SAUNDERS NCLEX-RN REVIEW 2026 | 10TH EDITION
| 5,000+ VERIFIED Q&A | NGN CASE STUDIES |
GRADED A+
Saunders NCLEX Cardiovascular
A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is
scheduled for cardiac catheterization. Which medication would need to be withheld for 24
hours before the procedure and for 48 hours after the procedure?
s
1.
Glipizide
2.
Metformin
3.
Repaglinide
4.
Regular insulin
Metformin
Metformin needs to be withheld 24 hours before and for 48 hours after cardiac catheterization
because of the injection of contrast medium during the procedure. If the contrast medium affects
kidney function, with metformin in the system the client would be at increased risk for lactic
acidosis. The medications in the remaining options do not need to be withheld 24 hours before
and 48 hours after cardiac catheterization.
A client who had cardiac surgery 24 hours ago has had a urine output averaging 20
mL/hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid.
Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the
blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2
mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the
client is at risk for which problem?
1.
Hypovolemia
2.
Acute kidney injury
,3.
Glomerulonephritis
4.
Urinary tract infection
Acute kidney injury
The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion,
hemolysis, low cardiac output, or vasopressor medication therapy. Renal injury is signaled by
decreased urine output and increased blood urea nitrogen (BUN) and creatinine levels. Normal
reference levels are BUN, 10-20 mg/dL (3.6-7.1 mmol/L), and creatinine, male, 0.6-1.2 mg/dL
(53-106 mcmol/L) and female 0.5-1.1 mg/dL (44-97 mcmol/L). The client may need medications
to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis. No data
in the question indicate the presence of hypovolemia, glomerulonephritis, or urinary tract
infection.
The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS
complexes are regular. The PR interval is 0.16 seconds, and QRS complexes measure 0.06
seconds. The overall heart rate is 64 beats/minute. Which action should the nurse take?
1.
Check vital signs.
2.
Check laboratory test results.
3.
Notify the health care provider.
4.
Continue to monitor for any rhythm change.
Continue to monitor for any rhythm change.
Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100
beats/minute. The PR and QRS measurements are normal, measuring between 0.12 and 0.20
seconds and 0.04 and 0.10 seconds, respectively. There are no irregularities in this rhythm
currently, so there is no immediate need to check vital signs or laboratory results, or to notify the
health care provider. Therefore, the nurse would continue to monitor the client for any rhythm
change.
A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The
nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing
action?
,1.
Call a code.
2.
Call the health care provider.
3.
Check the client's status and lead placement.
4.
Press the recorder button on the electrocardiogram console.
Check the client's status and lead placement.
Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly
electrode displacement. Accurate assessment of the client and equipment is necessary to
determine the cause and identify the appropriate intervention. The remaining options are
secondary to client assessment.
The nurse is evaluating a client's response to cardioversion. Which assessment would be the
priority?
1.
Blood pressure
2.
Status of airway
3.
Oxygen flow rate
4.
Level of consciousness
Status of airway
Nursing responsibilities after cardioversion include maintenance first of a patent airway, and then
oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia
detection.
The nurse is caring for a client who has just had implantation of an automatic internal
cardioverter-defibrillator. The nurse should assess which item based on priority?
1.
Anxiety level of the client and family
, 2.
Presence of a MedicAlert card for the client to carry
3.
Knowledge of restrictions on postdischarge physical activity
4.
Activation status of the device, heart rate cutoff, and number of shocks it is programmed to
deliver
Activation status of the device, heart rate cutoff, and number of shocks it is programmed to
deliver
The nurse who is caring for the client after insertion of an automatic internal cardioverter-
defibrillator needs to assess device settings, similar to after insertion of a permanent pacemaker.
Specifically, the nurse needs to know whether the device is activated, the heart rate cutoff above
which it will fire, and the number of shocks it is programmed to deliver. The remaining options
are also nursing interventions but are not the priority.
A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute.
The PR interval is 0.14 seconds, the QRS complex measures 0.08 seconds, and the PP and
RR intervals are regular. How should the nurse correctly interpret this rhythm?
1.
Sinus tachycardia
2.
Sinus bradycardia
3.
Sinus dysrhythmia
4.
Normal sinus rhythm
Sinus tachycardia
Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval
and normal-width PR and QRS intervals; however, the rate is the differentiating factor. In sinus
tachycardia, the atrial and ventricular rates are greater than 100 beats/minute.
The nurse is assessing the neurovascular status of a client who returned to the surgical
nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm,
and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from
admission. How should the nurse correctly interpret the client's neurovascular status?
| 5,000+ VERIFIED Q&A | NGN CASE STUDIES |
GRADED A+
Saunders NCLEX Cardiovascular
A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is
scheduled for cardiac catheterization. Which medication would need to be withheld for 24
hours before the procedure and for 48 hours after the procedure?
s
1.
Glipizide
2.
Metformin
3.
Repaglinide
4.
Regular insulin
Metformin
Metformin needs to be withheld 24 hours before and for 48 hours after cardiac catheterization
because of the injection of contrast medium during the procedure. If the contrast medium affects
kidney function, with metformin in the system the client would be at increased risk for lactic
acidosis. The medications in the remaining options do not need to be withheld 24 hours before
and 48 hours after cardiac catheterization.
A client who had cardiac surgery 24 hours ago has had a urine output averaging 20
mL/hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid.
Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the
blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2
mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the
client is at risk for which problem?
1.
Hypovolemia
2.
Acute kidney injury
,3.
Glomerulonephritis
4.
Urinary tract infection
Acute kidney injury
The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion,
hemolysis, low cardiac output, or vasopressor medication therapy. Renal injury is signaled by
decreased urine output and increased blood urea nitrogen (BUN) and creatinine levels. Normal
reference levels are BUN, 10-20 mg/dL (3.6-7.1 mmol/L), and creatinine, male, 0.6-1.2 mg/dL
(53-106 mcmol/L) and female 0.5-1.1 mg/dL (44-97 mcmol/L). The client may need medications
to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis. No data
in the question indicate the presence of hypovolemia, glomerulonephritis, or urinary tract
infection.
The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS
complexes are regular. The PR interval is 0.16 seconds, and QRS complexes measure 0.06
seconds. The overall heart rate is 64 beats/minute. Which action should the nurse take?
1.
Check vital signs.
2.
Check laboratory test results.
3.
Notify the health care provider.
4.
Continue to monitor for any rhythm change.
Continue to monitor for any rhythm change.
Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100
beats/minute. The PR and QRS measurements are normal, measuring between 0.12 and 0.20
seconds and 0.04 and 0.10 seconds, respectively. There are no irregularities in this rhythm
currently, so there is no immediate need to check vital signs or laboratory results, or to notify the
health care provider. Therefore, the nurse would continue to monitor the client for any rhythm
change.
A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The
nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing
action?
,1.
Call a code.
2.
Call the health care provider.
3.
Check the client's status and lead placement.
4.
Press the recorder button on the electrocardiogram console.
Check the client's status and lead placement.
Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly
electrode displacement. Accurate assessment of the client and equipment is necessary to
determine the cause and identify the appropriate intervention. The remaining options are
secondary to client assessment.
The nurse is evaluating a client's response to cardioversion. Which assessment would be the
priority?
1.
Blood pressure
2.
Status of airway
3.
Oxygen flow rate
4.
Level of consciousness
Status of airway
Nursing responsibilities after cardioversion include maintenance first of a patent airway, and then
oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia
detection.
The nurse is caring for a client who has just had implantation of an automatic internal
cardioverter-defibrillator. The nurse should assess which item based on priority?
1.
Anxiety level of the client and family
, 2.
Presence of a MedicAlert card for the client to carry
3.
Knowledge of restrictions on postdischarge physical activity
4.
Activation status of the device, heart rate cutoff, and number of shocks it is programmed to
deliver
Activation status of the device, heart rate cutoff, and number of shocks it is programmed to
deliver
The nurse who is caring for the client after insertion of an automatic internal cardioverter-
defibrillator needs to assess device settings, similar to after insertion of a permanent pacemaker.
Specifically, the nurse needs to know whether the device is activated, the heart rate cutoff above
which it will fire, and the number of shocks it is programmed to deliver. The remaining options
are also nursing interventions but are not the priority.
A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute.
The PR interval is 0.14 seconds, the QRS complex measures 0.08 seconds, and the PP and
RR intervals are regular. How should the nurse correctly interpret this rhythm?
1.
Sinus tachycardia
2.
Sinus bradycardia
3.
Sinus dysrhythmia
4.
Normal sinus rhythm
Sinus tachycardia
Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval
and normal-width PR and QRS intervals; however, the rate is the differentiating factor. In sinus
tachycardia, the atrial and ventricular rates are greater than 100 beats/minute.
The nurse is assessing the neurovascular status of a client who returned to the surgical
nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm,
and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from
admission. How should the nurse correctly interpret the client's neurovascular status?
