Creatinine kinase (CK)
White blood cell count (WBC)
Troponin T levels - ✔✔Troponin T levels
,Rationale: CK-MB elevates 4-6 hours after tissue necrosis. Troponin levels rise 6-8
hours after the infarct (tissue necrosis) but also can occur with other types of tissue
damage. Myoglobin also elevates, but to a lesser degree. WBC levels elevate with an
inflammatory response. Troponin levels are more elevated than are the other cardiac
enzymes, are more specific to cardiac tissue, and rise 6-8 hours after the infarct (tissue
necrosis).
✔✔A client with post-myocardial infarction develops acute bacterial pericarditis. Which
of the following medications would the physician most likely prescribe as the primary
drug?
Ticarcillin disodium (Ticar)
Acetaminophen (Tylenol)
Ibuprofen (Motrin)
Trioxsalen (Trisoralen) - ✔✔Ticarcillin disodium (Ticar)
Rationale: Acute bacterial pericarditis is a complication that can occur post-myocardial
infarction. Acute bacterial pericarditis usually requires antibiotics. NSAIDs usually are
prescribed to relieve pain from the inflammatory process. If the NSAIDs do not relieve
pain within 48 to 96 hours, corticosteroids are ordered. There is no mention of pain in
the stem of the question. Trisoralen is used to repigment skin for persons with vitiligo.
✔✔Which of the following diagnostic tests is preferred for evaluating heart valve
function?
Chest x-ray
Duplex Doppler
Echocardiogram
Electrocardiogram - ✔✔Echocardiogram
Rationale: The echocardiogram is the preferred test to evaluate heart valves, because it
allows the visualization of the valves as they open and close. A chest x-ray will
determine the size of the heart, the duplex measures blood flow through major arteries,
and an electrocardiogram identifies electrical activity.
✔✔An elderly client is being monitored for evidence of congestive heart failure. To
detect early signs of heart failure, the nurse would instruct the certified nursing
attendant (CNA) to do which of the following during care of the patient?
Observe electrocardiogram readings and report deviations to the nurse.
Assist the client with ambulation three times during the shift.
Monitor vital signs every 15 minutes and report each reading to the nurse.
Accurately weigh the patient, and report and record the readings. - ✔✔Accurately
weigh the patient, and report and record the readings.
,Rationale: Due to fluid accumulation, an expanded blood volume can result when the
heart fails. Body weight is a sensitive indicator of water and sodium retention, which will
manifest itself with edema, dyspnea - especially nocturnal - and pedal edema. Patients
also should be instructed about the need to perform daily weights upon discharge to
monitor body water. It is not within the role of the CNA to monitor ECG readings, and
ambulation is not an assessment. Vital signs every 15 minute are not necessary for this
level of patient care.
✔✔Which of the following drug classifications should the nurse question if prescribed for
a person with congested heart failure (CHF)?
Angiotensin-converting enzyme (ACE) inhibitor
Beta-adrenergic blocker
Alpha adrenergic antagonist
Rosiglitazone (Avandia) - ✔✔Rosiglitazone (Avandia)
Correct answer: Thiazolidinediones, like rosiglitazone (Avandia), are glucose-reducing
drugs that are prescribed for persons with type 2 diabetes mellitus. ACE inhibitors, such
as Lisinopril, are first-line drugs used to treat CHF. Propranolol (Inderal), a beta blocker,
has remained one of the most widely used beta-blocking drugs. It blocks both beta1 and
beta2 receptors in various organs, resulting in reduction of heart rate and the force of
contraction, and suppresses impulse conduction through the AV node, all of which
slows the progression of the disease process. Carvedilol (Coreg) is another beta-
adrenergic blocker used to treat heart failure.
✔✔A common arrhythmia found in some older clients is chronic atrial fibrillation. Based
on the nurse's knowledge of the disease pathology, which of the following prescriptions
should the nurse expect to be ordered?
Aspirin (acetylsalicylic acid)
Warfarin sodium (Coumadin)
Simvastatin (Zocor)
Vinorelbine tartrate (Navelbine) - ✔✔Warfarin sodium (Coumadin)
Rationale: Chronic atrial fibrillation places a patient at high risk for clot formation.
Warfarin sodium frequently is ordered as an anti-coagulant. Aspirin will not prevent clots
associated with atrial fibrillation. Zocor is used to lower LDL and increase HDL.
Navelbine is an anti-neoplastic.
✔✔Which of the following assessments would be an important finding for a patient with
arterial disease?
Intermittent claudication with exercise
Brownish discoloration around the ankles
Non-pitting edema on the lower extremities
Altered sensation to touch - ✔✔Intermittent claudication with exercise
, Rationale: Intermittent claudication is a common finding in persons with arterial disease,
usually due to progression of atherosclerosis and alteration of tissue perfusion to the
extremities. In venous disease, valves of the veins in the extremities become
incompetent, resulting in higher pressures than normal in the veins. The pressure is
transmitted to the capillaries of the lower extremities, resulting in thickening and non-
pitting edema of tissues around the ankles. Prolonged thickening results in the red
blood cells' being pressed outside the capillaries. The cells eventually break down,
resulting in collection of hemosiderin deposits being collected in the area. Altered
sensation to touch would be due to neuropathic changes commonly found with diabetes
mellitus.
✔✔1) A client is scheduled for a cardiac catherization using a radiopaque dye. Which of
the following assessments is most critical before the procedure?
Intake and output
Baseline peripheral pulse rates
Height and weight
Allergy to iodine or shellfish - ✔✔4.
This procedure requires an informed consent because it involves injection of a
radiopaque dye into the blood vessel. The risk of allergic reaction and possible
anaphylaxis is serious and must be assessed before the procedure.
✔✔2) A client with no history of cardiovascular disease comes into the ambulatory clinic
with flulike symptoms. The client suddenly complains of chest pain. Which of the
following questions would best help a nurse to discriminate pain caused by a non-
cardiac problem?
"Have you ever had this pain before?"
"Can you describe the pain to me?"
"Does the pain get worse when you breathe in?"
"Can you rate the pain on a scale of 1-10, with 10 being the worst?" - ✔✔3.
Chest pain is assessed by using the standard pain assessment parameters. Options 1,
2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary
origin usually worsens on inspiration.
✔✔3) A client with myocardial infarction has been transferred from a coronary care unit
to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow
for which of the following client activities?
Strict bed rest for 24 hours after transfer
Bathroom privileges and self-care activities
Unsupervised hallway ambulation with distances under 200 feet
Ad lib activities because the client is monitored. - ✔✔2.
On transfer from the CCU, the client is allowed self-care activities and bathroom
privileges. Supervised ambulation for brief distances are encouraged, with distances
gradually increased (50, 100, 200 feet).
QUESTIONS AND ANSWERS SURE A+
✔✔Older clients experiencing anginal pain with complaints of fatigue or weakness
usually are medicated with which of the following types of medication?
Sublingual nitroglycerin
Cardiac glycosides
HMG-CoA reductase inhibitors
Morphine sulfate - ✔✔Sublingual nitroglycerin
Rationale: Angina frequently is managed with sublingual nitroglycerin, which causes
vasodilation and increases blood flow to the coronary arteries. Cardiac glycosides are
used to treat heart failure, and morphine is used to treat myocardial infarction. The
HMG-CoA reductase inhibitors are used for patients with type 2 diabetes mellitus.
✔✔Which of the following diagnostic studies most likely would confirm a myocardial
infarction?
Serum myoglobin level
Creatinine kinase (CK)
White blood cell count (WBC)
Troponin T levels - ✔✔Troponin T levels
,Rationale: CK-MB elevates 4-6 hours after tissue necrosis. Troponin levels rise 6-8
hours after the infarct (tissue necrosis) but also can occur with other types of tissue
damage. Myoglobin also elevates, but to a lesser degree. WBC levels elevate with an
inflammatory response. Troponin levels are more elevated than are the other cardiac
enzymes, are more specific to cardiac tissue, and rise 6-8 hours after the infarct (tissue
necrosis).
✔✔A client with post-myocardial infarction develops acute bacterial pericarditis. Which
of the following medications would the physician most likely prescribe as the primary
drug?
Ticarcillin disodium (Ticar)
Acetaminophen (Tylenol)
Ibuprofen (Motrin)
Trioxsalen (Trisoralen) - ✔✔Ticarcillin disodium (Ticar)
Rationale: Acute bacterial pericarditis is a complication that can occur post-myocardial
infarction. Acute bacterial pericarditis usually requires antibiotics. NSAIDs usually are
prescribed to relieve pain from the inflammatory process. If the NSAIDs do not relieve
pain within 48 to 96 hours, corticosteroids are ordered. There is no mention of pain in
the stem of the question. Trisoralen is used to repigment skin for persons with vitiligo.
✔✔Which of the following diagnostic tests is preferred for evaluating heart valve
function?
Chest x-ray
Duplex Doppler
Echocardiogram
Electrocardiogram - ✔✔Echocardiogram
Rationale: The echocardiogram is the preferred test to evaluate heart valves, because it
allows the visualization of the valves as they open and close. A chest x-ray will
determine the size of the heart, the duplex measures blood flow through major arteries,
and an electrocardiogram identifies electrical activity.
✔✔An elderly client is being monitored for evidence of congestive heart failure. To
detect early signs of heart failure, the nurse would instruct the certified nursing
attendant (CNA) to do which of the following during care of the patient?
Observe electrocardiogram readings and report deviations to the nurse.
Assist the client with ambulation three times during the shift.
Monitor vital signs every 15 minutes and report each reading to the nurse.
Accurately weigh the patient, and report and record the readings. - ✔✔Accurately
weigh the patient, and report and record the readings.
,Rationale: Due to fluid accumulation, an expanded blood volume can result when the
heart fails. Body weight is a sensitive indicator of water and sodium retention, which will
manifest itself with edema, dyspnea - especially nocturnal - and pedal edema. Patients
also should be instructed about the need to perform daily weights upon discharge to
monitor body water. It is not within the role of the CNA to monitor ECG readings, and
ambulation is not an assessment. Vital signs every 15 minute are not necessary for this
level of patient care.
✔✔Which of the following drug classifications should the nurse question if prescribed for
a person with congested heart failure (CHF)?
Angiotensin-converting enzyme (ACE) inhibitor
Beta-adrenergic blocker
Alpha adrenergic antagonist
Rosiglitazone (Avandia) - ✔✔Rosiglitazone (Avandia)
Correct answer: Thiazolidinediones, like rosiglitazone (Avandia), are glucose-reducing
drugs that are prescribed for persons with type 2 diabetes mellitus. ACE inhibitors, such
as Lisinopril, are first-line drugs used to treat CHF. Propranolol (Inderal), a beta blocker,
has remained one of the most widely used beta-blocking drugs. It blocks both beta1 and
beta2 receptors in various organs, resulting in reduction of heart rate and the force of
contraction, and suppresses impulse conduction through the AV node, all of which
slows the progression of the disease process. Carvedilol (Coreg) is another beta-
adrenergic blocker used to treat heart failure.
✔✔A common arrhythmia found in some older clients is chronic atrial fibrillation. Based
on the nurse's knowledge of the disease pathology, which of the following prescriptions
should the nurse expect to be ordered?
Aspirin (acetylsalicylic acid)
Warfarin sodium (Coumadin)
Simvastatin (Zocor)
Vinorelbine tartrate (Navelbine) - ✔✔Warfarin sodium (Coumadin)
Rationale: Chronic atrial fibrillation places a patient at high risk for clot formation.
Warfarin sodium frequently is ordered as an anti-coagulant. Aspirin will not prevent clots
associated with atrial fibrillation. Zocor is used to lower LDL and increase HDL.
Navelbine is an anti-neoplastic.
✔✔Which of the following assessments would be an important finding for a patient with
arterial disease?
Intermittent claudication with exercise
Brownish discoloration around the ankles
Non-pitting edema on the lower extremities
Altered sensation to touch - ✔✔Intermittent claudication with exercise
, Rationale: Intermittent claudication is a common finding in persons with arterial disease,
usually due to progression of atherosclerosis and alteration of tissue perfusion to the
extremities. In venous disease, valves of the veins in the extremities become
incompetent, resulting in higher pressures than normal in the veins. The pressure is
transmitted to the capillaries of the lower extremities, resulting in thickening and non-
pitting edema of tissues around the ankles. Prolonged thickening results in the red
blood cells' being pressed outside the capillaries. The cells eventually break down,
resulting in collection of hemosiderin deposits being collected in the area. Altered
sensation to touch would be due to neuropathic changes commonly found with diabetes
mellitus.
✔✔1) A client is scheduled for a cardiac catherization using a radiopaque dye. Which of
the following assessments is most critical before the procedure?
Intake and output
Baseline peripheral pulse rates
Height and weight
Allergy to iodine or shellfish - ✔✔4.
This procedure requires an informed consent because it involves injection of a
radiopaque dye into the blood vessel. The risk of allergic reaction and possible
anaphylaxis is serious and must be assessed before the procedure.
✔✔2) A client with no history of cardiovascular disease comes into the ambulatory clinic
with flulike symptoms. The client suddenly complains of chest pain. Which of the
following questions would best help a nurse to discriminate pain caused by a non-
cardiac problem?
"Have you ever had this pain before?"
"Can you describe the pain to me?"
"Does the pain get worse when you breathe in?"
"Can you rate the pain on a scale of 1-10, with 10 being the worst?" - ✔✔3.
Chest pain is assessed by using the standard pain assessment parameters. Options 1,
2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary
origin usually worsens on inspiration.
✔✔3) A client with myocardial infarction has been transferred from a coronary care unit
to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow
for which of the following client activities?
Strict bed rest for 24 hours after transfer
Bathroom privileges and self-care activities
Unsupervised hallway ambulation with distances under 200 feet
Ad lib activities because the client is monitored. - ✔✔2.
On transfer from the CCU, the client is allowed self-care activities and bathroom
privileges. Supervised ambulation for brief distances are encouraged, with distances
gradually increased (50, 100, 200 feet).
