Download NCLEX RN CARDIOVASCULAR SYSTEM EXAM QUESTIONS AND ANSWERS WITH RATIONALES UPDATE 2025/2026 and more Exams Nursing in PDF only on Docsity!
NCLEX RN CARDIOVASCULAR SYSTEM EXAM QUESTIONS
AND ANSWERS WITH RATIONALES UPDATE 2025/
Age-related changes associated with the cardiac system include:
a. endocardial fibrosis.
b. myocardial thinning.
c. increase in the number of SA node cells.
d. decreased size of the left atrium.
a. endocardial fibrosis.
Rationale: Age-related changes associated with the cardiac system include: endocardial fibrosis, increased size of the left atrium, a decreasing number of SA node cells, and myocardial thickening.
A brain (B-type) natriuretic peptide (BNP) sample has been drawn from an older adult client who has been experiencing vital fatigue and shortness of breath. this test will allow the care team to investigate the possibility of what diagnosis?
a. pleurisy
b. heart failure
c. valve dysfunction
d. cardiomyopathy
b. heart failure
Rationale: The level of BNP in the blood increase as the ventricular walls expand from increasing pressure, making it a helpful diagnostic, monitoring, and prognostic tool in the setting of HF.
The cardiac care nurse is reviewing the conduction system of the heart. the nurse is aware that electrical conduction of the heart usually originates in the sinoatrial (SA) node and then proceeds in which sequence?
a. bundle of His to atrioventricular (AV) node to purkinje fibers
b. AV node to purkinje fibers to bundle of His
c. bundle of His to purkinje fibers to AV node
d. AV node to bundle of His to purkinje fibers
d. Av node to bundle of His to purkinje fibers
Rationale: The normal electrophysiological conduction route is SA node to the AV node to bundle of his to purkinje fibers.
A client has been admitted to the intensive care unit (ICU) after an ischemic stroke, and a central venous pressure (CVP) monitoring line was placed. the nurse notes a low CVP. which condition is the most likely reason for a low CVP?
a. hypovolemia
b. myocardial infraction
c. left side heart failure
d. aortic valve regurgitation
a. hypovolemia
Rationale: CVP is a measurement of the pressure in the vena cava or right atrium. a low CVP indicates a reduces right ventricular preload, most often from hypovolemia.
A client has been scheduled for cardiovascular computed tomography (CT) with contrast. to prepare the client for this test, what action should the nurse perform?
a. keep the client NPO for at least 6 hours prior to the test.
b. establish peripheral IV access.
c. limit the client's activity for 2 hours before the test
d. teach the client to perform incentive spirometry
A client is brought into the emergency department (ED) by a family member, who tells the nurse that the client grabbed their chest and reported substernal chest pain. the care team recognizes that need to monitor the clients cardiac function closely while interventions are performed. which form of monitoring should the nurse anticipate?
a. left-side heart catheterization
b. cardiac telemetry
c. transesophageal echocardiography
d. hardwire continuous electrocardiogram
d. hardwire continuous electrocardiogram (ECG) monitoring.
Rationale: Two types of continuous ECG monitoring techniques are used in health care setting: Hardwire cardiac monitoring(emergent) and cardiac catheterization (non emergent).
A client with complex cardiac history is scheduled for a transthoracic echocardiography. what should the nurse teach the client in anticipation of his diagnostic procedure?
a. test is noninvasive, and nothing will be inserted into the client's body.
b. the client's pain will be managed aggressively during the procedure
c. the test will provide a detailed profile of the heart's electrical activity.
d. the client will remain on bed rest for 1-2 hours after the test.
a. test is noninvasive, and nothing will be inserted into the client's body.
Rationale: before transthoracic echocardiography, the nurse informs the client about the test, explaining that it is painless.
The critical care nurse is caring for a client with a central venous pressure CVP monitoring system. the nurse notes that the client's CVP is increasing. this may indicate:
a. psychosocial stress
b. hypervolemia
c. dislodgment of the catheter
d. hypomagnesemia
b. hypervolemia
Rationale: CVP is a useful hemodynamic parameter to observe when managing an unstable client's fluid volume status. an increasing pressure may be caused by hypervolemia or by a condition, such as heart failure, that results in decreased myocardial contractility.
The critical care nurse is caring for a client with a pulmonary artery pressure monitoring system. in addition to assessing left ventricular function, what is an additional function of a pulmonary artery pressure monitoring system?
a. to assess the client's response to fluid and drug administration
b. to obtain specimens for arterial blood gas measurements
c. to dislodge pulmonary emboli
d. to diagnose the etiology of chronic obstructive pulmonary disease
a. to assess the client's response to fluid and drug administration.
Rationale: pulmonary artery pressure monitoring is an important tool used in critical care for assessing left ventricular function (cardiac output), diagnosing the etiology of shock, and evaluating the client's response to medical interventions, such as fluid administration and vasoactive medication.
During a shift assessment, the nurse is identifying the client's point of maximum impulse (PMI). Where will the nurse best palpate the PMI?
a. Left midclavicular line of the chest at the level of the nipple
b. Left midclavicular line of the chest at the fifth intercostal space
c. Midline between the xiphoid process and the left nipple
often an indication of heart failure in an adult. In addition to heart sounds, auscultation may reveal other abnormal sounds, such as murmurs and clicks, caused by turbulent blood flow through diseased heart valves.
For a client who has undergone peripheral arteriography, how should the nurse assess the adequacy of peripheral circulation?
a. checking for cardiac dysrhythmias
b. checking peripheral pulses
c. observing the client for bleeding
d. hemodynamic monitoring
b. checking peripheral pulses
Rationale: Peripheral arteriography is used to diagnose occlusive arterial disease in smaller arteries. The nurse observes the client for bleeding and cardiac dysrhythmias and assesses the adequacy of peripheral circulation by frequently checking the peripheral pulses. Hemodynamic monitoring is used to assess the volume and pressure of blood in the heart and vascular system.
For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular system, the nurse performs a thorough initial assessment to establish accurate baseline data. Which data is necessary to collect if the client is experiencing chest pain?
a. sound of the apical pulses
b. blood pressure in the left arm
c. description of the pain
d. pulse rate in upper extremities
c. description of the pain
Rationale: If the client is experiencing chest pain, a history of its location, frequency, and duration is necessary. A description of the pain is also needed, including if it radiates to a particular area, what precipitates its onset, and what brings relief. The nurse weighs the client and measures vital signs. The nurse may measure blood pressure in
both arms and compare findings. The nurse assesses apical and radial pulses, noting rate, quality, and rhythm. The nurse also checks peripheral pulses in the lower extremities.
The health care provider has ordered a high sensitivity C-reactive protein (hs-CRP) drawn on a client. the results of this test will allow the nurse to evaluate the role of what process that is implicated in the development of atherosclerosis?
a. immunosuppression
b. inflammation
c. infection
d. hemostasis
b. inflammation
Rationale: High sensitivity CRP is a protein produced by the liver in response to systemic inflammation.
A lipid profile has been ordered for a client who has been experiencing cardiac symptoms. when should the lipid profile be drawn in order to maximize the accuracy of results?
a. as a close to end of the day as possible
b. after a meal high in fat
c. after a 12 hour fast
d. thirty minutes after a normal meal
c. after a 12 fast
Rationale: Although cholesterol levels remain relatively constant over 24 hours, the blood specimen for a lipid profile should be obtained after a 12 hour fast.
The nurse auscultates the PMI (point of maximal impulse) at which anatomic location?
a. reduced pulse pressure and heart murmur
b. BP 108/60 mm Hg, ascites, and crackles
c. disorientation, 20 mL of urine over the last 2 hours
d. elevated jugular venous distention and postural changes in BP
c. disorientation, 20 mL of urine over the last 2 hours
Rationale: Assessment findings associated with reduced cardiac output include reduced pulse pressure, hypotension, tachycardia, reduced urine output, lethargy, or disorientation.
The nurse cares for a client in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the client's CVP as 8 mm Hg and recognizes that this finding indicates the client is experiencing which condition?
a. hypervolemia
b. overdiuresis
c. excessive blood loss
d. left-sided heart failure
a. hypervolemia
Rationale: The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (<2 mm Hg) indicates reduced right-ventricular preload, which is most often from hypovolemia.
The nurse cares for a client prescribed warfarin orally. The nurse reviews the client's prothrombin time (PT) level to evaluate the effectiveness of the medication. Which laboratory values should the nurse also evaluate?
a. Sodium
b. partial thromboplastic time (PTT)
c. complete blood count (CBC)
d. international normalized ratio (INR)
d. international normalized ratio (INR)
Rationale: The INR, reported with the PT, provides a standard method for reporting PT levels and eliminates the variation of PT results from different laboratories. The INR, rather than the PT alone, is used to monitor the effectiveness of warfarin. The therapeutic range for INR is 2 to 3.5, although specific ranges vary based on diagnosis. The other laboratory values are not used to evaluate the effectiveness of warfarin.
The nurse cares for a client with an intra-arterial blood pressure monitoring device. The nurse recognizes the most preventable complication associated with hemodynamic monitoring includes which condition?
a. air embolism
b. pneumothorax
c. catheter-related bloodstream infections
d. hemorrhage
c. catheter-related bloodstream infections
Rationale: Catheter-related bloodstream infections (CRBSIs) are the most common preventable complication associated with hemodynamic monitoring systems. Comprehensive guidelines for the prevention of these infections have been published by Centers for Disease Control and Prevention (CDC). Complications from use of hemodynamic monitoring systems are uncommon and can include pneumothorax, infection, and air embolism. A pneumothorax may occur during the insertion of catheters using a central venous approach (CVP and pulmonary artery catheters). Air emboli can be introduced into the vascular system if the stopcocks attached to the pressure transducers are mishandled during blood drawing, administration of medications, or other procedures that require opening the system to air.
The nurse cares for a client with clubbing of the fingers and toes. The nurse should complete which action given these findings?
a. Obtain an oxygen saturation level.
b. Obtain a 12-lead ECG tracing.
d. supine: BP 130/70 mm Hg, HR 80 bpm; sitting: BP 128/70 mm Hg, HR 80 bpm; standing: BP 130/68 mm Hg, HR 82 bpm
b. supine: BP 120/70 mm Hg, HR 70 bpm; sitting: BP 100/55 mm Hg, HR 90 bpm; standing: BP 98/52 mm Hg, HR 94 bpm
Rationale: Postural (orthostatic) hypotension is a sustained decrease of at least 20 mm Hg in systolic BP or 10 mm Hg in diastolic BP within 3 minutes of moving from a lying or sitting position to a standing position. The following is an example of BP and HR measurements in a client with postural hypotension: supine: BP 120/70 mm Hg, HR 70 bpm; sitting: BP 100/55 mm Hg, HR 90 bpm; standing: BP 98/52 mm Hg, HR 94 bpm. Normal postural responses that occur when a person moves from a lying to a standing position include (1) a HR increase of 5 to 20 bpm above the resting rate; (2) an unchanged systolic pressure, or a slight decrease of up to 10 mm Hg; and (3) a slight increase of 5 mm Hg in diastolic pressure.
The nurse is calculating a cardiac client's pressure. if the client's blood pressure is 122/76, what is the clients pulse pressure?
a. 46 mm Hg
b. 99 mm Hg
c. 198 mm Hg
d. 76 mm Hg
a. 46 mm Hg
Rationale: Pulse pressure is the difference between the systole and diastolic pressure.
The nurse is caring for a client admitted with angina who is scheduled for cardiac catheterization. the client is anxious and asks the reason for this test. the nurse should explain that cardiac catheterization is most commonly done for which purpose?
a. to assess how blocked or open a client's coronary arteries are
b. to detect how efficiently a client's heart muscles contracts
c. to evaluate cardiovascular response to stress
d. to evaluate the cardiac electrical activity
a. to assess how blocked or open a client's coronary arteries are.
Rationale: Cardiac catheterization is usually use to assess coronary patency to determine whether revascularization procedures are necessary.
The nurse is caring for a client admitted with unstable angina. the laboratory result for the initial troponin 1 is elevated in this client. the nurse should recognize what implication of this assessment finding?
a. this is only an accurate indicator of myocardial damage when it reaches its peak in24 hours
b. because the client has a history of unstable angina, this is a poor indicator of myocardial injury
c. this is an accurate indicator of myocardial injury.
d. this result indicates muscle injury but does not specify the source
c. this is an accurate indicator of myocardial injury.
Rationale: Troponin 1, which is specific to cardiac muscle, is elevated within hours after myocardial injury.
The nurse is caring for a client who has a history of heart disease. what factor should the nurse identify as possibly contributing to a decrease in cardiac output?
a. a change in position from standing to sitting
b. a heart rate of 54 bpm
c. a pulse oximetry reading of 94%
d. an increase in preload related to ambulation
b. a heart rate of 54 BPM
Rationale: Cardiac output is computed by multiplying the stroke volume by the heart rate. cardiac output can be affected by changes in either stroke volume or heart rate, such as a rate of 54 bpm.
a. systole
Rationale: Systole is the action of the chamber of the heart becoming smaller and ejecting blood.
The nurse is doing discharge teaching with a client who has coronary artery disease. the client asks why they have to take an aspirin every day if they don't have any pain. which rationale for this intervention would be best?
a. to help restore the normal function of the heart
b. to help prevent blockages that can cause chest pain or heart attacks
c. to help the blood penetrate the heart more freely
d. to help the blood carry more oxygen than it would otherwise
b. to help prevent blockages that can cause chest pain or heart attacks.
The nurse is performing an intake assessment on a client with a new diagnosis of coronary artery disease. what would be the most important determination to make during this intake assessment?
a. whether the client and involved family members understand the role of genetics in the etiology of the disease
b. whether the client and involved family members understand dietary changes and the role of nutrition
c. whether the client and involved family member are able to recognize symptoms of an acute cardiac problem and respond appropriately.
d. whether the client and involved family members understand the importance of social support and community agencies.
c. Whether the client and involved family member are able to recognize symptoms of an acute cardiac problem and respond appropriately.
Rationale: Involved family members are able to recognize symptoms of an acute cardiac problem, such as acute coronary syndrome (ACS) or HF, and seek timely treatment for these symptoms
The nurse observes a client during an exercise stress test (bicycle). Which finding indicates a positive test and the need for further diagnostic testing?
a. ST-segment changes on the ECG
b. BP changes; 148/80 mm Hg to 166/90 mm Hg
c. Dizziness and leg cramping
d. Heart rate changes; 78 bpm to 112 bpm
a. ST-segment changes observed on the ECG
Rationale: During the test, the following are monitored: two or more ECG leads for heart rate, rhythm, and ischemic changes; blood pressure; skin temperature; physical appearance; perceived exertion; and symptoms, including chest pain, dyspnea, dizziness, leg cramping, and fatigue. The test is terminated when the target heart rate is achieved or if the client experiences signs of myocardial ischemia. Further diagnostic testing, such as a cardiac catheterization, may be warranted if the client develops chest pain, extreme fatigue, a decrease in blood pressure or pulse rate, serious dysrhythmias or ST-segment changes on the ECG during the stress test. The other findings would not warrant stopping the test.
The nurse prepares to apply ECG electrodes to a male client who requires continuous cardiac monitoring. Which action should the nurse complete to optimize skin adherence and conduction of the heart's electrical current?
a. Clean the client's chest with alcohol prior to application of the electrodes.
b. Once the electrodes are applied, change them every 72 hours.
c. Clip the client's chest hair prior to applying the electrodes.
d. Apply baby powder to the client's chest prior to placing the electrodes.
c. Clip the client's chest hair prior to applying the electrodes.
Rationale: The nurse should complete the following actions when applying cardiac electrodes: (1) Clip (do not shave) hair from around the electrode site, if needed; (2) if the client is diaphoretic (sweaty), apply a small amount of benzoin to the skin, avoiding the area under the center of the electrode; (3) debride the skin surface of dead cells with soap and water and dry well (or as recommended by the manufacturer); (4) change the electrodes every 24 to
b. falls related to orthostatic hypotension
c. ineffective role performance related to hypotension
d. imbalanced fluid balance related to hemodynamic variability
b. falls related to orthostatic hypotension.
Rationale: Orthostatic hypotension creates a significant risk for falls due to the dizziness and lightheadedness that accompany it.
The nurse screens a client prior to a magnetic resonance angiogram (MRA) of the heart. Which action should the nurse complete prior to the client undergoing the procedure? Select all that apply.
a. Sedate the client prior to the procedure.
b. Remove the client's Transderm Nitro patch.
c. Offer the client a headset to listen to music during the procedure.
d. Remove the client's jewelry.
e. Position the client on the stomach for the procedure.
b. Remove the client's Transderm Nitro patch.
c. Offer the client a headset to listen to music during the procedure.
d. Remove the client's jewelry.
Rationale: Transdermal patches that contain a heat-conducting aluminized layer (e.g., NicoDerm, Androderm, Transderm Nitro, Transderm Scop, Catapres-TTS) must be removed before MRA to prevent burning of the skin. A client who is claustrophobic may need to receive a mild sedative before undergoing an MRA. During an MRA, the client is positioned supine on a table that is placed into an enclosed imager or tube containing the magnetic field. Clients are instructed to remove any jewelry, watches, or other metal items (e.g., ECG leads). An intermittent clanking or thumping that can be annoying is generated by the magnetic coils, so the client may be offered a headset to listen to music.
The nurse uses which term for the normal pacemaker of the heart?
a. Atrioventricular (AV) node
b. Sinoatrial (SA) node
c. Purkinje fibers
d. Bundle of His
b. Sinoatrial (SA) node
Rationale: The sinoatrial node is the primary pacemaker of the heart. The AV node coordinates the incoming electrical impulses from the atria and, after a slight delay, relays the impulse to the ventricles. The Purkinje fibers rapidly conduct the impulses through the thick walls of the ventricles
The nurse working on a cardiac care unit is caring for a client whose stroke volume has increased. the nurse is aware that afterload influences a client's stroke volume. the nurse recognizes that which factor increases afterload?
a. arterial vasoconstriction
b. venous vasoconstriction
c. arterial vasodilation
d. venous vasodilation
a. arterial vasoconstriction
Rationale: Afterload, or resistance to ejection of blood from the ventricle, is one determinant of stroke volume. there is a inverse relationship between afterload and stroke volume. Arterial vasoconstriction increases afterload, which leads to decreased stroke volume
