Comprehensive NCLEX-RN| Exam#3: (75 Questions and
Correct Answers/ Rationale (2022 update)
65. Question
Category: Physiological Adaptation
Which hereditary disease is most closely linked to an aneurysm?
A. Cystic fibrosis
B. Lupus erythematosus
C. Marfan’s syndrome
D. Myocardial infarction
Correct Answer: C. Marfan’s syndrome
Marfan’s syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore,
clients with the syndrome are more likely to develop an aortic aneurysm. Marfan syndrome (MFS) is a
spectrum of disorders caused by a heritable genetic defect of connective tissue that has an autosomal
dominant mode of transmission. The defect itself has been isolated to the FBN1 gene on chromosome
15, which codes for the connective tissue protein fibrillin. Abnormalities in this protein cause a myriad of
distinct clinical problems, of which the musculoskeletal, cardiac, and ocular system problems
predominate.
66. Question
Category: Physiological Adaptation
Which of the following treatments is the definitive one for a ruptured aneurysm?
A. Antihypertensive medication administration
B. Aortogram
C. Beta-adrenergic blocker administration
D. Surgical intervention
Correct Answer: D. Surgical intervention
,When the vessel ruptures, surgery is the only intervention that can repair it. The techniques used for
aneurysm surgery have for long been standardized. 95% of aneurysms are accessible via a small
frontotemporal craniotomy centred over the pterion. Only occasional cases, principally aneurysms of
the distal anterior cerebral artery and the lower vertebrobasilar trunk, require different surgical
approaches.
67. Question
Category: Reduction of Risk Potential
Which of the following heart muscle diseases is unrelated to other cardiovascular diseases?
A. Cardiomyopathy
B. Coronary artery disease
C. Myocardial infarction
D. Pericardial Effusion
Correct Answer: A. Cardiomyopathy
Cardiomyopathy isn’t usually related to underlying heart disease such as atherosclerosis. The etiology in
most cases is unknown.
68. Question
Category: Physiological Adaptation
Which of the following types of cardiomyopathy can be associated with childbirth?
A. Dilated
B. Hypertrophic
C. Myocarditis
D. Restrictive
Correct Answer: A. Dilated
Although the cause isn’t entirely known, cardiac dilation and heart failure may develop during the last
month of pregnancy of the first few months after birth. The condition may result from a pre -existing
cardiomyopathy not apparent prior to pregnancy.
69. Question
Category: Physiological Adaptation
,Septal involvement occurs in which type of cardiomyopathy?
A. Congestive
B. Dilated
C. Hypertrophic
D. Restrictive
Correct Answer: C. Hypertrophic
In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum – not the ventricle chambers –
is apparent. Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascul ar disease. It is defined by an
increase in left ventricular wall thickness that is not solely explained by abnormal loading conditions.
This disorder is caused by a mutation in cardiac sarcomere protein genes and is most frequently
transmitted as an autosomal dominant trait.
70. Question
Category: Physiological Adaptation
Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy?
A. Heart failure
B. DM
C. MI
D. Pericardial effusion
Correct Answer: A. Heart failure
Because the structure and function of the heart muscle is affected, heart failure most commonly occurs
in clients with cardiomyopathy. Heart failure can occur when the heart muscle is weak (systolic failure)
or when it is stiff and unable to relax normally (diastolic failure). Cardiomyopathy, which means “disease
of the heart muscle,” is one of many causes of heart failure.
71. Question
Category: Physiological Adaptation
What is the term used to describe an enlargement of the heart muscle?
A. Cardiomegaly
B. Cardiomyopathy
,C. Myocarditis
D. Pericarditis
Correct Answer: A. Cardiomegaly
Cardiomegaly denotes an enlarged heart muscle. The most critical pathophysiological changes leading to
cardiomegaly include dilated hypertrophy, fibrosis, and contractile malfunction. Contractile dysfunction
and abnormal myocardial remodeling can lead to hypertrophic cardiomyopathy or dilated
cardiomyopathy. Mechanical stretching, circulating neurohormones, and oxidative stress are significant
stimuli for the signal transduction of inflammatory cytokines and MAP kinase in cardiomyocytes. Signal
transduction leads to changes in structural proteins and proteins that regulate excitation-contraction.
Dilated cardiomyopathy mutations result in a reduced force of the sarcomere contraction and a
reduction in sarcomere content. Hypertrophic cardiomyopathy mutations result in a molecular
phenotype of hyperdynamic contractility, poor relaxation, and increased energy consumption.
72. Question
Category: Physiological Adaptation
Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the
following conditions?
A. Pericarditis
B. Hypertension
C. Obliterative
D. Restrictive
Correct Answer: D. Restrictive
These are the classic symptoms of heart failure. Heart failure is the pathophysiologic state in which the
heart, via an abnormality of cardiac function (detectable or not), fails to pump blood at a rate
commensurate with the requirements of the metabolizing tissues or is able to do so only with an
elevated diastolic filling pressure.
73. Question
Category: Physiological Adaptation
Which of the following types of cardiomyopathy does not affect cardiac output?
A. Dilated
B. Hypertrophic
,C. Restrictive
D. Obliterative
Correct Answer: B. Hypertrophic
Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the ventricle remains
relatively unchanged. Three explanations for the systolic anterior motion of the mitral valve have been
offered, as follows: (1) the mitral valve is pulled against the septum by contraction of the papillary
muscles, which occurs because of the valve’s abnormal location and septal hypertrophy altering the
orientation of the papillary muscles; (2) the mitral valve is pushed against the septum because of its
abnormal position in the outflow tract; (3) the mitral valve is drawn toward the septum because of the
lower pressure that occurs as blood is ejected at high velocity through a narrowed outflow tract (Venturi
effect).
74. Question
Category: Physiological Adaptation
Which of the following cardiac conditions does a fourth heart sound (S4) indicate?
A. Dilated aorta
B. Normally functioning heart
C. Decreased myocardial contractility
D. Failure of the ventricle to eject all the blood during systole
Correct Answer: D. Failure of the ventricle to eject all the blood during systole
An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. This
increased resistance is related to decreased compliance of the ventricle.
75. Question
Category: Pharmacological and Parenteral Therapies
Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy?
A. Antihypertensive
B. Beta-adrenergic blockers
C. Calcium channel blockers
D. Nitrates
Correct Answer: B. Beta-adrenergic blockers
,By decreasing the heart rate and contractility, beta-adrenergic blockers improve myocardial filling and
cardiac output, which are primary goals in the treatment of cardiomyopathy.
1. Question
Category: Management of Care
A patient with Parkinson’s disease has a nursing diagnosis of Impaired Physical Mobility related to
neuromuscular impairment. You observe a nursing assistant performing all of these actions. For which
action must you intervene?
A. The NA assists the patient to ambulate to the bathroom and back to bed.
B. The NA reminds the patient not to look at his feet when he is walking.
C. The NA performs the patient’s complete bath and oral care.
D. The NA sets up the patient’s tray and encourages the patient to feed himself.
Correct Answer: C. The NA performs the patient’s complete bath and oral care.
The nursing assistant should assist the patient with morning care as needed, but the goal is to keep this
patient as independent and mobile as possible.
2. Question
Category: Health Promotion and Maintenance
The nurse is preparing to discharge a patient with chronic low back pain. Which statement by the
patient indicates that additional teaching is necessary?
A. “I will avoid exercise because the pain gets worse.”
B. “I will use heat or ice to help control the pain.”
C. “I will not wear high-heeled shoes at home or work.”
D. “I will purchase a firm mattress to replace my old one.”
Correct Answer: A. “I will avoid exercise because the pain gets worse.”
Exercises are used to strengthen the back, relieve pressure on compressed nerves and protect the back
from re-injury. Doing exercises to strengthen the lower back can help alleviate and prevent lower back
pain. It can also strengthen the core, leg, and arm muscles. According to researchers, exercise also
increases blood flow to the lower back area, which may reduce stiffness and speed up the healing
process.
, 3. Question
Category: Physiological Adaptation
A patient with a spinal cord injury (SCI) complains about a severe throbbing headache that suddenly
started a short time ago. Assessment of the patient reveals increased blood pressure (168/94) and
decreased heart rate (48/minute), diaphoresis, and flushing of the face and neck. What action should
you take first?
A. Administer the ordered acetaminophen (Tylenol).
B. Check the Foley tubing for kinks or obstruction.
C. Adjust the temperature in the patient’s room.
D. Notify the physician about the change in status.
Correct Answer: B. Check the Foley tubing for kinks or obstruction.
These signs and symptoms are characteristic of autonomic dysreflexia, a neurologic emergency that
must be promptly treated to prevent a hypertensive stroke. The cause of this syndrome is noxious
stimuli, most often a distended bladder or constipation, so checking for poor catheter drainage, bladder
distention, or fecal impaction is the first action that should be taken.
4. Question
Category: Management of Care
Which patient should you, as charge nurse, assign to a new graduate RN who is orienting to the
neurologic unit?
A. A 28-year-old newly admitted patient with spinal cord injury.
B. A 67-year-old patient with stroke 3 days ago and left-sided weakness.
C. An 85-year-old dementia patient to be transferred to long-term care today.
D. A 54-year-old patient with Parkinson’s who needs assistance with bathing.
Correct Answer: B. A 67-year-old patient with stroke 3 days ago and left-sided weakness.
The new graduate RN who is oriented to the unit should be assigned stable, non-complex patients, such
as the patient with stroke.
5. Question
Category: Physiological Adaptation
Correct Answers/ Rationale (2022 update)
65. Question
Category: Physiological Adaptation
Which hereditary disease is most closely linked to an aneurysm?
A. Cystic fibrosis
B. Lupus erythematosus
C. Marfan’s syndrome
D. Myocardial infarction
Correct Answer: C. Marfan’s syndrome
Marfan’s syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore,
clients with the syndrome are more likely to develop an aortic aneurysm. Marfan syndrome (MFS) is a
spectrum of disorders caused by a heritable genetic defect of connective tissue that has an autosomal
dominant mode of transmission. The defect itself has been isolated to the FBN1 gene on chromosome
15, which codes for the connective tissue protein fibrillin. Abnormalities in this protein cause a myriad of
distinct clinical problems, of which the musculoskeletal, cardiac, and ocular system problems
predominate.
66. Question
Category: Physiological Adaptation
Which of the following treatments is the definitive one for a ruptured aneurysm?
A. Antihypertensive medication administration
B. Aortogram
C. Beta-adrenergic blocker administration
D. Surgical intervention
Correct Answer: D. Surgical intervention
,When the vessel ruptures, surgery is the only intervention that can repair it. The techniques used for
aneurysm surgery have for long been standardized. 95% of aneurysms are accessible via a small
frontotemporal craniotomy centred over the pterion. Only occasional cases, principally aneurysms of
the distal anterior cerebral artery and the lower vertebrobasilar trunk, require different surgical
approaches.
67. Question
Category: Reduction of Risk Potential
Which of the following heart muscle diseases is unrelated to other cardiovascular diseases?
A. Cardiomyopathy
B. Coronary artery disease
C. Myocardial infarction
D. Pericardial Effusion
Correct Answer: A. Cardiomyopathy
Cardiomyopathy isn’t usually related to underlying heart disease such as atherosclerosis. The etiology in
most cases is unknown.
68. Question
Category: Physiological Adaptation
Which of the following types of cardiomyopathy can be associated with childbirth?
A. Dilated
B. Hypertrophic
C. Myocarditis
D. Restrictive
Correct Answer: A. Dilated
Although the cause isn’t entirely known, cardiac dilation and heart failure may develop during the last
month of pregnancy of the first few months after birth. The condition may result from a pre -existing
cardiomyopathy not apparent prior to pregnancy.
69. Question
Category: Physiological Adaptation
,Septal involvement occurs in which type of cardiomyopathy?
A. Congestive
B. Dilated
C. Hypertrophic
D. Restrictive
Correct Answer: C. Hypertrophic
In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum – not the ventricle chambers –
is apparent. Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascul ar disease. It is defined by an
increase in left ventricular wall thickness that is not solely explained by abnormal loading conditions.
This disorder is caused by a mutation in cardiac sarcomere protein genes and is most frequently
transmitted as an autosomal dominant trait.
70. Question
Category: Physiological Adaptation
Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy?
A. Heart failure
B. DM
C. MI
D. Pericardial effusion
Correct Answer: A. Heart failure
Because the structure and function of the heart muscle is affected, heart failure most commonly occurs
in clients with cardiomyopathy. Heart failure can occur when the heart muscle is weak (systolic failure)
or when it is stiff and unable to relax normally (diastolic failure). Cardiomyopathy, which means “disease
of the heart muscle,” is one of many causes of heart failure.
71. Question
Category: Physiological Adaptation
What is the term used to describe an enlargement of the heart muscle?
A. Cardiomegaly
B. Cardiomyopathy
,C. Myocarditis
D. Pericarditis
Correct Answer: A. Cardiomegaly
Cardiomegaly denotes an enlarged heart muscle. The most critical pathophysiological changes leading to
cardiomegaly include dilated hypertrophy, fibrosis, and contractile malfunction. Contractile dysfunction
and abnormal myocardial remodeling can lead to hypertrophic cardiomyopathy or dilated
cardiomyopathy. Mechanical stretching, circulating neurohormones, and oxidative stress are significant
stimuli for the signal transduction of inflammatory cytokines and MAP kinase in cardiomyocytes. Signal
transduction leads to changes in structural proteins and proteins that regulate excitation-contraction.
Dilated cardiomyopathy mutations result in a reduced force of the sarcomere contraction and a
reduction in sarcomere content. Hypertrophic cardiomyopathy mutations result in a molecular
phenotype of hyperdynamic contractility, poor relaxation, and increased energy consumption.
72. Question
Category: Physiological Adaptation
Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the
following conditions?
A. Pericarditis
B. Hypertension
C. Obliterative
D. Restrictive
Correct Answer: D. Restrictive
These are the classic symptoms of heart failure. Heart failure is the pathophysiologic state in which the
heart, via an abnormality of cardiac function (detectable or not), fails to pump blood at a rate
commensurate with the requirements of the metabolizing tissues or is able to do so only with an
elevated diastolic filling pressure.
73. Question
Category: Physiological Adaptation
Which of the following types of cardiomyopathy does not affect cardiac output?
A. Dilated
B. Hypertrophic
,C. Restrictive
D. Obliterative
Correct Answer: B. Hypertrophic
Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the ventricle remains
relatively unchanged. Three explanations for the systolic anterior motion of the mitral valve have been
offered, as follows: (1) the mitral valve is pulled against the septum by contraction of the papillary
muscles, which occurs because of the valve’s abnormal location and septal hypertrophy altering the
orientation of the papillary muscles; (2) the mitral valve is pushed against the septum because of its
abnormal position in the outflow tract; (3) the mitral valve is drawn toward the septum because of the
lower pressure that occurs as blood is ejected at high velocity through a narrowed outflow tract (Venturi
effect).
74. Question
Category: Physiological Adaptation
Which of the following cardiac conditions does a fourth heart sound (S4) indicate?
A. Dilated aorta
B. Normally functioning heart
C. Decreased myocardial contractility
D. Failure of the ventricle to eject all the blood during systole
Correct Answer: D. Failure of the ventricle to eject all the blood during systole
An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. This
increased resistance is related to decreased compliance of the ventricle.
75. Question
Category: Pharmacological and Parenteral Therapies
Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy?
A. Antihypertensive
B. Beta-adrenergic blockers
C. Calcium channel blockers
D. Nitrates
Correct Answer: B. Beta-adrenergic blockers
,By decreasing the heart rate and contractility, beta-adrenergic blockers improve myocardial filling and
cardiac output, which are primary goals in the treatment of cardiomyopathy.
1. Question
Category: Management of Care
A patient with Parkinson’s disease has a nursing diagnosis of Impaired Physical Mobility related to
neuromuscular impairment. You observe a nursing assistant performing all of these actions. For which
action must you intervene?
A. The NA assists the patient to ambulate to the bathroom and back to bed.
B. The NA reminds the patient not to look at his feet when he is walking.
C. The NA performs the patient’s complete bath and oral care.
D. The NA sets up the patient’s tray and encourages the patient to feed himself.
Correct Answer: C. The NA performs the patient’s complete bath and oral care.
The nursing assistant should assist the patient with morning care as needed, but the goal is to keep this
patient as independent and mobile as possible.
2. Question
Category: Health Promotion and Maintenance
The nurse is preparing to discharge a patient with chronic low back pain. Which statement by the
patient indicates that additional teaching is necessary?
A. “I will avoid exercise because the pain gets worse.”
B. “I will use heat or ice to help control the pain.”
C. “I will not wear high-heeled shoes at home or work.”
D. “I will purchase a firm mattress to replace my old one.”
Correct Answer: A. “I will avoid exercise because the pain gets worse.”
Exercises are used to strengthen the back, relieve pressure on compressed nerves and protect the back
from re-injury. Doing exercises to strengthen the lower back can help alleviate and prevent lower back
pain. It can also strengthen the core, leg, and arm muscles. According to researchers, exercise also
increases blood flow to the lower back area, which may reduce stiffness and speed up the healing
process.
, 3. Question
Category: Physiological Adaptation
A patient with a spinal cord injury (SCI) complains about a severe throbbing headache that suddenly
started a short time ago. Assessment of the patient reveals increased blood pressure (168/94) and
decreased heart rate (48/minute), diaphoresis, and flushing of the face and neck. What action should
you take first?
A. Administer the ordered acetaminophen (Tylenol).
B. Check the Foley tubing for kinks or obstruction.
C. Adjust the temperature in the patient’s room.
D. Notify the physician about the change in status.
Correct Answer: B. Check the Foley tubing for kinks or obstruction.
These signs and symptoms are characteristic of autonomic dysreflexia, a neurologic emergency that
must be promptly treated to prevent a hypertensive stroke. The cause of this syndrome is noxious
stimuli, most often a distended bladder or constipation, so checking for poor catheter drainage, bladder
distention, or fecal impaction is the first action that should be taken.
4. Question
Category: Management of Care
Which patient should you, as charge nurse, assign to a new graduate RN who is orienting to the
neurologic unit?
A. A 28-year-old newly admitted patient with spinal cord injury.
B. A 67-year-old patient with stroke 3 days ago and left-sided weakness.
C. An 85-year-old dementia patient to be transferred to long-term care today.
D. A 54-year-old patient with Parkinson’s who needs assistance with bathing.
Correct Answer: B. A 67-year-old patient with stroke 3 days ago and left-sided weakness.
The new graduate RN who is oriented to the unit should be assigned stable, non-complex patients, such
as the patient with stroke.
5. Question
Category: Physiological Adaptation
