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Cardiac NCLEX Questions with VERIFIED Answers (Guaranteed Success)

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Cardiac NCLEX Questions with VERIFIED Answers (Guaranteed Success)

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Cardiac NCLEX Questions with VERIFIED Answers (Guaranteed Success)

Q1: Which of the following assessments would be an important finding for a patient with arterial

disease?

A. Intermittent claudication with exercise

B. Brownish discoloration around the ankles

C. Non-pitting edema on the lower extremities

D. Altered sensation to touch.

Answer: A. Intermittent claudication with exercise


Q2: 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.

Answer: 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.


Q3: 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?".

Answer: 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.

,Q4: 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..

Answer: 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).


Q5: 4) A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction

who was admitted 2 days ago. The nurse would plan to do which of the following next? Review the

intake and output records for the last 2 days Change the time of diuretic administration from morning

to evening Request a sodium restriction of 1 g/day from the physician. Order daily weights starting the

following morning..

Answer: 1. Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by

intake greater than output and by a sudden increase in weight. Diuretics should be given in the

morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with

severe symptoms.


Q6: 5) A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees

no electrocardiogram complexes on the screen. The first action of the nurse is to: Check the client

status and lead placement Press the recorder button on the electrocardiogram console. Call the

physician Call a code blue.

Answer: 1. Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible

electrode displacement. Accurate assessment of the client and equipment is necessary to determine

the cause and identify the appropriate intervention.

,Q7: 6) A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The

nurse ensures accurate measurement by avoiding which of the following? Seating the client with arm

bared, supported, and at heart level. Measuring the blood pressure after the client has been seated

quietly for 5 minutes. Using a cuff with a rubber bladder that encircles at least 80% of the limb. Taking

a blood pressure within 15 minutes after nicotine or caffeine ingestion..

Answer: 4. BP should be taken with the client seated with the arm bared, positioned with support and

at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the

recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding

the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff

bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury

sphygmomanometer should be calibrated every 6 months to ensure accuracy.


Q8: 7) IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that

which of the following medications is available on the nursing unit? Vitamin K Aminocaporic acid

Potassium chloride Protamine sulfate.

Answer: 4. The antidote to heparin is protamine sulfate and should be readily available for use if

excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin.


Q9: 8) A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin

(Coumadin). The client's prothrombin time is 20 seconds, with a control of 11 seconds. The nurse

assesses that this result is: The same as the client's own baseline level Lower than the needed

therapeutic level Within the therapeutic range Higher than the therapeutic range.

Answer: 3. The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk

for thrombus. Based on the client's control value, the therapeutic range for this individual would be

16.5 to 22 seconds. Therefore the result is within therapeutic range.

, Q10: 9) A client who has been receiving heparin therapy also is started on warfarin. The client asks a

nurse why both medications are being administered. In formulating a response, the nurse incorporates

the understanding that warfarin: Stimulates the breakdown of specific clotting factors by the liver, and

it takes 2-3 days for this to exert an anticoagulant effect. Inhibits synthesis of specific clotting factors in

the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect. Stimulates

production of the body's own thrombolytic substances, but it takes 2-4 days for this to begin. Has the

same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin

to be therapeutic..

Answer: 2. Warfarin works in the liver and inhibits synthesis of four vitamin K- dependent clotting

factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited.


Q11: 10) A 60-year-old male client comes into the emergency department with complaints of crushing

chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial

infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an

ECG, and 2mg of morphine given intravenously. The nurse should first: Administer the morphine

Obtain a 12-lead ECG Obtain the lab work Order the chest x-ray.

Answer: 1. Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse's

priority action would be to relieve the crushing chest pain.


Q12: 11) When administered a thrombolytic drug to the client experiencing an MI, the nurse explains

to him that the purpose of this drug is to: Help keep him well hydrated Dissolve clots he may have

Prevent kidney failure Treat potential cardiac arrhythmias..

Answer: 2. Thrombolytic drugs are administered within the first 6 hours after onset of a MI to lyse clots

and reduce the extent of myocardial damage.

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