NCLEX-RN
NCLEX RN Questions Medical Surgical Nursing Questions
Question 1 of 5
A client has chest pain rated at 8 on a 10 point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads and Troponin levels are elevated. What is the highest priority for nursing management of this client at this time?
Correct Answer: D
Rationale: The client is experiencing an acute myocardial infarction, indicated by ST elevation and elevated troponin. Reducing pain and myocardial oxygen demand is critical to minimize further cardiac damage.
Question 2 of 5
When teaching the client with myocardial infarction (MI), the nurse explains that the pain associated with MI is caused by:
Correct Answer: D
Rationale: MI pain results from myocardial ischemia due to insufficient oxygen delivery to the heart muscle, caused by coronary artery occlusion.
Question 3 of 5
Crackles heard on lung auscultation indicate which of the following?
Correct Answer: D
Rationale: Crackles indicate fluid in the alveoli, often due to pulmonary edema in heart failure or post-MI, reflecting left ventricular dysfunction.
Question 4 of 5
A client with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction of 15%. The client is taking warfarin (Coumadin). The expected outcome of this drug is to:
Correct Answer: C
Rationale: Warfarin prevents thrombus formation, critical in atrial fibrillation and low ejection fraction, which increase clot risk due to stasis.
Question 5 of 5
A 70-year-old female is scheduled to undergo mitral valve replacement for severe mitral stenosis and mitral regurgitation. Although the diagnosis was made during childhood, she did not have symptoms until 4 years ago. Recently, she noticed increased symptoms, despite daily doses of digoxin and furosemide. During the initial interview with the client, the nurse would most likely learn that the client's childhood health history included:
Correct Answer: C
Rationale: Rheumatic fever in childhood is a common cause of mitral valve disease, leading to stenosis or regurgitation later in life.