The Chicago Review Press NCLEX-RN Practice Test and Review by Linda Waide y Berta Roland - Read Online
The Chicago Review Press NCLEX-RN Practice Test and Review
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Fully revised to conform to the 2004 NCLEX Test Plan, this study guide and test includes “hot spot,” fill-in-the-blank, and select-all-that-apply questions to reflect the new test format. Ten written practice tests cover all the body systems and two additional practice tests cover mental health and miscellaneous topics. Each practice test includes a system overview and complete explanations for both correct and incorrect answers. In addition to the written tests, a 100-item interactive software CD in the NCLEX format is included to allow students to become comfortable with the on-screen exam.
Publicado: Chicago Review Press una impresión de Independent Publishers Group el
ISBN: 9781613741504
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Practice Test 1

Cardiocirculatory and Peripheral Circulatory Systems

The Cardiocirculatory System

OVERVIEW

The cardiocirculatory system consists of blood, vessels to transport the blood, and a four-chambered muscular pump called the heart. The cardiocirculatory system is responsible for transporting food and oxygen to all the cells and organs of the body.

Blood vessels in the lungs absorb oxygen that is inhaled from the air, and blood vessels in the small intestine absorb food materials from the digestive tract. Blood also provides a means whereby cellular wastes, i.e., carbon dioxide and urea, are transported to the lungs and kidneys, where they are eliminated from the body.

BLOOD VESSELS

There are three types of blood vessels: arteries, veins, and capillaries.

Arteries

Arteries are large vessels that carry oxygenated blood away from the heart. In order to withstand the high pressure of the heart’s pumping action, arteries are made of connective tissue, elastic fibers, and inner walls of epithelial cells. As the heart forces blood into the arteries, their elastic qualities enable them to expand and contract. Some of the arteries in the body are very large compared to their smaller branches, called arterioles. The walls of arterioles are much thinner than the walls of the larger arteries. The thin walls of arterioles allow them to carry blood to the smallest of vessels, which are known as capillaries.

Capillaries

The walls of capillaries are very thin (just one epithelial cell thick). Because they are so small (microscopic), they are capable of allowing oxygen and nutrients to pass out of the bloodstream and into the tissue fluid (interstitial fluid) that surrounds all body cells. Once nutrients and oxygen are inside the cells, the nutrients are burned (catabolized) and needed energy is released within the cells. At the same time that oxygen and nutrients are passing into the interstitial fluid, the waste products of catabolism, namely, carbon dioxide and water, pass out of the cells and into the thin-walled capillaries. These waste products flow back to the heart via small veins known as venules, which branch to form larger vessels known as veins.

Veins

Veins do not have to withstand the pressures that arteries do. Therefore, vein walls are thinner than arterial walls, and veins are less elastic and have less connective tissue than arteries. Compared to arteries, blood pressure in the veins is low. To keep blood flowing toward the heart, veins have small valves on their inner walls that prevent blood from flowing backward. In addition to these valves, muscular action also helps to milk blood flow along in the veins.

THE HEART

The four chambers of the heart actually form two pumps. The right side of the heart pumps blood from the heart into the lungs, where it gives off carbon dioxide and picks up oxygen; the left side of the heart pumps the oxygenated blood from the lungs into the body.

Pulmonary Circulation

Pulmonary circulation consists of the flow of blood through the vessels from the heart to the lungs and then back to the heart again.

When blood goes into the heart, the top two chambers (the right and left atria) relax and deoxygenated blood flows from the veins into the right atrium. This is known as venous return. At the same time, oxygenated blood coming from the lungs flows into the left atrium. At this point the blood-filled atria contract and the blood pushes open the heart valves (the bicuspid and tricuspid valves). This allows oxygenated blood from the left atrium to pass into the left ventricle, and deoxygenated blood from the right atrium to pass into the right ventricle.

When blood leaves the heart, the right and left ventricles contract and deoxygenated blood in the right ventricle flows into the lung (via the pulmonary artery), where it will give off its carbon dioxide and pick up oxygen, and oxygenated blood in the left ventricle flows out of the heart (via the coronary arteries and aorta), where it begins its travels into the body.

DISEASES/DISORDERS OF THE CARDIOCIRCULATORY SYSTEM INCLUDE

Acquired Inflammatory Heart Disease

ENDOCARDITIS Other names for endocarditis are infective or bacterial endocarditis. The infection affects the endocardium, heart valves, or cardiac processes and is characterized by bacteria or fungi creating vegetative growths on the heart valves and on the endocardial lining of the heart chambers. These growths may also be located on the endothelium of a blood vessel, where they may embolize to organs such as the spleen, kidneys, central nervous system, and lungs. An organism commonly associated with endocarditis is Streptococcus viridans.

MYOCARDITIS Myocarditis is associated with diffuse inflammation of the cardiac muscle (the myocardium). This condition is caused by viral infections, bacterial infections, immune reactions, radiation therapy, chemical poisons, parasitic infestations, and helminthic infestations.

PERICARDITIS Pericarditis is the inflammation of the pericardium (the membranous fibroserous sac that encloses the heart and the bases of the great vessels). Common causes include infections with bacteria, viruses, or fungi; also neoplasms, radiation to the chest, and postcardiac injury.

RHEUMATIC FEVER/HEART DISEASE Rheumatic fever is a consequence of infection with a group of beta-hemolytic streptococcal bacteria. Rheumatic heart disease refers to the sequelae, or aftereffects, of rheumatic fever, and may include: Myocarditis, pericarditis, endocarditis, and eventually, valvular disease.

Cardiac Complications

CARDIAC ARRHYTHMIAS/DYSRHYTHMIAS Cardiac arrhythmias/dysrhythmias are faulty electrical conductions that change the rate and rhythm of the heart. Types of arrhythmias include: Sinus arrhythmia, sinus tachycardia, sinus bradycardia, sinoatrial arrest/block, premature atrial contraction, ventricular tachycardia, and ventricular fibrillation.

CARDIAC TAMPONADE Cardiac tamponade is a sequela of pericarditis or injuries to the heart or great blood vessels that cause an accumulation of blood in the pericardial sac. The classic signs of cardiac tamponade are increased venous pressure with neck vein distention, reduced arterial blood pressure, muffled heart sounds, and pulsus paradoxus (an abnormal inspiratory drop in systemic blood pressure greater than 15 mm Hg.)

CARDIOGENIC SHOCK Cardiogenic shock occurs when cardiac output diminishes and severe tissue ischemia takes place. Cardiogenic shock is associated with left-sided heart failure and is seen in approximately 15% of clients experiencing a myocardial infarction (MI).

HYPOVOLEMIC SHOCK Hypovolemic shock is best described as lack of tissue perfusion due to insufficient blood volume. Untreated, this condition may cause irreversible cerebral and renal damage, cardiac arrest, and death. Typical causes of this condition are gastrointestinal bleeding and accidental or surgical trauma, severe burns, or ascites resulting in significant blood loss..

VENTRICULAR ANEURYSM An aneurysm is an abnormal ballooning or dilatation of a blood vessel (usually an artery) due to either a congenital defect or weakness in the vessel wall. A ventricular aneurysm is a ballooning or out-pouching of the left ventricle. Untreated, this condition may lead to arrhythmias, systemic embolization, and heart failure, including sudden death.

Congential Acyanotic Defects

ATRIAL SEPTAL DEFECT (ASD) An atrial septal defect is a congenital heart defect that allows blood to flow through an opening between the right and left atria.

COARCTATION OF THE AORTA This is a localized malformation that results in the narrowing of the aorta. Untreated, it may lead to left-sided heart failure and possibly cerebral hemorrhage and aortic rupture.

PATENT DUCTUS ARTERIOSUS (PDA) In PDA, the lumen of the ductus remains open following birth, allowing blood to flow from the aorta to the pulmonary artery and causing recirculation of arterial blood through the lungs. Respiratory distress and signs of heart failure are the two most common symptoms.

VENTRAL SEPTAL DEFECT (VSD) This is the most common congenital heart disorder. The defect (a septum between the left and right ventricles of the heart) allows blood to be shunted between the ventricles, and may cause left atria and right ventricle hypertrophy. Untreated, the condition leads to biventricular heart failure and cyanosis.

Congenital Cyanotic Defects

TETRALOGY OF FALLOT As the name implies, this condition is created by four cardiac defects, namely: ventricular septal defect (VSD), right ventricular outflow tract obstruction (pulmonary stenosis), right ventricular hypertrophy, and dextroposition of the aorta with an overriding of the ventricular septal defect. These defects allow unoxygenated blood to mix with oxygenated blood, causing cyanosis.

Degenerative Cardiovascular Disorders

CORONARY ARTERY DISEASE (CAD) CAD is associated with narrowing of the coronary arteries sufficient to prevent an adequate supply of blood to the myocardium (heart muscle). The usual cause is atherosclerosis, the most common form of arteriosclerosis, which is marked by cholesterol-lipid-calcium deposits in the linings of the arteries.

DILATED CARDIOMYOPATHY In this condition, the striated muscle fibers of the myocardium (heart muscle) suffer extensive damage, interfering with myocardial metabolism and causing gross dilatation of all four chambers of the heart.

HEART FAILURE This condition results from failure of the heart to maintain adequate circulation to the heart. As a consequence, failure of the right, left, or both ventricles may occur.

HYPERTENSION Hypertension is a condition in which a person has greater than normal blood pressure. A person is said to have hypertension if the systolic pressure is persistently above 140 mm Hg, if the diastolic pressure is persistently above 90 mm Hg, and when either the systolic pressure is 160 or above, or the diastolic pressure is 115 or above.

HYPERTROPHIC CARDIOMYOPATHY This is a primary disease of cardiac muscle. Another name for it is idiopathic hypertrophic subaortic stenosis. It is associated with thickening of the interventricular septum (especially in the free wall of the left ventricle). If low cardiac output occurs, the condition may lead to fatal heart failure.

MYOCARDIAL INFARCTION (MI) Myocardial infarction is commonly known as a heart attack. It is a consequence of prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries. MI is the leading cause of death in the United States and Western Europe.

RESTRICTIVE CARDIOMYOPATHY Characterized by restricted ventricular filling, this condition is the result of left ventricular hypertrophy as well as endocardial fibrosis and thickening. In some cases, it may be irreversible.

Vascular Disorders

ABDOMINAL ANEURYSM An abdominal aneurysm is a localized dilatation (ballooning) of the wall of the abdominal aorta. This disorder may be asymptomatic; however, symptoms may include generalized abdominal pain, low back pain that is unaffected by movement, a feeling of gastric fullness, and a pulsating mass in the periumbilical area.

ARTERIAL OCCLUSIVE DISEASE This disease is characterized by the narrowing of the lumen of the aorta and the major branches of the aorta. This narrowing affects blood flow to the legs and feet. Occlusions may cause ischemia, skin ulcerations, and gangrene.

BEURGER’S DISEASE This disease is associated with chronic recurring inflammation and vascular occlusion. It typically affects the peripheral arteries and veins of the extremities. Smoking tobacco is thought to be the main cause. Treatment includes the discontinuation of tobacco in any form.

FEMORAL AND POPLITEAL ANEURYSMS Also known as peripheral arterial aneurysms, these are the result of progressive atherosclerotic changes in the walls of the major peripheral arteries. Symptoms include pain in the legs and feet due to ischemia.

RAYNAUD’S DISEASE This is a peripheral vascular disorder found almost exclusively in women between 18 and 40 years of age. It is characterized by severe vasoconstriction in the extremities when exposed to cold or vasoconstriction associated with emotional stress. Symptoms include intermittent attacks of pallor or cyanosis in the digits (typically the fingers). Other symptoms include numbness and tingling in the fingers. Rarely, gangrene necessitating amputation of the affected digits may occur.

THORACIC AORTIC ANEURYSM This condition is characterized by widening (ballooning) of either the ascending, transverse, or descending parts of the aorta. The most common cause is atherosclerosis, which weakens the wall of the aorta and slowly distends the lumen. Pain is the most common symptom.

THROMBOPHLEBITIS An acute condition associated with inflammation and thrombus formation in deep or superficial veins, this disease is usually progressive and may lead to pulmonary embolism. Superficial thrombophlebitis is generally self-limiting and rarely leads to pulmonary embolism.

Valvular Heart Diseases

All of these conditions interfere with the normal flow of blood into, through, and out of the heart. They include

Mitral insufficiency

Mitral stenosis

Mitral valve prolapse (MVP)

Aortic insufficiency

Aortic stenosis

Pulmonic insufficiency

Pulmonic stenosis

Tricuspid insufficiency

Practice Test 1

Questions

1 - 1

A client is admitted to the Coronary Care Unit complaining of chest pain and nausea. Six hours after admission, the client tells the nurse, I need to have a bowel movement. The most appropriate response by the nurse would be:

You need to walk slowly to the bathroom. I will assist you.

I will see that a commode chair is brought to your bedside.

You should avoid straining while having a bowel movement.

Wait until a prescription can be obtained for a Fleet enema.

1 - 2

A client is admitted to the Intensive Cardiac Care Unit (ICCU) with a diagnosis of super-ventricular tachycardia. The client complains of dizziness and fatigue. In the presence of a rapid heart rate, the nurse will assess the client first for the development of:

fluid in the lungs.

pallor.

increasing urinary output.

unstable angina.

1 - 3

Your client is hypertensive and has been taking an angiotensin-converting enzyme inhibitor for several days. Today’s medication prescriptions include a loop diuretic. The expected outcome of this therapy is:

excretion of calcium with no diuretic effect.

an increase in diastolic blood pressure.

a decrease in blood pressure.

hypotension.

1 - 4

A client diagnosed with acute myocardial infarction develops acute pericarditis 4 days after admission to the hospital. Nursing assessment on the fifth day of hospitalization reveals client complaints of chest pressure, shortness of breath, increasing anxiety, and restlessness. Physical findings show diminished heart sounds and a mild friction rub. The nurse recognizes these symptoms as evidence of:

cardiac tamponade.

pericardial effusion.

increased cardiac output.

cardiomyopathy.

1 - 5

Your 55-year-old client is unresponsive and has a pulse that is barely palpable. The electrocardiogram has identified a supraventricular tachycardia of 180 beats per minute (BPM). You will anticipate cardioversion by defibrillation with:

20 joules.

50 joules.

200 joules.

500 joules.

1 - 6

Which of the following statements are correct regarding coronary artery disease (CAD) in women?

Select all that apply by placing a in the square:

1. Diabetes mellitus is a predictor of CAD in women.

2. Estrogen replacement in postmenopausal women reduces the risk ofCAD.

3. Smoking cigarettes contributes to CAD in women.

4. Hypertension is not a risk factor for CAD in women.

5. CAD is the number-one cause of death in American women.

1 - 7

A client with generalized arteriosclerosis approaches the nurse and says, I don’t sleep well at night because my feet get cold. What should I do? Which of the following responses by the nurse would be the most effective and safest recommendations?

Rub your feet briskly to improve circulation.

Place a light blanket over your feet atnight.

Place your feet on a covered hot-waterbottle.

Put a covered heating pad on your feet with the dial on the lowest setting.

1 - 8

A client with esophageal varices is experiencing hematemesis. A balloon tamponade has been inserted. The nurse recognizes that the primary purpose of this intervention is to:

apply pressure to the affected area.

prevent paralytic ileus.

provide a means for irrigating the stomach.

prevent vomiting of blood.

1 - 9

A 3-year-old was hospitalized with congestive heart failure. The child has been digitalized and is now receiving a maintenance dose of digoxin 0.08 mg po bid. The available medication contains 0.05 mg digoxin per 1 cc of solution. How much of the solution will the nurse administer?

0.06 cc

0.6 cc

1.6 cc

2.6 cc

1 - 10

The most distinctive electrocardiogram change associated with hyperkalemia is:

absence of P waves.

atrial fibrillation.

heightened QRS complexes.

peaked T waves.

1 - 11

Which assessment should be completed frequently on clients receiving Tridil?

blood pressure

blood glucose

breath sounds

urine output

1 - 12

Atrial flutter may best be described as:

an irregular, chaotic ventricular rhythm.

an irregular rhythm with little wave formation between QRS complexes.

an atrial rhythm characterized by a sawtooth pattern between QRS complexes.

a barely discernible rhythm, not associated with any heart muscle activity.

1 - 13

A client is receiving a continuous drip of nitroprusside sodium (Nitropress) to decrease cardiac afterload. What special precaution will the nurse take when administering this medication?

Use special intravenous tubing.

Protect the solution from light.

Put medication in glass bottles only.

Do not allow solution to hang for more than 4 hours.

1 - 14

Your client has an asymptomatic abdominal aortic aneurysm. Ultrasonographic examination indicates the aneurysm is 3.5 centimeters. You anticipate:

administration of an antihypertensive medication.

excision of the aneurysm with replacement of the excised segment with a synthetic graft.

a gastrointestinal bleed that may progress to shock.

a complaint by the client of intense back and flank pain with awareness of a pulsating mass in the abdomen.

1 - 15

You are concerned that your client is getting too much digoxin. What signs and symptoms are indicative of digitalis toxicity?

convulsions

yellow-green halo vision

muscle cramping

orthostatic hypotension

1 - 16

The nurse routinely obtains a client’s central venous pressure readings. Should interventions become necessary based on the central venous pressure readings, they would be implemented for the purpose of:

maintaining a normal range of pressure in the right atrium.

lowering the pressure in the pulmonary artery.

detecting dysrhythmias in the left ventricle.

promoting circulation through the aorta.

1 - 17

A client is diagnosed with Raynaud’s phenomenon. When assisting the client to manage activities of daily living, the nurse should include which of the following in the teaching plan?

Moving to a warmer climate.

Taking pain medication when exposed to cold or cold objects.

Wearing gloves when exposed to cold or cold objects.

Limiting activity to decrease metabolic demands upon the body.

1 - 18

The foot of your client’s casted leg is mottled and warmer than the unaffected leg. You notify the physician immediately because you suspect:

arterial insufficiency.

venous insufficiency.

compartmental syndrome.

fat emboli.

1 - 19

Which of the following symptoms is characteristic of intermittent claudication?

extensive discoloration

dependent edema

pain associated with activity

petechiae

1 - 20

A client experiencing stage II hypertension may be treated with which of the following medications?

levothyroxine

phenytoin

cefprozil

metoprolol

1 - 21

Your client has thromboangiitis obliterans. You are teaching the client how to participate in the treatment of this condition. Which statement by the client indicates a need for further teaching?

It will be helpful if I can find employment that allows me to sit most of the time.

I know it’s essential that I quit smoking.

I intend to walk 30 minutes twicedaily.

I’ll need to be careful that I don’t injure my legs.

1 - 22

The nurse is observing a client for symptoms of postoperative shock. The earliest symptom of postoperative shock would be obtained by monitoring the:

pulse rate.

pulse pressure.

temperature.

respirations.

1 - 23

A client with hypertension is receiving the angiotensin-converting enzyme inhibitor enalapril to decrease blood pressure. The nurse understands that this medication lowers blood pressure by:

promoting vasodilation.

blocking beta-adrenergic impulses.

inhibiting angiotensin-converting enzyme.

preventing reabsorption of sodium chloride.

1 - 24

A 65-year-old takes 0.125 mg of digoxin po qid. Which condition could predispose the client to develop digitalis toxicity?

pneumonia

hyperkalemia

hypothyroidism

hypocalcemia

1 - 25

A client complaining of severe substernal pain is presently being seen in the emergency department. An acute anterior myocardial infarction is suspected. An elevation of which enzyme would confirm the diagnosis at this time?

creatine kinase (CK) and its isoenzyme (CK-MB)

creatine kinase (CK) and its isoenzyme(CK-MM)

lactic dehydrogenase (LDH2)

serum glutamic-oxaloacetic transaminase (SGOT)

1 - 26

Which of the following laboratory value combinations is most likely to represent the client with the least risk of heart disease?

a high-density lipoprotein of 70 mg/dl and a low-density lipoprotein of110 mg/dl

a high-density lipoprotein of 30 mg/dl and a low-density lipoprotein of110 mg/dl

a high-density lipoprotein of 30 mg/dl and a low-density lipoprotein of 140 mg/dl

a high-density lipoprotein of 70 mg/dl and a low-density lipoprotein of140 mg/dl

1 - 27

Your client is experiencing an evolving myocardial infarction and is being evaluated for thrombolytic therapy. Which statement made by the client would constitute a possible contraindication for this treatment?

I’ve been having chest pain for 2 hours.

I feel really nauseated right now.

I’ve been taking blood pressure medicine for years.

I’m still taking medicine for my stomach ulcers.

1 - 28

A client experiencing coronary artery disease may be treated with all of the following medications. Which medication will the nurse recognize as a calcium channel blocker?

metoprolol

nifedipine

nitroglycerin

aspirin

1 - 29

A 7-month-old infant with tetralogy of Fallot is in the recovery room following a right heart catheterization. Which of the following assessment findings should be reported immediately?

an apical pulse of 74 beats per minute

the left foot cool to the touch

mild clubbing of fingers and toes

irritable when dressing is changed

1 - 30

A client is returned to the unit following an angiocardiography. Which nursing action is appropriate at this time?

Discourage fluid intake and place the client in a prone position.

Apply heat to the puncture site and passively exercise the involved extremity.

Limit motion of the affected extremity and assess the puncture site.

Restrict fluid intake and encourage ambulation.

1 - 31

An adult client was admitted to the coronary care unit following a subendocardial myocardial infarction. A balloon-tipped pulmonary artery catheter was inserted when the client began to exhibit signs of cardiogenic shock. The nurse measures the client’s pulmonary capillary wedge pressure and finds it to be 18 mm Hg. The nurse knows this pressure is:

within normal limits.

elevated above normal.

less than normal.

life threatening.

1 - 32

Your client’s cardiac monitor displayed the above dysrhythmia. The client’s blood pressure is 110/70 mm Hg, the pulse rate is between 120 and 140 beats per minute, and the respiratory rate is 18 breaths per minute. The client is alert, oriented, and complaining of palpitations and fatigue. The nurse will anticipate the administration of:

lidocaine.

atropine.

digitalis.

pronestyl.

1 - 33

A 64-year-old client in the Intensive Coronary Care Unit is experiencing the above dysrhythmia. The client is hemodynamically stable. You will anticipate the administration of:

digoxin.

inderal.

lidocaine.

verapamil.

1 - 34

The nurse will recognize the above rhythm strip as an example of:

normal sinus rhythm.

sinus tachycardia.

ventricular tachycardia.

atrial fibrillation.

1 - 35

The above rhythm strip is an example of:

second-degree AV block, type II.

premature junctional contractions.

premature ventricular contractions.

third-degree AV block.

1 - 36

A client in the Intensive Coronary Care Unit converts to the above dysrhythmia. What should be done immediately?

cardioversion

defibrillation

administration of lidocaine

administration of sodium bicarbonate

1 - 37

The above rhythm strip is an example of:

sinus tachycardia.

sinus bradycardia.

first-degree block.

normal sinus rhythm.

1 - 38

The above rhythm is an example of which dysrhythmia?

first-degree AV heart block

second-degree AV heart block, type I

second-degree AV heart block, type II

third-degree AV heart block

1 - 39

Sinus tachycardia may best be described by which of the following?

a chaotic rhythm with no discernible pattern that is not associated with cardiac output

a regular rhythm with rate greater than 100 beats per minute

a ventricular rapid rhythm that may or may not produce a palpable pulse

a regular rhythm with rates between 60 and 100 beats per minute

1 - 40

Sinus bradycardia is best described as:

an irregular rhythm of ventricular origin with faint, if any, palpable pulse.

an irregular, slow ventricular rate with variable numbers of P waves between complexes.

a normal rhythm with a rate of less than 60 beats per minute.

a normal rhythm with a rate of more than 100 beats per minute.

1 - 41

Which of the following instructions should be given to a client who has Nitrostat on hand for the treatment of angina?

Keep your medication in the refrigerator at all times.

Replace your tablets every 8 months.

Swallow your pill with a big glass of water, not milk.

If your angina is not relieved after 3 pills, come to the emergency department.

1 - 42

Nursing measures that include instructing clients in the prevention of coronary artery disease are referred to as:

primary interventions.

acute-care interventions.

secondary interventions.

tertiary interventions.

1 - 43

A client who is taking daily digoxin says to you, I have been experiencing nausea. Upon further inquiry, it is discovered that the client’s pulse rate is 52 beats per minute. The nurse should instruct the client to:

double the digoxin dose.

take an antacid 1 hour prior to today’s digoxin dose.

take the digoxin on an empty stomach, but with a full glass of water.

hold the digoxin dose and come to the clinic for evaluation.

1 - 44

A client who has had a 12-lead electrocardiogram tells you there was a premature ventricular contraction noted by the technician taking the electrocardiogram. Your response to your client’s concern about this is based on the knowledge that:

premature ventricular contractions may be benign.

there are no lifestyle changes to decrease their incidence.

premature ventricular contractions are a prelude to lethal arrhythmias.

premature ventricular contractions indicate myocardial infarction.

1 - 45

Risk factors in primary (essential) hypertension include:

Select all that apply by placing a in the square:

1. age

2. low serum lipids

3. race

4. diabetes mellitus

5. active lifestyle

1 - 46

Your client was brought to the emergency department following a myocardial infarction. Morphine sulfate IV has been prescribed. You understand this medication will decrease the cardiac workload by:

Select all that apply by placing a in the square:

1. increasing myocardial oxygen consumption.

2. reducing contractility.

3. lowering blood pressure.

4. increasing the heart rate.

5. decreasing pain.

1 - 47

Which of the following do you recognize as risk factors associated with sudden cardiac death (SCD)?

Select all that apply by placing a in the square:

1. hypercholesterolemia

2. coronary artery disease

3. hypotension

4. cigarette smoking

5. female gender

1 - 48

The contraction phase of the cardiac cycle is referred to as the:

_____________________________________________.

Fill in the blank

Practice Test 1

Answers, Rationales, and Explanations

1 - 1

The client should be told that straining at stool is discouraged. Straining initiates the Valsalva’s maneuver, which increases pressure in the large vein in the thorax and can interfere with the return of blood flow to the heart. The client should be provided with a bedpan to conserve energy.

1. Clients admitted to a Coronary Care Unit (CCU) are placed on bed rest and should not walk to the bathroom.

2. Until a definitive diagnosis is made, the client should not use a bedside commode chair.

4. There is no indication that the client needs an enema.

Client Need: Health Promotion and Maintenance

1 - 2

The nurse will assess the client for the development of fluid in the lungs, which may be manifested by the presence of crackles (formerly referred to as rales). Rapid heart rhythms may cause heart failure along with accumulation of fluid in the lungs.

2. Pallor (paleness of skin) may be present. However, the nurse will assess the client for the most life-threatening possibilities, such as fluid accumulation in the lungs.

3. Urinary output will be decreased in the presence of heart failure, not increased. Diminished cardiac output prevents an adequate supply of blood from reaching the body tissues and organs (low perfusion). Low perfusion of the kidneys causes an abnormal reduction in urinary output (oliguria).

4. Rapid heart rates are not always associated with unstable angina. However, fluid in the lungs is likely and life threatening.

Client Need: Physiological Integrity

1 - 3

An expected outcome of loop diuretic therapy is a decrease in blood pressure. Loop diuretics are often administered with angiotensin-converting enzyme (ACE) inhibitors to manage hypertension. A diuretic reduces circulatory volume by increasing renal excretion of water, sodium, chloride, magnesium, hydrogen, and calcium. An ACE inhibitor prevents the production of angiotensin II, a potent vasoconstrictor. Therefore, by reducing circulatory volume and preventing vasoconstriction, the blood pressure can be lowered.

1. When a loop diuretic is administered, it inhibits reabsorption (the absorbing of sodium and chloride by the nephron after they have been through the glomerulus). The client will receive the benefit of the diuretic without the excretion of calcium.

2. Loop diuretics cause a decrease in diastolic blood pressure, not an increase.

4. Hypotension is a side effect of ACE inhibitors and diuretics, not an expected therapeutic outcome.

Client Need: Health Promotion and Maintenance

1 - 4

Chest pressure, shortness of breath, anxiety, restlessness, diminished heart rate, and friction rub are all classic manifestations of pericardial effusion (the accumulation of an abnormally large amount of pericardial fluid in the pericardium). Other symptoms of pericardial effusion include hypotension and elevated jugular vein distension (JVD).

1. Cardiac tamponade may follow pericardial effusion. Symptoms of cardiac tamponade include increased intracardiac pressure, limitation of ventricular filling, reduction in stroke volume, jugular vein distention, a decrease in cardiac output, and increase in heart rate. The usual complaint is dyspnea.

3. Chest pressure, shortness of breath, anxiety, restlessness, diminished heart sounds, and friction rub would cause a decrease in cardiac output, not an increase in cardiac output.

4. Cardiomyopathy is a disease of the myocardium (the middle layer of the walls of the heart). Cardiomyopathy is characterized by impaired contractility and pumping ability of the heart.

Client Need: Physiological Integrity

1 - 5

Cardioversion by defibrillation with 50 joules is anticipated. Treatment for symptomatic supraventricular tachycardia is cardioversion. Defibrillation with 50 joules is the appropriate dosage.

1. Defibrillation with 20 joules is a pediatric defibrillation dose.

3. Defibrillation with 200 joules is indicated for ventricular fibrillation or pulseless ventricular tachycardia.

4. Defibrillation with 500 joules is an inappropriately excessive dosage of current.

Client Need: Physiological Integrity

1 - 6

Women with diabetes mellitus are 5 to 7 times more likely to develop CAD than women who do not have diabetes mellitus.

Estrogen replacement in postmenopausal women may reduce the risk of CAD by 50%. Estrogen replacement lowers LDL and raises HDL cholesterol.

Smoking cigarettes is the biggest contributor to CAD in women under 50 years old. Nicotine causes vasoconstriction and can increase blood pressure.

CAD is the number-one cause of death in American women.

4. Hypertension is a risk factor in the development of CAD in women.

Client Need: Health Promotion and Maintenance

1 - 7

The nurse should recommend that the client cover the feet with a light blanket. This is the most effective and safest way to keep the feet warm.

1. Clients with arteriosclerosis are susceptible to thrombi formation. Therefore, rubbing the feet is dangerous since it could cause the release of thrombi.

3 and 4. Clients with poor circulation may experience paresthesia (numbness and tingling) of the extremities. For this reason it would be unsafe to suggest the use of a hot-water bottle or a heating pad.

Client Need: Physiological Integrity

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The primary purpose for the balloon tamponade is to apply pressure at the site of the bleeding. Esophageal varices are dilated, tortuous veins that may bleed easily. This condition is usually caused by portal hypertension and is life threatening.

2. A paralytic ileus is characterized by lack of bowel sounds and lack of peristalsis, accompanied by distention of the abdomen. The client may experience nausea and vomiting. Fecal material may be vomited because of the potential for reverse peristalsis. This condition is treated with a nasogastric tube, not a balloon tamponade. Paralytic ileus may occur following abdominal surgery or with the administration of certain psychotropic drugs.

3. Balloon tamponade does allow for gastric suctioning. However, this is not the primary purpose. Gastric suctioning is usually done to monitor bleeding.

4. Balloon tamponade will not prevent vomiting of blood. However, to prevent the aspiration of blood, an endotracheal tube is sometimes inserted.

Client Need: Physiological Integrity

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The nurse will administer 1.6 cc of the solution. The following equation may be used:

1, 2, and 4. are incorrect dosages.

Client Need: Physiological Integrity

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The most distinctive electrocardiogram (ECG) change associated with hyperkalemia is an elevated T wave.

1. The P wave represents atrial muscle depolarization. Absence of the P wave is associated with conditions such as atrial flutter and ventricular fibrillation.

2. Atrial fibrillation is a dysrhythmia in which minute areas of the atrial myocardium are in uncoordinated stages of depolarization and repolarization. This is due to multiple reentry circuits within the atrial myocardium. When this occurs, the atria quivers continuously in a chaotic pattern.

3. Heightened QRS complexes are associated with ventricular hypertrophy. Ventricular hypertrophy is due to chronic pressure overload.

Client Need: Physiological Integrity

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Clients receiving nitroglycerin (Tridil) intravenously should have their blood pressure monitored frequently. Tridil is the intravenous form of nitroglycerin. Because of its vasodilating effects, the blood pressure should be monitored frequently for the frequent side effect of hypotension.

2. Tridil does not affect blood glucose.

3. The respiratory system is not directly affected by Tridil.

4. The genitourinary system is not directly affected by Tridil.

Client Need: Health Promotion and Maintenance

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Atrial flutter is best described as an atrial rhythm characterized by a sawtooth pattern between QRS complexes. Atrial flutter occurs when the sinoatrial node is no longer the primary atrial pacemaker and an ectopic pacemaker resumes pacing. This ectopic pacemaker may have a very high rate, which is represented as a sawtooth pattern on the electrocardiogram (ECG). The QRS complexes appear normal.

1. An atrial flutter is not a ventricular rhythm.

2. An atrial flutter has a very definite pattern between the QRS complexes.

4. An atrial flutter is associated with heart muscle activity and there is a discernible rhythm.

Client Need: Health Promotion and Maintenance

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When administering nitroprusside sodium (Nitropress), the nurse will need to protect the fluid from light by wrapping the infusion bottle in aluminum foil. Nitropress is a potent arterial/venous vasodilator that increases or decreases cardiac output depending on the extent of preload and afterload reduction.

1. Unlike Tridil, Nitropress does not require special intravenous tubing. However, Nitropress should only be mixed with distilled water.

3. Unlike Tridil, Nitropress does not require a glass bottle.

4. Nitropress should not be left hanging for more than 24 hours.

Client Need: Physiological Integrity

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The nurse will anticipate administering an antihypertensive medication and scheduling ultrasonographic examinations every 6 months to determine any changes in the size of the aneurysm.

2. Surgery is not generally performed when an abdominal aortic aneurysm is less than 4 to 5 cm.

3. Gastrointestinal bleeding that produces shock is the presenting sign when an abdominal aortic aneurysm ruptures into the duodenum.

4. Clients do not have complaints if their abdominal aortic