Saunders Comprehensive Review for the NCLEX-RN
Chapter 33: Assessment of the Cardiovascular System
1. You are caring for a client who has had a recent myocardial infarction. Why is damage to
the myocardium problematic for this client?
A. Damage to this area causes plaque to build up on the heart valves.
B. Damage to this layer can decrease the contractile force of the heart.
C. Damage to this layer can lead to excessive cortisol and endorphin release.
D. Damage to this area causes striated heart muscle fibers to release damaging high -density
lipoproteins.
Correct answer: B
Rationale: The myocardium is the layer responsible for the contractile force of the heart .
2. A client with mitral valve disease has presented to the clinic for further evaluation of the
mitral valve. Which chamber of the heart will be affected if the mitral valve is narrowed?
A. Right atrium
B. Left atrium
C. Right ventricle
D. Left ventricle
Correct answer: B
Rationale: The mitral valve separates the left atrium from the left ventricle. Narrowing of
this valve results in a damming of blood in the left atrium.
3. What is the function of the property of automaticity in heart muscle?
A. To initiate an impulse in response to a stimulus
B. To transmit electrical impulses that are received
C. To respond to a stimulus only after repolarization
D. To spontaneously and repetitively initiate an impulse
Correct answer: D
Rationale: Automaticity refers to the ability of cardiac cells to spontaneously and
repetitively initiate an impulse. The initiation of an impulse in response to a stimulus refers
to excitability. The transmission of electrical impulses that are received refers to the
property of conductivity, and the response to a stimulus only after repolarization refers to
refractoriness.
4. A client brought to the emergency room following a myocardial infarction is found to be
hypotensive. What effect from baroreceptor stimulation on this client’s heart rate would be
expected?
A. The heart rate would increase.
,B. The heart rate would decrease.
C. There would be no effect on heart rate.
D. The heart rate would vacillate between accelerations and deceleration.
Correct answer: A
Rationale: When a client experiences hypotension, baroreceptors in the aortic arch sense a
pressure decrease in the vessels. The parasympathetic system responds by lessening the
inhibitory effect on the SA node, and this results in an increase in heart rate.
5. A client with a history of having several myocardial infarctions has excessive filling of
the ventricles as a result. What physiologic response would you expect to see manifested in
this client?
A. Excessive LVED volume and decreased cardiac output
B. Reduced LVED volume and increased cardiac output
C. Excessive impedance of the left ventricle
D. Reduced impedance of the left ventricle
Correct answer: A
Rationale: According to Starling’s law, the more the heart is filled during diastole, the more
forcefully it contracts. This is true, within limits. Overstretching or excessive filling of the
ventricles results in excessive LVED volume and pressure and decreased cardiac output.
6. You are caring for a client with heart disease that has resulted in a reduced stroke volume.
What physiologic response would be expected to maintain normal cardiac output?
A. Mean arterial pressure would increase.
B. Mean arterial pressure would decrease.
C. Heart rate would increase.
D. Heart rate would decrease.
Correct answer: C
Rationale: Cardiac output is equal to stroke volume times the heart rate.
7. Which conditions would lead to an increase in stroke volume?
A. Increased preload; increased afterload
B. Increased preload; decreased afterload
C. Decreased preload; increased afterload
D. Decreased preload; decreased afterload
Correct answer: B
Rationale: An increased preload increases contractility; decreased afterload reduces the
amount of resistance to ejection of blood from the left ventricle. Both changes together
increase stroke volume of the left ventricle.
8. What effect on blood pressure should the nurse expect when the client is given a drug that
causes vasoconstriction?
A. Increased diastolic blood pressure
B. Decreased diastolic blood pressure
C. Increased systolic blood pressure
D. Decreased systolic blood pressure
Correct answer: A
Rationale: Diastolic pressure is determined by the amount of vasoconstriction in the
periphery. An increase in peripheral vascular resistance increases diastolic pressure.
,9. The client is being given a drug that blocks the action of the sympathetic division of the
autonomic nervous system. For which of the following cardiovascular clinical
manifestations should the nurse remain alert?
A. Increased heart rate; increased blood pressure
B. Increased heart rate; decreased blood pressure
C. Decreased heart rate; increased blood pressure
D. Decreased heart rate; decreased blood pressure
Correct answer: D
Rationale: The sympathetic nervous system directly stimulates the ventricles, increasing
heart rate; it also causes vasoconstriction, increasing blood pressure. Agents that block
sympathetic impulses decrease heart rate and blood pressure.
10. With which of the following clients is the nurse alert for the possibility of hypertension
and coronary artery disease?
A. 50-year-old white man with asthma
B. 60-year-old Asian-American woman with breast cancer
C. 45-year-old African-American man with diabetes mellitus
D. 65-year-old white woman on estrogen hormone replacement therapy
Correct answer: C
Rationale: The incidence of coronary artery disease and hypertension is higher among
African Americans than among whites or Asian Americans. Diabetes mellitus increases the
risk for hypertension and coronary artery disease in people of any race or ethnicity.
11. You are taking the history of a client suspected of having cardiovascular disease. Which
past illness in the client’s history would alert you to the possibility of an abnormality of the
heart valves?
A. A history of infection with Mycobacterium tuberculosis
B. Recurrent viral pneumonia
C. Rheumatic fever
D. Asthma
Correct answer: C
Rationale: Rheumatic fever is an inflammatory disease that is typically caused by infection
with group A beta-hemolytic streptococcus. This infection can lead to damage to heart
valves.
12. You are performing a physical assessment on an older adult client who has presented for
a routine check-up. In assessing the heart rate, you find the rate to be 50 beats/min. What
would be your best action?
A. Document the finding because it is a normal part of the aging process.
B. Place the client in a prone position.
C. Inform the health care provider.
D. Assess the peripheral pulses.
Correct answer: C
Rationale: With aging, pacemaker cells decrease in number resulting in bradycardia. The
nurse should inform the health care provider because an ECG should be ordered to further
evaluate this finding and intervene, if necessary.
13. Which female client is most at risk for cardiovascular disease?
A. A woman on hormone replacement therapy
, B. A woman who has never been pregnant
C. A woman with elevated HDL levels
D. A woman with abdominal obesity
Correct answer: D
Rationale: A woman with abdominal obesity (greater waist than hip circumference),
especially if the onset of obesity is in adolescence, is at greater risk of cardiovascular
disease.
14. A client with a history of previous myocardial infarction is admitted to your unit with
heart failure. What statement made by this client would alert you to suspect the occurrence
of heart failure?
A. “It is getting more difficult to climb the stairs to reach the bathroom.”
B. “ I think my dose of digoxin may need to be increased.”
C. “ I have trouble remembering things recently.”
D. “ I have noted a loss of appetite recently.” Nursing Process Step: Analysis
Correct answer: A
Rationale: Dyspnea on exertion (DOE) is an early manifestation of heart failure and is
associated with activity, such as stair climbing.
15. Which statement made by a client would alert the nurse to the presence of edema?
A. “I seldom sleep soundly at night.”
B. “My shoes seem to be fitting tighter.”
C. “I seem to feel more anxious lately.”
D. “I drink at least two full glasses of water a day.”
Correct answer: B
Rationale: A sudden weight gain can result from fluid accumulation in the interstitial spaces.
This is known as edema. The nurse should note whether the client has a feeling of tightness
of shoes, indentations from socks, or tightness of rings.
16. A client has been diagnosed as having Class I functional status cardiovascular disability
as defined by the New York Heart Association. Which of the following statements regarding
activity should the nurse make to this client?
A. You have no limitations on ordinary physical activity.
B. The discomfort you experience may occur with ordinary physical activity.
C. Although you are comfortable at rest, you will experience some discomfort with less than
ordinary physical activity.
D. The discomfort you have may be present even at rest, and discomfort may increase with
any physical activity.
Correct answer: A
Rationale: Class I criteria apply to clients with cardiac disease that does not limit their
physical activity. Physical activity does not incur undue fatigue, shortness of breath,
dyspnea or anginal pain.
18. What technique should you use to evaluate clubbing of the fingers?
A. Assess for the presence of Allen’s sign.
B. Assess for the presence of petechiae.
C. Assess the angle of the nail bed.
Chapter 33: Assessment of the Cardiovascular System
1. You are caring for a client who has had a recent myocardial infarction. Why is damage to
the myocardium problematic for this client?
A. Damage to this area causes plaque to build up on the heart valves.
B. Damage to this layer can decrease the contractile force of the heart.
C. Damage to this layer can lead to excessive cortisol and endorphin release.
D. Damage to this area causes striated heart muscle fibers to release damaging high -density
lipoproteins.
Correct answer: B
Rationale: The myocardium is the layer responsible for the contractile force of the heart .
2. A client with mitral valve disease has presented to the clinic for further evaluation of the
mitral valve. Which chamber of the heart will be affected if the mitral valve is narrowed?
A. Right atrium
B. Left atrium
C. Right ventricle
D. Left ventricle
Correct answer: B
Rationale: The mitral valve separates the left atrium from the left ventricle. Narrowing of
this valve results in a damming of blood in the left atrium.
3. What is the function of the property of automaticity in heart muscle?
A. To initiate an impulse in response to a stimulus
B. To transmit electrical impulses that are received
C. To respond to a stimulus only after repolarization
D. To spontaneously and repetitively initiate an impulse
Correct answer: D
Rationale: Automaticity refers to the ability of cardiac cells to spontaneously and
repetitively initiate an impulse. The initiation of an impulse in response to a stimulus refers
to excitability. The transmission of electrical impulses that are received refers to the
property of conductivity, and the response to a stimulus only after repolarization refers to
refractoriness.
4. A client brought to the emergency room following a myocardial infarction is found to be
hypotensive. What effect from baroreceptor stimulation on this client’s heart rate would be
expected?
A. The heart rate would increase.
,B. The heart rate would decrease.
C. There would be no effect on heart rate.
D. The heart rate would vacillate between accelerations and deceleration.
Correct answer: A
Rationale: When a client experiences hypotension, baroreceptors in the aortic arch sense a
pressure decrease in the vessels. The parasympathetic system responds by lessening the
inhibitory effect on the SA node, and this results in an increase in heart rate.
5. A client with a history of having several myocardial infarctions has excessive filling of
the ventricles as a result. What physiologic response would you expect to see manifested in
this client?
A. Excessive LVED volume and decreased cardiac output
B. Reduced LVED volume and increased cardiac output
C. Excessive impedance of the left ventricle
D. Reduced impedance of the left ventricle
Correct answer: A
Rationale: According to Starling’s law, the more the heart is filled during diastole, the more
forcefully it contracts. This is true, within limits. Overstretching or excessive filling of the
ventricles results in excessive LVED volume and pressure and decreased cardiac output.
6. You are caring for a client with heart disease that has resulted in a reduced stroke volume.
What physiologic response would be expected to maintain normal cardiac output?
A. Mean arterial pressure would increase.
B. Mean arterial pressure would decrease.
C. Heart rate would increase.
D. Heart rate would decrease.
Correct answer: C
Rationale: Cardiac output is equal to stroke volume times the heart rate.
7. Which conditions would lead to an increase in stroke volume?
A. Increased preload; increased afterload
B. Increased preload; decreased afterload
C. Decreased preload; increased afterload
D. Decreased preload; decreased afterload
Correct answer: B
Rationale: An increased preload increases contractility; decreased afterload reduces the
amount of resistance to ejection of blood from the left ventricle. Both changes together
increase stroke volume of the left ventricle.
8. What effect on blood pressure should the nurse expect when the client is given a drug that
causes vasoconstriction?
A. Increased diastolic blood pressure
B. Decreased diastolic blood pressure
C. Increased systolic blood pressure
D. Decreased systolic blood pressure
Correct answer: A
Rationale: Diastolic pressure is determined by the amount of vasoconstriction in the
periphery. An increase in peripheral vascular resistance increases diastolic pressure.
,9. The client is being given a drug that blocks the action of the sympathetic division of the
autonomic nervous system. For which of the following cardiovascular clinical
manifestations should the nurse remain alert?
A. Increased heart rate; increased blood pressure
B. Increased heart rate; decreased blood pressure
C. Decreased heart rate; increased blood pressure
D. Decreased heart rate; decreased blood pressure
Correct answer: D
Rationale: The sympathetic nervous system directly stimulates the ventricles, increasing
heart rate; it also causes vasoconstriction, increasing blood pressure. Agents that block
sympathetic impulses decrease heart rate and blood pressure.
10. With which of the following clients is the nurse alert for the possibility of hypertension
and coronary artery disease?
A. 50-year-old white man with asthma
B. 60-year-old Asian-American woman with breast cancer
C. 45-year-old African-American man with diabetes mellitus
D. 65-year-old white woman on estrogen hormone replacement therapy
Correct answer: C
Rationale: The incidence of coronary artery disease and hypertension is higher among
African Americans than among whites or Asian Americans. Diabetes mellitus increases the
risk for hypertension and coronary artery disease in people of any race or ethnicity.
11. You are taking the history of a client suspected of having cardiovascular disease. Which
past illness in the client’s history would alert you to the possibility of an abnormality of the
heart valves?
A. A history of infection with Mycobacterium tuberculosis
B. Recurrent viral pneumonia
C. Rheumatic fever
D. Asthma
Correct answer: C
Rationale: Rheumatic fever is an inflammatory disease that is typically caused by infection
with group A beta-hemolytic streptococcus. This infection can lead to damage to heart
valves.
12. You are performing a physical assessment on an older adult client who has presented for
a routine check-up. In assessing the heart rate, you find the rate to be 50 beats/min. What
would be your best action?
A. Document the finding because it is a normal part of the aging process.
B. Place the client in a prone position.
C. Inform the health care provider.
D. Assess the peripheral pulses.
Correct answer: C
Rationale: With aging, pacemaker cells decrease in number resulting in bradycardia. The
nurse should inform the health care provider because an ECG should be ordered to further
evaluate this finding and intervene, if necessary.
13. Which female client is most at risk for cardiovascular disease?
A. A woman on hormone replacement therapy
, B. A woman who has never been pregnant
C. A woman with elevated HDL levels
D. A woman with abdominal obesity
Correct answer: D
Rationale: A woman with abdominal obesity (greater waist than hip circumference),
especially if the onset of obesity is in adolescence, is at greater risk of cardiovascular
disease.
14. A client with a history of previous myocardial infarction is admitted to your unit with
heart failure. What statement made by this client would alert you to suspect the occurrence
of heart failure?
A. “It is getting more difficult to climb the stairs to reach the bathroom.”
B. “ I think my dose of digoxin may need to be increased.”
C. “ I have trouble remembering things recently.”
D. “ I have noted a loss of appetite recently.” Nursing Process Step: Analysis
Correct answer: A
Rationale: Dyspnea on exertion (DOE) is an early manifestation of heart failure and is
associated with activity, such as stair climbing.
15. Which statement made by a client would alert the nurse to the presence of edema?
A. “I seldom sleep soundly at night.”
B. “My shoes seem to be fitting tighter.”
C. “I seem to feel more anxious lately.”
D. “I drink at least two full glasses of water a day.”
Correct answer: B
Rationale: A sudden weight gain can result from fluid accumulation in the interstitial spaces.
This is known as edema. The nurse should note whether the client has a feeling of tightness
of shoes, indentations from socks, or tightness of rings.
16. A client has been diagnosed as having Class I functional status cardiovascular disability
as defined by the New York Heart Association. Which of the following statements regarding
activity should the nurse make to this client?
A. You have no limitations on ordinary physical activity.
B. The discomfort you experience may occur with ordinary physical activity.
C. Although you are comfortable at rest, you will experience some discomfort with less than
ordinary physical activity.
D. The discomfort you have may be present even at rest, and discomfort may increase with
any physical activity.
Correct answer: A
Rationale: Class I criteria apply to clients with cardiac disease that does not limit their
physical activity. Physical activity does not incur undue fatigue, shortness of breath,
dyspnea or anginal pain.
18. What technique should you use to evaluate clubbing of the fingers?
A. Assess for the presence of Allen’s sign.
B. Assess for the presence of petechiae.
C. Assess the angle of the nail bed.
