NCLEX-PN
Pediatric Cardiac Disorders NCLEX Questions Quizlet Questions
Question 1 of 5
The nurse is developing a discharge-teaching plan for the client diagnosed with congestive heart failure. Which interventions should be included in the plan? Select all that apply.
Correct Answer: A,B,C
Rationale: Weight gain monitoring (
A) detects fluid retention, pulse counting (
B) ensures digoxin safety, and removing salt (
C) reduces sodium intake. Dark urine (
D) is not specific, and furosemide at bedtime (E) causes nocturia, so morning dosing is preferred.
Question 2 of 5
The nurse is assessing the client diagnosed with congestive heart failure. Which laboratory data would indicate that the client is in severe congestive heart failure?
Correct Answer: A
Rationale: Elevated BNP (
A) is specific to heart failure, reflecting ventricular stress. CK-MB (
B) indicates myocardial infarction, D-dimer (
C) suggests clotting, and V/Q scan (
D) is for pulmonary embolism.
Question 3 of 5
The nurse and an unlicensed assistive personnel (UAP) are caring for four clients on a telemetry unit. Which nursing task would be best for the nurse to delegate to the UAP?
Correct Answer: D
Rationale: Positioning for an x-ray (
D) is within the UAP’s scope and safe. Smoking (
A) is inappropriate, ICU transport (
B) requires nursing judgment, and discharge teaching (
C) is a nursing responsibility.
Question 4 of 5
The nurse has written an outcome goal 'demonstrates tolerance for increased activity' for a client diagnosed with congestive heart failure. Which intervention should the nurse implement to assist the client to achieve this outcome?
Correct Answer: D
Rationale: Frequent rest periods (
D) prevent overexertion, supporting activity tolerance in CHF. Intake/output (
A), sodium diet (
B), and daily weights (
C) are important but less directly related to activity.
Question 5 of 5
The client diagnosed with rule-out myocardial infarction is experiencing chest pain while walking to the bathroom. Which action should the nurse implement first?
Correct Answer: C
Rationale: Activity-related chest pain suggests ischemia. Having the client sit (
C) stops exertion, reducing oxygen demand. Nitroglycerin (
A), ECG (
B), and vital signs (
D) follow.