NCLEX-PN
Pediatric Cardiac Disorders NCLEX Questions Quizlet Questions
Extract:
Question 1 of 4
The unlicensed assistive personnel (UAP) tells the primary nurse that the client diagnosed with coronary artery disease is having chest pain. Which action should the nurse take first?
Correct Answer: D
Rationale: Chest pain in CAD requires immediate nurse assessment (
D) to determine severity and cause. Vital signs (
A), telemetry (
B), and notifying HCP (
C) follow assessment.
Question 2 of 4
What is the priority problem in the client diagnosed with congestive heart failure?
Correct Answer: B
Rationale: Decreased cardiac output (
B) is the primary problem in CHF, causing symptoms like fluid overload (
A). Activity intolerance (
C) and knowledge deficit (
D) are secondary.
Question 3 of 4
The nurse is told in report the client has aortic stenosis. Which anatomical position should the nurse auscultate to assess the murmur?
Correct Answer: A
Rationale: Aortic stenosis murmur is best heard at the second intercostal space, right sternal notch (
A), where the aortic root is closest. Erb’s point (
B), left sternal notch (
C), and fourth space (
D) are for other murmurs.
Question 4 of 4
The client is diagnosed with pericarditis. When assessing the client, the nurse is unable to auscultate a friction rub. Which action should the nurse implement?
Correct Answer: C
Rationale: Leaning forward (
C) enhances auscultation of a pericardial friction rub, which may be positional. Notifying HCP (
A), documenting resolution (
B), or chest tube (
D) are premature or unrelated.
Question 5 of 4
The client is three (3) hours post-myocardial infarction. Which data would warrant immediate intervention by the nurse?
Correct Answer: D
Rationale: Cool, clammy, diaphoretic skin (
D) indicates cardiogenic shock or sympathetic response, requiring immediate intervention. Pulses (
A), SpO2 (
B), and urine output (
C) are normal.