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NCLEX RN CARDIOVASCULAR SYSTEM QUESTIONS AND
ANSWERS WITH RATIONALES UPDATE 2025/
- Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
A) Lower back pain, increased BP, decreased RBC, increased WBC
B) Severe lower back pain, decreased BP, decreased RBC, increased WBC
C) Severe lower back pain, decreased BP, decreased RBC, decreased WBC
D) Intermittent lower back pain, decreased BP, decreased RBC, increased WBC
B) Severe lower back pain, decreased BP, decreased RBC, increased WBC
Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it can't be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn't increase. For the same reason, the RBC count is decreased - not increase. The WBC count increases as cells migrate to the site of injury.
A 76 year old man enters the ER with complaints of back pain and feeling fatigued. Upon examination, his blood pressure is 190/100, pulse is 118, and hematocrit and hemoglobin are both low. The nurse palpates the abdomen which is soft, non-tender and auscultates an abdominal pulse. The most likely diagnosis is:
A) Buerger's disease
B) CHF
C) Secondary hypertension
D) Aneurysm
D) Aneurysm
Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). Which heart rhythm will the nurse most anticipate in this client if PVCs are occurring?
1.A P wave preceding every QRS complex
2.QRS complexes that are short and narrow
3.Inverted P waves before the QRS complexes
4.Premature beats followed by a compensatory pause
4.Premature beats followed by a compensatory pause
A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation should the nurse observe for when performing the client's focused assessment?
1.Flat neck veins
2.Nausea and vomiting
3.Hypotension and dizziness
4.Clubbed fingertips and headache
3.Hypotension and dizziness
A client has experienced a myocardial infarction. The nurse plans care for the client, knowing that the person's chest pain is caused by tissue hypoxia in which layer of the heart?
1.Myocardium
2.Endocardium
3.Parietal pericardium
4.Visceral pericardium
1.Myocardium
A client has received antidysrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The nurse evaluates this therapy as most effective if the client's PVCs continued to exhibit which finding?
1.Occur in pairs
2.Appear to be multifocal
3.Fall on the second half of the T wave
4.Decrease to a frequency of less than 6 per minute
4.Decrease to a frequency of less than 6 per minute
1."It will really hurt when the catheter is first put in."
2."I will receive general anesthesia for the procedure."
3."I will have to go to the operating room for this procedure."
4."I probably will feel tired after the test from lying on a hard x-ray table for a few hours."
4."I probably will feel tired after the test from lying on a hard x-ray table for a few hours."
A client is seen in the emergency department for complaints of chest pain that began 3 hours ago. The nurse should suspect myocardial injury or infarction if which laboratory value came back elevated?
1.Myoglobin
2.Cardiac troponin
3.C-reactive protein
4.Creatine kinase (CK)
2.Cardiac troponin
A client's electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/min. The PR interval is 0.16 second, the QRS complex measures 0.06 second, and the PP interval is slightly irregular. How should the nurse interpret this rhythm?
1.Sinus tachycardia
2.Sinus dysrhythmia
3.Sinus bradycardia
4.Normal sinus rhythm
2.Sinus dysrhythmia
A client who had coronary artery bypass surgery states to the home health nurse: "get so frustrated. I can't even do my gardening." The nurse then assesses the client for activity level since the surgery. Which client statement indicates a need for further teaching?
1."I pace my activities throughout the day."
2."I plan regular rest periods during the day."
3."I avoid outdoor physical activity during the heat of the day."
4."I try to walk immediately after lunch, after I've finished my morning housecleaning."
4."I try to walk immediately after lunch, after I've finished my morning housecleaning."
A client who has had a myocardial infarction asks the nurse why she should not bear down or strain to ensure having a bowel movement. The nurse's response incorporates the information that bearing down or straining would trigger which physical response?
1.Vagus nerve stimulation, causing a decrease in heart rate and cardiac contractility
2.Vagus nerve stimulation, causing an increase in heart rate and cardiac contractility
3.Sympathetic nerve stimulation, causing an increase in heart rate and cardiac contractility
4.Sympathetic nerve stimulation, causing a decrease in heart rate and cardiac contractility
1.Vagus nerve stimulation, causing a decrease in heart rate and cardiac contractility
A client with a diagnosis of angina pectoris is hospitalized for an angioplasty. The client returns to the nursing unit after the procedure, and the nurse provides instructions to the client regarding home care measures. Which statement, if made by the client, indicates an understanding of the instructions?
1."I need to cut down on cigarette smoking."
2."I am so relieved that my heart is repaired."
3."I need to adhere to my dietary restrictions."
4."I am so relieved that I can eat anything I want to now."
3."I need to adhere to my dietary restrictions."
A client with a diagnosis of cardiac dysrhythmias and a history of type I diabetes mellitus is placed on propranolol therapy. The client asks the nurse if the drug will affect insulin needs. The best response by the nurse would be that:
A) The drug will have no effect on insulin needs.
B) The drug might cause hypoglycemia.
C) The drug could cause hyperglycemia.
D) The client should ask the physician this question.
A client with myocardial infarction is experiencing new, multiform premature ventricular contractions (PVCs). Knowing that the client is allergic to lidocaine hydrochloride, the nurse plans to have which medication available for immediate use?
1.Procainamide
2.Digoxin (Lanoxin)
3.Verapamil (Calan SR)
4.Metoprolol (Lopressor)
1.Procainamide
A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit. What activity level should the nurse encourage for the client immediately after transfer?
1.Ad lib activities as tolerated
2.Strict bed rest for 24 hours after transfer
3.Bathroom privileges and self-care activities
4.Unsupervised hallway ambulation for distances up to 200 feet
3.Bathroom privileges and self-care activities
A client with no history of heart disease has experienced acute myocardial infarction and has been given thrombolytic therapy with tissue plasminogen activator. What assessment finding should the nurse identify as the most likely indicator that the client is experiencing complications of this therapy?
1.Tarry stools
2.Nausea and vomiting
3.Orange-colored urine
4.Decreased urine output
1.Tarry stools
Thrombolytic agents are used to dissolve existing thrombi, and the nurse should monitor the client for obvious or occult signs of bleeding. This includes assessment for obvious bleeding within the gastrointestinal (GI) tract, urinary system, and skin. It also includes Hematest testing of secretions for occult blood. The correct option is the only one that indicates the presence of blood.
The health care provider has written a prescription for a client to have an echocardiogram. Which action should the nurse take to prepare the client for the procedure?
1.Questions the client about allergies to iodine or shellfish
2.Has the client sign an informed consent form for an invasive procedure
3.Tells the client that the procedure is painless and takes 30 to 60 minutes
4.Keeps the client on nothing-by-mouth (NPO) status for 2 hours before the procedure
3.Tells the client that the procedure is painless and takes 30 to 60 minutes
The home health nurse makes a home visit to a client who has an implantable cardioverter-defibrillator (ICD) and reviews the instructions concerning pacemakers and dysrhythmias with the client. Which client statement indicates that further teaching is necessary?
1."If I feel an internal defibrillator shock, I should sit down."
2."I won't be able to have a magnetic resonance imaging test (MRI)."
3."My wife knows how to call the emergency medical services (EMS) if I need it."
4."I can stop taking my antidysrhythmic medicine now because I have a pacemaker."
4."I can stop taking my antidysrhythmic medicine now because I have a pacemaker."
A hospitalized client's serum calcium level is 7.9 mg/dL. The nurse is immediately concerned and takes action, knowing that this level could ultimately lead to which complication?
1.Stroke
2.Cardiac arrest
3.High blood pressure
4.Urinary stone formation
2.Cardiac arrest
The normal calcium level is 8.6 to 10 mg/dL. A low calcium level could lead to severe ventricular dysrhythmias, prolonged QT interval, and ultimately cardiac arrest. Calcium is needed by the heart for contraction. Calcium ions
C) Magnesium
Rationale: Magnesium deficiency is associated with dysrhythmias, including atrial fibrillation, premature atrial and ventricular contractions, ventricular tachycardia, and ventricular fibrillation. This might be related to its role in maintaining intracellular potassium.
A nurse employed in a cardiac unit determines that which client is the least likely to have implantation of an automatic internal cardioverter-defibrillator (AICD)?
1.A client with syncopal episodes related to ventricular tachycardia
2.A client with ventricular dysrhythmias despite medication therapy
3.A client with an episode of cardiac arrest related to myocardial infarction
4.A client with three episodes of cardiac arrest unrelated to myocardial infarction
3.A client with an episode of cardiac arrest related to myocardial infarction
The nurse has provided dietary instructions to a client with coronary artery disease. Which statement by the client indicates an understanding of the dietary instructions?
1."I'll need to become a strict vegetarian."
2."I should use polyunsaturated oils in my diet."
3."I need to substitute eggs and whole milk for meat."
4."I should eliminate all cholesterol and fat from my diet."
2."I should use polyunsaturated oils in my diet."
The client with coronary artery disease should avoid foods high in saturated fat and cholesterol such as eggs, whole milk, and red meat. These foods contribute to increases in low-density lipoproteins. The use of polyunsaturated oils is recommended to control hypercholesterolemia.
The nurse has provided self-care activity instructions to a client after insertion of an automatic internal cardioverter- defibrillator (AICD). The nurse determines that further instruction is needed if the client makes which statement?
1."I can perform activities such as swimming, driving, or operating heavy equipment as I need to."
2."I need to avoid doing anything that could involve rough contact with the AICD insertion site."
3."I should try to avoid doing strenuous things that would make my heart rate go up to or above the rate cutoff on the AICD."
4."I should keep away from electromagnetic sources such as transformers, large electrical generators, metal detectors, and I shouldn't lean over running motors."
1."I can perform activities such as swimming, driving, or operating heavy equipment as I need to."
The nurse in the telemetry unit explains two nonpharmacological treatments such as ___________, or ___________, can be used to treat dysrhythmias.
A) ECG; pacemaker
B) Cardioversion; defibrillation
C) Aspirin; Plavix
D) Exercise; stress test
B) Cardioversion; defibrillation
The more serious types of dysrhythmias are corrected through electrical shock of the heart, a treatment called elective cardioversion, or defibrillation.
The nurse is assessing an electrocardiogram (ECG) rhythm strip for a client. The P waves and QRS complexes are regular. The PR interval is 0.14 second, and the QRS complexes measure 0.08 second. The overall heart rate is 82 beats/min. The nurse interprets the cardiac rhythm to be which rhythm?
1.Sinus bradycardia
2.Sick sinus syndrome
3.Normal sinus rhythm
4.First-degree heart block
3.Normal sinus rhythm
The nurse is assessing the client's condition after cardioversion. Which observation should be of highest priority to the nurse?
1.Blood pressure
2.Status of airway
A nurse is caring for a client with unstable ventricular tachycardia. The nurse should instruct the client to take which action, if prescribed, during an episode of ventricular tachycardia?
1.Lie down flat in bed.
2.Remove any metal jewelry.
3.Breathe deeply, regularly, and easily.
4.Inhale deeply and cough forcefully every 1 to 3 seconds.
4.Inhale deeply and cough forcefully every 1 to 3 seconds.
The nurse is discussing smoking cessation with a client diagnosed with coronary artery disease (CAD). Which statement should the nurse make to try to motivate the client to quit smoking?
1."None of the cardiovascular effects are reversible, but quitting might prevent lung cancer."
2."Because most of the damage has already been done, it will be all right to cut down a little at a time."
3."If you totally quit smoking right now, you can cut your cardiovascular risk to zero within a year."
4."If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years."
4."If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years."
The nurse is instructing the post-cardiac surgery client about activity limitations for the first 6 weeks after hospital discharge. The nurse should include which item in the instructions?
1.Driving is permitted so long as the lap and shoulder seat belts are worn.
2.Lifting should be restricted to objects that do not weigh more than 25 pounds.
3.Use the arms for balance, not weight support, when getting out of bed or a chair.
4.Activities that involve straining may be resumed so long as they do not cause pain.
3.Use the arms for balance, not weight support, when getting out of bed or a chair.
The nurse is performing a health screening on a 54-year-old client. The client has a blood pressure of 118/78 mm Hg, total cholesterol level of 190 mg/dL, and fasting blood glucose level of 184 mg/dL. The nurse interprets this to mean that the client has which modifiable risk factor for coronary artery disease (CAD)?
1.Age
2.Hypertension
3.Hyperlipidemia
4.Glucose intolerance
4.Glucose intolerance
The nurse is performing an admission assessment on a client with a diagnosis of angina pectoris who takes nitroglycerin for chest pain at home. During the assessment the client complains of chest pain. The nurse should immediately ask the client which question?
1."Where is the pain located?"
2."Are you having any nausea?"
3."Are you allergic to any medications?"
4."Do you have your nitroglycerin with you?"
1."Where is the pain located?"
The nurse is teaching the client with angina pectoris about disease management and lifestyle changes that are necessary to control disease progression. Which statement by the client indicates a need for further teaching?
1."I will avoid using table salt with meals."
2."It is best to exercise once a week for 1 hour."
3."I will take nitroglycerin whenever chest discomfort begins."
4."I will use muscle relaxation to cope with stressful situations."
2."It is best to exercise once a week for 1 hour."
The nurse is trying to determine the ability of the client with myocardial infarction (MI) to manage independently at home after discharge. Which statement by the client is the strongest indicator of the potential for difficulty after discharge?
1."I need to start exercising more to improve my health."
2."I will be sure to keep my appointment with the cardiologist."
3."I don't have anyone to help me with doing heavy housework at home."
4."I think I have a good understanding of what all my medications are for."
3."I don't have anyone to help me with doing heavy housework at home."
A nurse who is auscultating a 56-year-old client's apical heart rate before administering digoxin (Lanoxin) notes that the heart rate is 52 beats/min. The nurse should make which interpretation about this information?
1.Normal, because of the client's age
2.Abnormal, requiring further assessment
3.Normal, as a result of the effects of digoxin
4.Normal, because this is the reason the client is receiving digoxin
2.Abnormal, requiring further assessment
The nurse working in a long-term care facility is assessing a client who is experiencing chest pain. The nurse should interpret that the pain is most likely caused by myocardial infarction (MI) on the basis of what assessment finding?
1.The client is not experiencing dyspnea.
2.The client is not experiencing nausea or vomiting.
3.The pain has not been relieved by rest and nitroglycerin tablets.
4.The client says the pain began while she was trying to open a stuck dresser drawer.
3.The pain has not been relieved by rest and nitroglycerin tablets.
A nursing student who is researching a medication at the nursing station asks the registered nurse (RN) what an α1- adrenergic receptor is. The RN responds by telling the student that these receptors are found primarily in which peripheral vascular structures and produce which actions?
1.The peripheral arteries and veins, and when stimulated cause vasoconstriction
2.Arterial and bronchial walls, and when stimulated cause vasodilation and bronchodilation
3.The heart, and when stimulated cause an increase in heart rate, atrioventricular (AV) node conduction, and contractility
4.Several tissues, and when stimulated cause contraction of smooth muscle, inhibition of lipolysis, and promotion of platelet aggregation
1.The peripheral arteries and veins, and when stimulated cause vasoconstriction
n which of the following areas is an abdominal aortic aneurysm most commonly located?
A) Distal to the iliac arteries
B) Distal to the renal arteries
C) Adjacent to the aortic branch
D) Proximal to the renal arteries
B) Distal to the renal arteries
A patient comes to the emergency department with abdominal pain. Work-up reveals the presence of a rapidly enlarging abdominal aortic aneurysm. Which of the following actions should the nurse expect?
A) The patient will be admitted to the medicine unit for observation and medication.
B) The patient will be admitted to the day surgery unit for sclerotherapy.
C) The patient will be admitted to the surgical unit and resection will be scheduled.
D) The patient will be discharged home to follow-up with his cardiologist in 24 hours.
C) The patient will be admitted to the surgical unit and resection will be scheduled.
A pulsating abdominal mass usually indicates which of the following conditions?
A) Abdominal aortic aneurysm
B) Enlarged spleen
C) Gastric distention
D) Gastritis
A) Abdominal aortic aneurysm
What is the definitive test used to diagnose an abdominal aortic aneurysm?
A) Abdominal X-ray
B) Arteriogram
C) CT scan
When planning care for a client receiving treatment for cardiac dysrhythmias, an appropriate client outcome would be:
A) The client will avoid use of caffeine during therapy.
B) The client will maintain heart rate below 60 beats per minute.
C) The client will limit fluid intake to 1000 ml/day.
D) The client will limit cigarettes to 15/day.
A) The client will avoid use of caffeine during therapy.
Rationale: Causes of dysrhythmias include electrolyte imbalance, hyperthyroidism, anxiety, caffeine ingestion, and tobacco use. The client should be taught to avoid caffeine and tobacco.
Which laboratory test results may be associated with peaked or tall, tented T waves on a client's electrocardiogram (ECG)?
1.Chloride level of 98 mEq/L
2.Sodium level of 135 mEq/L
3.Potassium level of 6.8 mEq/L
4.Magnesium level of 1.6 mEq/L
3.Potassium level of 6.8 mEq/L
Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?
A) HPN
B) Aneurysm rupture
C) Cardiac arrythmias
D) Diminished pedal pulses
B) Aneurysm rupture
Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?
A) DM
B) HTN
C) PVD
D) Syphilis
B) HTN
Which of the following signs and symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
A) Abdominal pain.
B) Absent pedal pulses.
C) Chest pain.
D) Lower back pain.
D) Lower back pain.
Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client?
A) Bruit
B) Crackles
C) Dullness
D) Friction rubs
A) Bruit
Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
