NCLEX-PN
Pediatric Cardiac Disorders NCLEX Questions Quizlet Questions
Extract:
Question 1 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 2 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.
Question 3 of 5
The client is one (1) day postoperative coronary artery bypass surgery. The client complains of chest pain. Which intervention should the nurse implement first?
Correct Answer: B
Rationale: Chest pain post-CABG may indicate complications. Assessing the dressing and vital signs (
B) identifies bleeding or instability. Morphine (
A), repositioning (
C), and telemetry (
D) follow.
Question 4 of 5
The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication?
Correct Answer: D
Rationale: Hypotension (BP 90/58,
D) contraindicates calcium channel blockers, which lower BP further. Pulse 64 (
A), elevated calcium (
B), and PVCs (
C) are not contraindications.
Question 5 of 5
The client has just returned from a cardiac catheterization. Which assessment data would warrant immediate intervention from the nurse?
Correct Answer: C
Rationale: Refusing to keep the leg straight (
C) risks bleeding from the femoral site, requiring immediate intervention. Normal BP/pulse (
A), intact dressing (
B), and no numbness (
D) are expected.