NCLEX-RN
Cardiovascular System NCLEX RN Questions Questions
Question 1 of 5
The nurse is caring for a client who has developed cardiac tamponade. Which of the following prescriptions should the nurse clarify with the primary healthcare provider (PHCP)?
Correct Answer: A
Rationale: Positive pressure ventilation can worsen cardiac tamponade by further compressing the heart, so it should be clarified.
Question 2 of 5
The nurse is watching the monitor of a client wearing a continuous cardiac monitor when it begins to alarm and fails to display any QRS complexes. Which nursing intervention should the nurse do first?
Correct Answer: B
Rationale: Absent QRS complexes may result from loose or disconnected leads, so checking lead placement is the first step.
Question 3 of 5
The nurse is caring for a client who has sustained a myocardial infarction. Which laboratory test would be increased that is specific to myocardium damage?
Correct Answer: B
Rationale: Troponin is the most specific marker for myocardial damage, remaining elevated for days post-MI.
Extract:
The nurse is caring for a client who was admitted for an exacerbation of congestive heart failure.
• Click to highlight the findings in the nurses' note which indicate that the client is progressing towards discharge.
Nurses Notes
Day 1 - 0900 - The client was ambulated 25 feet and did not tolerate the ambulation reporting dyspnea. Gait was unsteady. Provided education on aerobic exercise and the benefits for heart failure.
Client verbally taught back the education with understanding.
Day 3 - 0915 - The client ambulated 30 feet in the hallway without assistance. Gait was steady. The oxygen saturation after ambulation was 95% on room air. Scheduled furosemide was refused by the client.
Educated the client on the purpose of the medication and its benefits.
Question 4 of 5
Click to highlight the findings in the nurses' note which indicate that the client is progressing towards discharge.
Correct Answer: C,D,E
Rationale: C: Correct - Education with client understanding indicates progress in self-management. D: Correct - Ambulating 30 feet without assistance and with steady gait shows improved physical tolerance. E: Correct - Oxygen saturation of 95% on room air post-ambulation indicates stable respiratory status. A, B, F: Incorrect - Dyspnea, unsteady gait, and medication refusal suggest ongoing issues, not progress toward discharge.
Extract:
Question 5 of 5
The nurse is caring for a client who has been ordered a sodium-restricted diet following a myocardial infarction. Which of the following meals would be most appropriate to suggest?
Correct Answer: A
Rationale: Fresh foods like turkey, sweet potato, and green beans are low in sodium, unlike canned or processed foods.