NCLEX Review Question in Cardiovascular System Part 7/20

61. The nurse assessing the client with pericardial effusion at 1600 notes the apical pulse is
72 and the BP is 138/94. At 1800, the client has neck vein distention, the apical pulse is 70,
and the BP is 106/94. Which action would the nurse implement first?
a. Stay with the client and use a calm voice.
b. Notify the health-care provider immediately.
c. Place the client left lateral recumbent.
d. Administer morphine intravenous push slowly.
62. Which data would cause the nurse to question administering digoxin to a client
diagnosed with congestive heart failure?
a. The potassium level is 3.2 mEq/L.
b. The digoxin level is 1.2 mcg/mL.
c. The client’s apical pulse is 64.
d. The client denies yellow haze.

63. What is the priority problem in the client diagnosed with congestive heart failure?
a. Fluid volume overload.
b. Decreased cardiac output.
c. Activity intolerance.
d. Knowledge deficit.
64. The client comes to the emergency department saying, “I am having a heart attack.”
Which question is most pertinent when assessing the client?
a. “Can you describe your chest pain?”
b. “What were you doing when the pain started?”
c. “Did you have a high-fat meal today?”
d. “Does the pain get worse when you lie down?”
65. Which laboratory data confirm the diagnosis of congestive heart failure?
a. Chest x-ray (CXR).
b. Liver function tests.
c. Blood urea nitrogen (BUN).
d. Beta-type natriuretic peptide (BNP).
66. The client is diagnosed with pericarditis. When assessing the client, the nurse is unable
to auscultate a friction rub. Which action should the nurse implement?
a. Notify the health-care provider.
b. Document that the pericarditis has resolved.
c. Ask the client to lean forward and listen again.
d. Prepare to insert a unilateral chest tube.
67. The unlicensed nursing assistant comes and tells the primary nurse that the client
diagnosed with coronary artery disease is having chest pain. Which action should the nurse
take first?
a. Tell the assistant to go take the client’s vital signs.
b. Ask the assistant to have the telemetry nurse read the strip.
c. Notify the client’s health-care provider.
d. Go to the room and assess the client’s chest pain.
68. Which pre-procedure information should be taught to the female client having an
exercise stress test in the morning?
a. Wear open-toed shoes to the stress test.
b. Inform the client not to wear a bra.
c. Do not eat anything for four (4) hours.
d. Take the beta blocker one (1) hour before the test.

69. The client with coronary artery disease is prescribed transdermal nitroglycerin, a
coronary vasodilator. Which behavior indicates the client understands the discharge
teaching concerning this medication?
a. The client places the medication under the tongue.
b. The client removes the old patch before placing the new.
c. The client applies the patch to a hairy area.
d. The client changes the patch every 36 hours.
70. The nurse is transcribing the doctor’s orders for a client with congestive heart failure.
The order reads 2.5 mg of Lanoxin daily. Which action should the nurse implement?
a. Discuss the order with the health-care provider.
b. Take the client’s apical pulse rate before administering.
c. Check the client’s potassium level before giving the medication.
d. Determine if a digoxin level has been drawn.

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NCLEX Questions in Cardiovascular System

1. Myra is ordered laboratory tests after she is admitted to the hospital for angina. The
isoenzyme test that is the most reliable early indicator of myocardial insult is:
a. SGPT
b. LDH
c. CK-MB
d. AST

2. Joey is a 46 year-old radio technician who is admitted because of mild chest pain. He is 5
feet, 8 inches tall and weighs 190 pounds. He is diagnosed with a myocardial infarct.
Morphine sulfate, Diazepam (Valium) and Lidocaine are prescribed.
The physician orders 8 mg of Morphine Sulfate to be given IV. The vial on hand is labeled 1
ml/ 10 mg. The nurse should administer:
a. 8 minims
b. 10 minims
c. 12 minims
d. 15 minims
3. An early finding in the EKG of a client with an infarcted mycardium would be:
a. Disappearance of Q waves
b. Elevated ST segments
c. Absence of P wave
d. Flattened T waves

4. Mr. Ong, a client with CHF, has been receiving a cardiac glycoside, a diuretic, and a
vasodilator drug. His apical pulse rate is 44 and he is on bed rest. The nurse concludes that
his pulse rate is most likely the result of the:
a. Diuretic
b. Vasodilator
c. Bed-rest regimen
d. Cardiac glycoside

5. After the acute phase of congestive heart failure, the nurse should expect the
dietarymanagement of the client to include the restriction of:
a. Magnesium
b. Sodium
c. Potassium
d. Calcium
6. Mr. Ong is admitted to the hospital with a diagnosis of Left-sided CHF. In the assessment,
the nurse should expect to find:
a. Crushing chest pain
b. Dyspnea on exertion
c. Extensive peripheral edema
d. Jugular vein distention
7. What would be the primary goal of therapy for a
client with pulmonary edema and heart failure?
a. Enhance comfort
b. Increase cardiac output
c. Improve respiratory status
d. Peripheral edema decreased
8. During the second day of hospitalization of the
client after a Myocardial Infarction. Which of the
following is an expected outcome?
a. Able to perform self-care activities without pain
b. Severe chest pain
c. Can recognize the risk factors of Myocardial Infarction
d. Can Participate in cardiac rehabilitation walking program

9. Upon admission to an intensive care unit, a client diagnosed with an acute myocardial
infarction is ordered oxygen. The nurse knows that the major reason that oxygen
a. saturate the red blood cells
b. relieve dyspnea
c. decrease cyanosis
d. increase oxygen level in the myocardium

10. A 66 year-old client is admitted for mitral valve replacement surgery. The client has a
history of mitral valve regurgitation and mitral stenosis since her teenage years. During the
admission assessment, the nurse should ask the client if as a child she had
a. measles
b. rheumatic fever
c. hay fever
d. encephalitis

Answer: C
Rationale: The cardiac marker, Creatinine phosphokinase (CPK) isoenzyme levels,
especially the MB sub-unit which is cardio-specific, begin to rise in 3-6 hours, peak in 12-18
hours and are elevated 48 hours after the occurrence of the infarct. They are therefore
most reliable in assisting with early diagnosis. The cardiac markers elevate as a result of
myocardial tissue damage.
2. Answer: C
Using ratio and proportion 8 mg/10 mg = X minims/15 minims 10 X= 120 X = 12 minims.
The nurse will administer 12 minims intravenously equivalent to 8mg Morphine Sulfate
3. Answer: B
This is a typical early finding after a myocardial infarct because of the altered contractility
of the heart. The other choices are not typical of MI.

4. Answer: D
A cardiac glycoside such as digitalis increases force of cardiac contraction, decreases the
conduction speed of impulses within the myocardium and slows the heart rate.

5. Answer: B
Restriction of sodium reduces the amount of water retention that reduces the cardiac
workload
6. Answer: B
Pulmonary congestion and edema occur because of fluid extravasation from the pulmonary
capillary bed, resulting in difficult breathing. Left-sided heart failure creates a backward
effect on the pulmonary system that leads to pulmonary congestion.
7. Answer: B
Rationale: The primary goal of therapy for the client with pulmonary edema or heart
failure is increasing cardiac output. Pulmonary edema is an acute medical emergency
requiring immediate intervention.
8. Answer: A
Rationale: By the second day of hospitalization after suffering a Myocardial Infarction,
Clients are able to perform care without chest pain
9. Answer: D
Rationale: Anoxia of the myocardium occurs in myocardial infarction. Oxygen
administration will help relieve dyspnea and cyanosis associated with the condition but the
major purpose is to increase the oxygen concentration in the damaged myocardial tissue.
10. Answer: B
Rationale: Clients that present with mitral stenosis often have a history of rheumatic fever
or bacterial endocardi