CARDIAC NCLEX EXAM /NCLEX CARDIAC EXAM ACTUAL EXAM
300 QUESTIONS AND CORRECT DETAILED ANSWERS
The student nurse is preparing a teaching plan for a patient being discharged status
post MI. What should the student include in the teaching plan? (Mark all that apply.)
A. Need for increased fluid intake
B. Need for early resumption of prediagnosis activity
C. Need for careful monitoring for cardiac symptoms
D. Need for dietary modifications
E. Need for carefully regulated exercise - ANSWER: C. Need for careful monitoring
for cardiac symptoms
D. Need for dietary modifications
E. Need for carefully regulated exercise
Dietary modifications, exercise, weight loss, and careful monitoring are important
strategies for managing three major cardiovascular risk factors: hyperlipidemia,
hypertension, and diabetes. There is no need to increase fluid intake and activity
should be slowly and deliberately increased
The nurse is caring for an 84-year-old man who has just returned from the OR after
inguinal hernia repair. The OR report indicates that the patient received large
volumes of IV fluids during surgery and the nurse recognizes that the patient is at
risk for left-sided heart failure. What signs and symptoms would indicate left-sided
heart failure?
A. Jugular vein distention
B. Bibasilar fine crackles
C. Right upper quadrant pain
D. Dependent edema - ANSWER: B. Bibasilar fine crackles
Bibasilar fine crackles are a sign of alveolar fluid, a sequela of left ventricular fluid,
or pressure overload. Jugular vein distention, right upper quadrant pain
(hepatomegaly), and dependent edema are caused by right-sided heart failure,
usually a chronic condition.
The nurse is reviewing a newly admitted patient's electronic health record, which
notes a history of orthopnea? What nursing action is most clearly indicated?
A. Avoid positioning the patient supine.
B. Limit the patient's activity level.
C. Teach the patient deep breathing and coughing exercises.
D. Administer supplemental oxygen at all times. - ANSWER: A. Avoid positioning the
patient supine.
,Orthopnea is defined as difficulty breathing while lying flat. This is a possible
complication of HF and, consequently, the nurse should avoid positioning the
patient supine. Oxygen supplementation may or may not be necessary and activity
does not always need to be curtailed. Deep breathing and coughing exercises do
not directly address this symptom.
The nurse is caring for an adult patient with HF who is prescribed digoxin. When
assessing the patient for adverse effects, the nurse should assess for which of the
following signs and symptoms?
A. Numbness and tingling in the extremities
B. Confusion and bradycardia
C. Uncontrolled diuresis and tachycardia
D. Chest pain and shortness of breath - ANSWER: B. Confusion and bradycardia
A key concern associated with digitalis therapy is digitalis toxicity. Symptoms
include anorexia, nausea, visual disturbances, confusion, and bradycardia. The
other listed signs and symptoms are not characteristic of digitalis toxicity.
The ED nurse is caring for a patient with a suspected MI. What drug should the nurse
anticipate administering to this patient?
A. Warfarin
B. Oxycodone
C. Morphine
D. Acetaminophen - ANSWER: C. Morphine
The patient with suspected MI is given aspirin, nitroglycerin, morphine, an IV beta-
blocker, and other medications, as indicated, while the diagnosis is being
confirmed. Tylenol, warfarin, and oxycodone are not typically used.
A patient is admitted to the critical care unit (CCU) with a diagnosis of
cardiomyopathy. When reviewing the patient's most recent laboratory results, the
nurse should prioritize assessment of which of the following?
A. Sodium
B. AST, ALT, and bilirubin
C. BUN
D. White blood cell differential - ANSWER: A. Sodium
Sodium is the major electrolyte involved with cardiomyopathy. Cardiomyopathy
often leads to heart failure which develops, in part, from fluid overload. Fluid
overload is often associated with elevated sodium levels. Consequently, sodium
levels are followed more closely than other important laboratory values, including
BUN, leukocytes, and liver function tests.
,The nurse is caring for a patient admitted with unstable angina. The laboratory result
for the initial troponin I is elevated in this patient. The nurse should recognize what
implication of this assessment finding?
A. This result indicates muscle injury, but does not specify the source.
B. This is an accurate indicator of myocardial injury.
C. This is only an accurate indicator of myocardial damage when it reaches its peak in
24 hours.
D. Because the patient has a history of unstable angina, this is a poor indicator of
myocardial injury. - ANSWER: B. This is an accurate indicator of myocardial injury.
Troponin I, which is specific to cardiac muscle, is elevated within hours after
myocardial injury. Even with a diagnosis of unstable angina, this is an accurate
indicator of myocardial injury.
The nurse is providing discharge education to a patient diagnosed with HF. What
should the nurse teach this patient to do to assess her fluid balance in the home
setting?
A. Monitor her weight daily
B. Monitor her bowel movements
C. Monitor her blood pressure daily
D. Assess her radial pulses daily - ANSWER: A. Monitor her weight daily
To assess fluid balance at home, the patient should monitor daily weights at the
same time every day. Assessing radial pulses and monitoring the blood pressure may
be done, but these measurements do not provide information about fluid balance.
Bowel function is not indicative of fluid balance
When discussing angina pectoris secondary to atherosclerotic disease with a patient,
the patient asks why he tends to experience chest pain when he exerts himself. The
nurse should describe which of the following phenomena?
A. Exercise increases the metabolism of cardiac medications.
B. Exercise causes vasoconstriction of the coronary arteries.
C. Exercise shunts blood flow from the heart to the mesenteric area.
D. Exercise increases the heart's oxygen demands. - ANSWER: D. Exercise increases
the heart's oxygen demands.
Physical exertion increases the myocardial oxygen demand. If the patient has
arteriosclerosis of the coronary arteries, then blood supply is diminished to the
myocardium. Exercise does not cause vasoconstriction or interfere with drug
metabolism. Exercise does not shunt blood flow away from the heart.
A resident of a long-term care facility has complained to the nurse of chest pain.
What aspect of the resident's pain would be most suggestive of angina as the cause?
, A. The pain is most severe when the resident moves his upper body.
B. The pain is worse when the resident coughs.
C. The pain is worse when the resident inhales deeply.
D. The pain occurs immediately following physical exertion. - ANSWER: D. The pain
occurs immediately following physical exertion.
Chest pain associated with angina is often precipitated by physical exertion. The
other listed aspects of chest pain are more closely associated with noncardiac
etiologies.
A patient who has undergone valve replacement surgery is being prepared for
discharge home. Because the patient will be discharged with a prescription for
warfarin (Coumadin), the nurse should educate the patient about which of the
following?
A. The need to learn to sleep in a semi-Fowler's position for the first 6 to 8 weeks to
prevent emboli
B. The need for regularly scheduled testing of the patient's International Normalized
Ratio (INR)
C. The need to take enteric-coated ASA on a daily basis
D. The need to avoid foods that contain vitamin K - ANSWER: B. The need for
regularly scheduled testing of the patient's International Normalized Ratio (INR)
Patients who take warfarin (Coumadin) after valve replacement have individualized
target INRs; usually between 2 and 3.5 for mitral valve replacement and 1.8 and 2.2
for aortic valve replacement. Natural sources of vitamin K do not normally need to
be avoided and ASA is not indicated. Sleeping upright is unnecessary.
The nurse is performing an initial assessment of a client diagnosed with HF. The
nurse also assesses the patient's sensorium and LOC. Why is the assessment of the
patient's sensorium and LOC important in patients with HF?
A. Decreased LOC causes an exacerbation of the signs and symptoms of HF.
B. The most significant adverse effect of medications used for HF treatment is
altered LOC.
C. Patients with HF are susceptible to overstimulation of the sympathetic nervous
system.
D. HF ultimately affects oxygen transportation to the brain. - ANSWER: D. HF
ultimately affects oxygen transportation to the brain
As the volume of blood ejected by the heart decreases, so does the amount of
oxygen transported to the brain. Sympathetic stimulation is not a primary concern in
patients with HF, although it is a possibility. HF affects LOC but the reverse is not
usually true. Medications used to treat HF carry many adverse effects, but the most
common and significant effects are cardiovascular.
300 QUESTIONS AND CORRECT DETAILED ANSWERS
The student nurse is preparing a teaching plan for a patient being discharged status
post MI. What should the student include in the teaching plan? (Mark all that apply.)
A. Need for increased fluid intake
B. Need for early resumption of prediagnosis activity
C. Need for careful monitoring for cardiac symptoms
D. Need for dietary modifications
E. Need for carefully regulated exercise - ANSWER: C. Need for careful monitoring
for cardiac symptoms
D. Need for dietary modifications
E. Need for carefully regulated exercise
Dietary modifications, exercise, weight loss, and careful monitoring are important
strategies for managing three major cardiovascular risk factors: hyperlipidemia,
hypertension, and diabetes. There is no need to increase fluid intake and activity
should be slowly and deliberately increased
The nurse is caring for an 84-year-old man who has just returned from the OR after
inguinal hernia repair. The OR report indicates that the patient received large
volumes of IV fluids during surgery and the nurse recognizes that the patient is at
risk for left-sided heart failure. What signs and symptoms would indicate left-sided
heart failure?
A. Jugular vein distention
B. Bibasilar fine crackles
C. Right upper quadrant pain
D. Dependent edema - ANSWER: B. Bibasilar fine crackles
Bibasilar fine crackles are a sign of alveolar fluid, a sequela of left ventricular fluid,
or pressure overload. Jugular vein distention, right upper quadrant pain
(hepatomegaly), and dependent edema are caused by right-sided heart failure,
usually a chronic condition.
The nurse is reviewing a newly admitted patient's electronic health record, which
notes a history of orthopnea? What nursing action is most clearly indicated?
A. Avoid positioning the patient supine.
B. Limit the patient's activity level.
C. Teach the patient deep breathing and coughing exercises.
D. Administer supplemental oxygen at all times. - ANSWER: A. Avoid positioning the
patient supine.
,Orthopnea is defined as difficulty breathing while lying flat. This is a possible
complication of HF and, consequently, the nurse should avoid positioning the
patient supine. Oxygen supplementation may or may not be necessary and activity
does not always need to be curtailed. Deep breathing and coughing exercises do
not directly address this symptom.
The nurse is caring for an adult patient with HF who is prescribed digoxin. When
assessing the patient for adverse effects, the nurse should assess for which of the
following signs and symptoms?
A. Numbness and tingling in the extremities
B. Confusion and bradycardia
C. Uncontrolled diuresis and tachycardia
D. Chest pain and shortness of breath - ANSWER: B. Confusion and bradycardia
A key concern associated with digitalis therapy is digitalis toxicity. Symptoms
include anorexia, nausea, visual disturbances, confusion, and bradycardia. The
other listed signs and symptoms are not characteristic of digitalis toxicity.
The ED nurse is caring for a patient with a suspected MI. What drug should the nurse
anticipate administering to this patient?
A. Warfarin
B. Oxycodone
C. Morphine
D. Acetaminophen - ANSWER: C. Morphine
The patient with suspected MI is given aspirin, nitroglycerin, morphine, an IV beta-
blocker, and other medications, as indicated, while the diagnosis is being
confirmed. Tylenol, warfarin, and oxycodone are not typically used.
A patient is admitted to the critical care unit (CCU) with a diagnosis of
cardiomyopathy. When reviewing the patient's most recent laboratory results, the
nurse should prioritize assessment of which of the following?
A. Sodium
B. AST, ALT, and bilirubin
C. BUN
D. White blood cell differential - ANSWER: A. Sodium
Sodium is the major electrolyte involved with cardiomyopathy. Cardiomyopathy
often leads to heart failure which develops, in part, from fluid overload. Fluid
overload is often associated with elevated sodium levels. Consequently, sodium
levels are followed more closely than other important laboratory values, including
BUN, leukocytes, and liver function tests.
,The nurse is caring for a patient admitted with unstable angina. The laboratory result
for the initial troponin I is elevated in this patient. The nurse should recognize what
implication of this assessment finding?
A. This result indicates muscle injury, but does not specify the source.
B. This is an accurate indicator of myocardial injury.
C. This is only an accurate indicator of myocardial damage when it reaches its peak in
24 hours.
D. Because the patient has a history of unstable angina, this is a poor indicator of
myocardial injury. - ANSWER: B. This is an accurate indicator of myocardial injury.
Troponin I, which is specific to cardiac muscle, is elevated within hours after
myocardial injury. Even with a diagnosis of unstable angina, this is an accurate
indicator of myocardial injury.
The nurse is providing discharge education to a patient diagnosed with HF. What
should the nurse teach this patient to do to assess her fluid balance in the home
setting?
A. Monitor her weight daily
B. Monitor her bowel movements
C. Monitor her blood pressure daily
D. Assess her radial pulses daily - ANSWER: A. Monitor her weight daily
To assess fluid balance at home, the patient should monitor daily weights at the
same time every day. Assessing radial pulses and monitoring the blood pressure may
be done, but these measurements do not provide information about fluid balance.
Bowel function is not indicative of fluid balance
When discussing angina pectoris secondary to atherosclerotic disease with a patient,
the patient asks why he tends to experience chest pain when he exerts himself. The
nurse should describe which of the following phenomena?
A. Exercise increases the metabolism of cardiac medications.
B. Exercise causes vasoconstriction of the coronary arteries.
C. Exercise shunts blood flow from the heart to the mesenteric area.
D. Exercise increases the heart's oxygen demands. - ANSWER: D. Exercise increases
the heart's oxygen demands.
Physical exertion increases the myocardial oxygen demand. If the patient has
arteriosclerosis of the coronary arteries, then blood supply is diminished to the
myocardium. Exercise does not cause vasoconstriction or interfere with drug
metabolism. Exercise does not shunt blood flow away from the heart.
A resident of a long-term care facility has complained to the nurse of chest pain.
What aspect of the resident's pain would be most suggestive of angina as the cause?
, A. The pain is most severe when the resident moves his upper body.
B. The pain is worse when the resident coughs.
C. The pain is worse when the resident inhales deeply.
D. The pain occurs immediately following physical exertion. - ANSWER: D. The pain
occurs immediately following physical exertion.
Chest pain associated with angina is often precipitated by physical exertion. The
other listed aspects of chest pain are more closely associated with noncardiac
etiologies.
A patient who has undergone valve replacement surgery is being prepared for
discharge home. Because the patient will be discharged with a prescription for
warfarin (Coumadin), the nurse should educate the patient about which of the
following?
A. The need to learn to sleep in a semi-Fowler's position for the first 6 to 8 weeks to
prevent emboli
B. The need for regularly scheduled testing of the patient's International Normalized
Ratio (INR)
C. The need to take enteric-coated ASA on a daily basis
D. The need to avoid foods that contain vitamin K - ANSWER: B. The need for
regularly scheduled testing of the patient's International Normalized Ratio (INR)
Patients who take warfarin (Coumadin) after valve replacement have individualized
target INRs; usually between 2 and 3.5 for mitral valve replacement and 1.8 and 2.2
for aortic valve replacement. Natural sources of vitamin K do not normally need to
be avoided and ASA is not indicated. Sleeping upright is unnecessary.
The nurse is performing an initial assessment of a client diagnosed with HF. The
nurse also assesses the patient's sensorium and LOC. Why is the assessment of the
patient's sensorium and LOC important in patients with HF?
A. Decreased LOC causes an exacerbation of the signs and symptoms of HF.
B. The most significant adverse effect of medications used for HF treatment is
altered LOC.
C. Patients with HF are susceptible to overstimulation of the sympathetic nervous
system.
D. HF ultimately affects oxygen transportation to the brain. - ANSWER: D. HF
ultimately affects oxygen transportation to the brain
As the volume of blood ejected by the heart decreases, so does the amount of
oxygen transported to the brain. Sympathetic stimulation is not a primary concern in
patients with HF, although it is a possibility. HF affects LOC but the reverse is not
usually true. Medications used to treat HF carry many adverse effects, but the most
common and significant effects are cardiovascular.
