CARDIAC NCLEX EXAM /NCLEX CARDIAC EXAM ACTUAL EXAM 300 QUES- TIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES

1. 1) A client is scheduled for a cardiac catherization using 4. Allergy to iodine or a radiopaque dye. Which of the following assessments shellfish is most critical before the procedure? 1. Intake and output 2. Baseline peripheral pulse rates 3. Height and weight 4. Allergy to iodine or shellfish 2. 2) A client with no history of cardiovascular disease comes into the ambulatory clinic with flulike symp- toms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem? 1. "Have you ever had this pain before?" 2. "Can you describe the pain to me?" 3. "Does the pain get worse when you breathe in?" 4. "Can you rate the pain on a scale of 1-10, with 10 being the worst?" 3. 3) A client with myocardial infarction has been trans- ferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activi- This procedure requires an informed consent be- cause it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is se- rious and must be as- sessed before the proce- dure. 3."Does the pain get worse when you breathe in?" Chest pain is assessed by using the standard pain assessment parame- ters. Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleu- ropulmonary origin usual- ly worsens on inspiration. 2. Bathroom privileges and self-care activities On transfer from the CCU, the client is al- ties? 1. Strict bed rest for 24 hours after transfer 2. Bathroom privileges and self-care activities lowed self-care activities and bathroom privileges. Supervised ambulation for 3. Unsupervised hallway ambulation with distances un- brief distances are en- der 200 feet 4. Ad lib activities because the client is monitored. 4. A nurse notes 2+ bilateral edema in the lower extrem- ities of a client with myocardial infarction who was couraged, with distances gradually increased (50, 100, 200 feet). 1. Review the intake and output records for the last admitted 2 days ago. The nurse would plan to do which 2 days of the following next? 1. Review the intake and output records for the last 2 days 2. Change the time of diuretic administration from morning to evening 3. Request a sodium restriction of 1 g/day from the physician. 4. Order daily weights starting the following morning. Edema, the accumulation of excess fluid in the inter- stitial spaces, can be mea- sured by intake greater than output and by a sud- den increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms. 5. A client is wearing a continuous cardiac monitor, which 1. Check the client status begins to sound its alarm. A nurse sees no electrocar- diogram complexes on the screen. The first action of the nurse is to: 1. Check the client status and lead placement 2. Press the recorder button on the electrocardiogram and lead placement Sudden loss of electrocar- diogram complexes indi- cates ventricular asystole console. 3. Call the physician 4. Call a code blue 6. 6) A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse en- or possible electrode dis- placement. Accurate as- sessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. 4. Taking a blood pressure within 15 minutes after sures accurate measurement by avoiding which of the nicotine or catteine inges- following? 1. Seating the client with arm bared, supported, and at heart level. 2. Measuring the blood pressure after the client has been seated quietly for 5 minutes. 3. Using a cuff with a rubber bladder that encircles at least 80% of the limb. tion BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit 4. Taking a blood pressure within 15 minutes after nico- with the legs on the floor, tine or caffeine ingestion. feet uncrossed, and not speak during the record- ing. The client should not have smoked tobacco or taken in catteine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the read- ing is taken. The cutt blad- der should encircle at least 80% of the limb being 7. 7) IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit? 1.Vitamin K 2.Aminocaporic acid 3.Potassium chloride 4.Protamine sulfate 8. 8) A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The measured. Gauges other than a mercury sphygmo- manometer should be cal- ibrated every 6 months to ensure accuracy 4. Protamine sulfate The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleed- ing or hemorrhage should occur. Vitamin K is an anti- dote for warfarin. 3. Within the therapeutic range (11 x 1.5=16.5) client's prothrombin time is 20 seconds, with a control The therapeutic range for of 11 seconds. The nurse assesses that this result is: 1. The same as the client's own baseline level 2. Lower than the needed therapeutic level 3. Within the therapeutic range 4. Higher than the therapeutic range prothrombin time is 1.5 to 2 times the control for clients at risk for throm- bus. Based on the client's control value, the thera- peutic range for this in- dividual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range 9. 9) A client who has been receiving heparin therapy also 2. Inhibits synthesis of is started on warfarin. The client asks a nurse why both specific clotting factors in medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin: the liver, and it takes 3-4 days for this medication to exert an anticoagulant ef- 1. Stimulates the breakdown of specific clotting factors fect. by the liver, and it takes 2-3 days for this to exert an anticoagulant effect. 2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect. Warfarin works in the liv- er and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, 3. Stimulates production of the body's own thrombolyt- and II), but it takes 3 to 4 ic substances, but it takes 2-4 days for this to begin. 4. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic. 10. 10) A 60-year-old male client comes into the emer- gency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The days before the therapeu- tic ettect of warfarin is ex- hibited. 1. Administer the mor- phine admitting diagnosis is acute myocardial infarction. Im- Although obtaining the mediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2mg of morphine given intravenously. The nurse should first: 1. Administer the morphine 2. Obtain a 12-lead ECG 3. Obtain the lab work 4. Order the chest x-ray 11. 11) When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to: ECG, chest x-ray, and blood work are all impor- tant, the nurse's priority action would be to relieve the crushing chest pain. 2. Dissolve clots he may have 1. Help keep him well hydrated 2. Dissolve clots he may have 3. Prevent kidney failure 4. Treat potential cardiac arrhythmias. Thrombolytic drugs are administered within the first 6 hours after onset of a MI to lyse clots and re- duce the extent of myocar- dial damage. 12. 12) When interpreting an ECG, the nurse would keep in 1,3,5 In a client who has mind which of the following about the P wave? Select all that apply. 1. Reflects electrical impulse beginning at the SA node 2.Indicated electrical impulse beginning at the AV node 3.Reflects atrial muscle depolarization 4.Identifies ventricular muscle depolarization 5.Has duration of normally 0.11 seconds or less. 13. 13) A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height. 2. .Start an intravenous line Advanced cardiac life sup- port recommends that at indigestion. The nurse connects him to an ECG monitor least one or two intra- and begins administering oxygen at 2 L/minute per NC. The nurse's next action would be to: 1. Call for the doctor 2. Start an intravenous line venous lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a 3. Obtain a portable chest radiograph 4. Draw blood for laboratory studies 14. 14) The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following? 1. Cancer 2.Hypertension 3.Liver disease 4.Myocardial infarction 15. 15) When teaching a client about propranolol hy- portable