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CARDIOVASCULAR SYSTEM NCLEX RN QUESTIONS AND
ANSWERS UPDATE 2025/
A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect?
a. Decreased myocardial contraction
b. Decreased heart rate
c. Increased cardiac conduction
d. Increased intranodal conduction time
c. Increased cardiac conduction
A 50-year-old female presents with a low heart rate and low blood pressure. She is given an intravenous (IV) infusion of fluids. The increase in atrial distension results in:
a. Renal retention of fluids
b. Depressed myocardial contractility
c. Release of acetylcholine
d. Increased heart rate
d. Increased heart rate
A 50-year-old female received trauma to the chest that caused severe impairment of the primary pacemaker cells of the heart. Which of the following areas received the greatest damage?
a. Atrioventricular (AV) node
b. Sinoatrial (SA) node
c. Bundle of His
d. Ventricles
b. Sinoatrial (SA) node
A 65-year-old male develops blockage in the pulmonary artery. As a result of the blockage, blood would first back up into the:
a. Aorta
b. Left ventricle
c. Pulmonary veins
d. Right ventricle
d. Right ventricle
The 66-year-old male client has his BP checked at a health fair. His BP is 168/98. Which action should the nurse implement first?
a. Recommend that the client have his blood pressure checked in 1 month.
b. Explain that this BP is within the normal range for an elderly person
c. Discuss the importance of eating a low salt, low fat, low cholesterol diet
d. Instruct the client to see his HCP as soon as possible
d. Instruct the client to see his HCP as soon as possible
After noting a pulse deficit when assessing a patient who has just arrived in the emergency department, the nurse will anticipate that the patient may require
a. electrocardiographic (ECG) monitoring.
b. 2-D echocardiogram.
c. cardiac catheterization.
d. hourly blood pressure (BP) checks
a. electrocardiographic (ECG) monitoring.
An aide asks a nurse how surfactant works. How should the nurse respond? Surfactant facilitates alveolar distention and ventilation by:
c. "Unless you have a headache your blood pressure is probably within normal limits"
d. "Your blood pressure reflects how well your heart is working."
b. "Damage can be occurring to your heart and kidneys even if you feel great."
The client is admitted to the telemetry unit diagnosed with acute exacerbation of congestive heart failure. Which signs/symptoms would the nurse expect to find when assessing this client?
a. Apical pulse rate of 110 and 4+ pitting edema of feet
b. Radial pulse of 90 and capillary refill time <3 seconds
c. Thick white sputum and crackles that clear with cough
d. The client sleeping with no pillows and eupnea.
a. Apical pulse rate of 110 and 4+ pitting edema of feet
The client with coronary artery disease asks the nurse, "Why do I get chest pain?" Which statement would be the most appropriate response by the nurse?"
a. "Chest pain is caused by decreased oxygen to the heart muscle."
b. "Chest pain occurs when the lungs cannot adequately oxygenate the blood"
c. "The heart muscle is unable to pump effectively to perfuse the body"
d. "There is ischemia to the myocardium as a result of hypoxemia."
a. "Chest pain is caused by decreased oxygen to the heart muscle."
A consequence of alveolar hypoxia is:
a. Reactive vasodilation
b. Local bronchoconstriction
c. Decreased respiratory rate
d. Pulmonary artery vasoconstriction
d. Pulmonary artery vasoconstriction
A diabetic patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about:
a. ACE inhibitors and beta blockers.
b. biventricular pacemakers.
c. dietary supplements and exercise.
d. diuretics and digoxin.
a. ACE inhibitors and beta blockers
During a physical examination of a patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The most appropriate action for the nurse to take next will be to
a. auscultate both the carotid arteries for the presence of a bruit.
b. document that the PMI is in the normal anatomic location.
c. assess the patient for symptoms of left ventricular hypertrophy.
d. ask the patient about risk factors for coronary artery disease.
c. assess the patient for symptoms of left ventricular hypertrophy.
The elderly client has coronary artery disease. Which question should the nurse ask the client during the client teaching?
a. "Do you get a yearly x-ray?"
b. "Do you have a daily bowel movement?"
c. "Are you sexually active?"
d. "Have you had any weight change?"
c. "Are you sexually active?"
Important mechanisms for maintaining venous return to the right atrium include (elect all that apply):
a. Cardiac output
b. Atrioventricular (AV) valves
c. Skeletal muscle contraction
d. Blood volume
e. Vascular tone
a. Cardiac output
b. Atrioventricular (AV) valves
c. Skeletal muscle contraction
d. Blood volume
Venous return is dependent on blood volume and flow through the venous system and the AV valves. Skeletal muscle function assists the flow of blood toward the heart. This important mechanism of venous return is called the muscle pump. Vascular tone must be maintained to facilitate return.
Increases in which of the following would cause the nurse to assess for decreased blood flow? (Select all that apply.)
a. Blood viscosity
b. Blood vessel diameter
c. Blood pressure
d. Blood vessel length
a. Blood viscosity
c. Blood pressure
d. Blood vessel length
Resistance to flow is generally greater in longer tubes because resistance increases with length. Blood flow varies inversely with the viscosity of the fluid. Thick fluids move more slowly and experience greater resistance to flow than thin fluids. Increased blood pressure decreases blood flow because resistance in increased.
The male client diagnosed with essential hypertension has been prescribed an alpha-adrenergic blocker. Which intervention should the nurse discuss with the client?
a. Explain that impotence is an expected side effect of the medication
b. Eat at least one banana a day to help increase the potassium level
c. Take the medication on an empty stomach to increase absorption
d. Change position slowly when going from lying to sitting position
d. Change position slowly when going from lying to sitting position
A man asks a nurse why he cannot use digoxin (Lanoxin) for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not first-line therapy for which reason?
a. It causes tachycardia and increases the cardiac workload.
b. It does not correct the underlying pathology of heart failure.
c. It has a wide therapeutic range that makes dosing difficult.
d. It may actually shorten the patient's life expectancy.
b. It does not correct the underlying pathology of heart failure.
Digoxin improves cardiac output, alters electrical effects, and helps to decrease sympathetic outflow from the central nervous system (CNS) through its neurohormonal effects; however, it does not alter the underlying pathology of heart failure or prevent cardiac remodeling. Digoxin causes bradycardia and increases the cardiac workload by increasing contractility. It has a narrow therapeutic range and many adverse effects. Digoxin does not improve life expectancy; in women it may actually shorten life expectancy.
A nurse assesses the heart after acetylcholine because the effect of acetylcholine on the heart is to
a. Decrease the refractory period
b. Increase calcium influx
c. Increase the strength of myocardial contraction
d. Decrease the heart rate
e. Administering furosemide (Lasix)
f. Administering morphine sulfate intravenously
a. Inserting a Foley catheter
d. Administering oxygen
e. Administering furosemide (Lasix)
f. Administering morphine sulfate intravenously
Rationale: Pulmonary edema is a life-threatening event that can result from severe heart failure. In pulmonary edema, the left ventricle fails to eject sufficient blood, and pressure increases in the lungs because of the accumulated blood. Oxygen is always prescribed and the client is placed in high fowler's to ease the work of breathing. Furosemide, a rapidly acting diuretic, will eliminate accumulated fluid. A Foley catheter is inserted to measure output accurately. IV administration of morphine sulfate reduces venous return (preload), decreases anxiety, and also reduces the work of breathing. Transporting the client to the coronary care unit is not a priority intervention. In fact, this may not be necessary at all if the client's response to treatment is successful.
The nurse is administering a beta-blocker to the client diagnosed with essential hypertension. Which intervention should the nurse implement?
a. Notify the HCP if the potassium level is 3.8 mEq/L
b. Do not administer the medication if the client's radial pulse is >
c. Monitor the client's blood pressure while he or she is lying, standing, and sitting
d. Question administering the medication if the BP is <90/60 mmHg
d. Question administering the medication if the BP is <90/60 mmHg
The nurse is assessing the client diagnosed with congestive heart failure. Which signs/symptoms would indicate that the medical treatment has been effective?
a. The client is able to perform activities of daily living without dyspnea
b. The client's peripheral pitting edema has gone from 3+ to 4+
c. The client has minimal jugular vein distention
d. The client is able to take the radial pulse accurately
a. The client is able to perform activities of daily living without dyspnea
A nurse is discussing heart failure with a group of nursing students. Which statement by a student reflects an understanding of how compensatory mechanisms can compound existing problems in patients with heart failure?
a. "An increase in arteriolar tone to improve tissue perfusion can decrease resistance."
b. "An increase in contractility to increase cardiac output can cause pulmonary edema."
c. "When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles."
d. "When venous tone increases to increase ventricular filling, an increase in arterial pressure occurs."
c. When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles."
A nurse is discussing the different types of regulation. Which regulation is the nurse describing? Local myogenic regulation of blood vessel diameter and thus blood flow through a vessel is an example of:
a. Autonomic regulation
b. Somatic regulation
c. Autoregulation
d. Metabolic regulation
c. Autoregulation
A nurse is discussing the pressure generated at the end of diastole. Which term is the nurse describing?
a. Preload
b. Afterload
c. Systemic vascular resistance
d. Total peripheral resistance
a. Preload
A nurse is evaluating stroke volume. Which of the following factors affect stroke volume? (Select all that apply.)
The nurse is monitoring a client who is taking propranolol (Inderal LA). Which assessment data indicates a potential serious complication associated with this medication?
a. A baseline resting heart rate of 88 beats/minute followed by a resting heart rate of 72 beats/minute after two doses of the medication
b. The development of audible expiratory wheezes
c. The development of complaints of insomnia
d. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication
b. The development of audible expiratory wheezes
The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure. The nurse should assess the infant for which EARLY signs of heart failure?
a. Slow and shallow breathing
b. Cough
c. Pallor
d. Tachycardia
d. Tachycardia
The nurse is planning care for a patient with heart problems. Which information should the nurse remember? The _____ artery travels down the interventricular septum and delivers blood to portions of the left and right ventricle.
a. Right coronary
b. Circumflex
c. Left anterior descending
d. Cardiac
c. Left anterior descending
The nurse is planning to administer hydrochlorothiazide to a client. The nurse understands that which is a concern related to the administration of this medication?
a. Hypokalemia, hyperglycemia, sulfa allergy
b. Hyperkalemia, hypoglycemia, penicillin allergy
c. Increased risk of osteoporosis
d. Hypouricemia, hyperkalemia
a. Hypokalemia, hyperglycemia, sulfa allergy
The nurse is preparing to administer a beta blocker to the client diagnosed with CAD. Which assessment data would cause the nurse to question administering the medication?
a. The client's potassium level is 4.5 mEq/L
b. The client is complaining of a headache
c. The client has a BP of 110/
d. The client had an apical pulse of 56
d. The client had an apical pulse of 56
A nurse is preparing to administer digoxin (Lanoxin) to a patient. The patient's heart rate is 62 beats per minute, and the blood pressure is 120/60 mm Hg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do?
a. Contact the provider to request an increased dose of digoxin.
b. Give the dose of digoxin and notify the provider of the potassium level.
c. Request an order for a diuretic.
d. Withhold the dose and notify the provider of the heart rate.
b. Give the dose of digoxin and notify the provider of the potassium level.
The patient's serum potassium level is above normal limits, but only slightly. An elevated potassium level can reduce the effects of digoxin, so there is no risk of toxicity. There is no indication that an increased dose of digoxin
The nurse is teaching the Dietary Approaches to Stop Hypertension (DASH) diet to a client diagnosed with hypertension. Which statement indicates that the client understands the client teaching concerning the DASH diet?
a. "I should eat at least 4-5 servings of vegetables a day."
b. "I should drink no more than two glasses of whole milk a day"
c. "I should decrease my grain intake to no more than twice a week."
d. "I should eat meat that has a lot of white streaks in it."
a. "I should eat at least 4-5 servings of vegetables a day."
The nurse just received the AM shift report. Which client should the nurse assess first?
a. Client diagnosed with DVT who is complaining of chest pain.
b. Client diagnosed with CAD who has a BP of 170/
c. Client diagnosed with pneumonia who has a pulse oximeter reading of 98%
d. Client diagnosed with Ulcerative colitis who has non-bloody diarrhea.
a. Client diagnosed with DVT who is complaining of chest pain.
A nurse observes a cardiologist multiplying the heart rate by stroke volume. What is the cardiologist measuring?
a. Vascular resistance
b. Preload
c. Cardiac output
d. Ejection fraction
c. Cardiac output
A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take?
a. Withhold the drug for an hour and reassess the level.
b. Withhold the drug and notify the prescriber immediately.
c. Administer Digibind to counteract the toxicity.
d. Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.
d. Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.
The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin (Lanoxin). Which statement by the parent indicates the need for further instruction?
a. "If more than one dose is missed, I will call the HCP."
b. "If my child vomits after medication administration, I will repeat the dose."
c. "I will not mix the medication with food."
d. "I will take my child's pulse before administering the medication."
b. "If my child vomits after medication administration, I will repeat the dose."
A nurse recalls the chamber that receives blood from the systemic circulation is the:
a. Right atrium
b. Right ventricle
c. Left atrium
d. Left ventricle
a. Right atrium
A nurse remembers the majority of total airway resistance occurs in the:
a. Bronchi
b. Nose
c. Oral pharynx
d. Diaphragm
b. Nose
A patient is taking enalapril (Vasotec) an ACE inhibitor. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for:
a. hypernatremia.
b. hypertension.
c. hyperkalemia.
d. hypokalemia.
c. hyperkalemia
A patient researches baroreceptors online. Which information indicates a good understanding? Baroreceptors are located in the:
a. Renal artery
b. Superior vena cava
c. Carotid sinus
d. Circle of Willis
c. Carotid sinus
A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medication?
a. ACE inhibitor
b. Digoxin (Lanoxin)
c. Furosemide (Lasix)
d. Spironolactone (Aldactone)
c. Furosemide (Lasix)
A patient with heart failure who has been given digoxin (Lanoxin) daily for a week complains of nausea. Before giving the next dose, the nurse will:
a. Assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute.
b. Contact the provider to report digoxin toxicity.
c. Request an order for a decreased dose of digoxin.
d. Review the serum electrolyte values and withhold the dose if the potassium level is greater than 3.5 mEq/L
a. Assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute.
Anorexia, nausea, and vomiting are the most common adverse effects of digoxin and should cause nurses to evaluate for more serious signs of toxicity. If the HR is greater than 60 beats per minute, the dose may be given. Nausea by itself is not a sign of toxicity. A decreased dose is not indicated. A serum potassium level less than 3. mEq/L is an indication for withholding the dose
A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate:
a. complete blood count.
b. ejection fraction.
c. maximal exercise capacity.
d. serum electrolyte levels.
d. serum electrolyte levels.
The potassium-sparing diuretic spironolactone (Aldactone) prolongs survival and improves heart failure symptoms by which mechanism?
a. Blocking aldosterone receptors
b. Increasing diuresis
c. Reducing venous pressure
d. Reducing afterload
a. Blocking aldosterone receptors
