NCLEX-PN cardiac practice questions

Question 1

A client in a long-term care facility asks the nurse what digoxin does. Which of the following responses by the nurse is correct?

Accepted Answer

A: "It makes your heart beat more strongly and more slowly.". Two effects, and both matter. Digoxin makes each contraction stronger, so the heart empties better, and it slows the rate down, so the heart has longer to fill between beats. A failing heart benefits from both.

That is also why the pulse is counted before every dose. The drug that slows the rate on purpose can slow it too far, and the pulse is the nurse's warning that it has.

Question 2

The nurse is performing hourly neurological checks on a 66-year-old client with atrial fibrillation who was admitted 6 hours ago after a transient ischemic attack. The nurse compares the 1000 findings with those at 0900. Which finding at 1000 would be a priority for the nurse to follow up?

Accepted Answer

B: Right hand grip strength 2/5 at 1000, compared with 5/5 at 0900. A transient ischemic attack (TIA) is a brief period of stroke-like symptoms caused by a temporary blockage of blood flow to part of the brain.

Muscle strength is graded on a scale of 0 to 5. A grade of 5 is full strength against full resistance, 4 is movement against some resistance, 3 is movement against gravity but not against resistance, 2 is movement only with gravity eliminated, 1 is a flicker or trace of contraction, and 0 is no contraction at all.

A transient ischemic attack causes stroke symptoms that resolve, and it means the client is at high risk of a stroke in the following hours and days. A drop in right hand grip from 5/5 to 2/5 in 1 hour is a new motor deficit. This is a new stroke until proved otherwise. The nurse notes 0900 as the time the client was last known to be well and reports to the registered nurse (RN) immediately, so the stroke team can be called, an emergency CT scan can be done, and the client can be considered for treatment that dissolves or removes the clot.

Question 3

The home health nurse visits a 74-year-old client with heart failure who has been admitted twice in 3 months for fluid overload. The client says, "I never add salt to anything, so sodium can't be my problem." The nurse reviews the foods and over-the-counter products the client uses on most days. Which of the following items should the nurse recognize as major sources of sodium?

Accepted Answer

A: Deli-sliced turkey breast on a sandwich at lunch; B: Effervescent antacid tablets for heartburn after dinner; C: Cottage cheese with canned peaches at lunch; E: Bottled soy sauce poured over steamed rice at dinner. Heart failure is a condition in which the heart cannot pump enough blood to meet the body's needs.

About three quarters of the sodium most people eat comes from processed and restaurant foods, not from the salt shaker. A client who has stopped salting food can still take in several thousand mg a day without knowing it, and two admissions in 3 months for fluid overload point to an intake problem the client does not see.

Cottage cheese is marketed as a healthy, high-protein food, but salt is added during processing, and a 1-cup serving carries roughly 700 to 900 mg of sodium. Deli-sliced turkey looks lean, yet sliced lunch meats are brined and cured, and a sandwich's worth often holds 500 mg or more before the bread is counted. Condiments are easy to forget, yet a single tablespoon of regular soy sauce carries about 900 mg of sodium, close to half of a 2,000-mg day.

Medications count too. Effervescent antacid tablets are made with sodium bicarbonate, and two tablets can deliver over 1,000 mg of sodium. The nurse reinforces reading the labels of over-the-counter products, suggests the client ask the pharmacist about a low-sodium choice for heartburn, and reports the hidden sources to the registered nurse (RN) so the plan of care can be updated.

Question 4

The nurse is preparing to give digoxin to four clients. Which client's dose should the nurse hold and report?

Accepted Answer

A: A 5-month-old infant with an apical pulse of 84/min. Digoxin is a heart medicine that makes each heartbeat stronger and slows the heart rate.

Digoxin slows conduction through the heart, so the apical pulse is counted for a full minute before every dose. The usual hold limits rise with younger age because normal heart rates are faster: under about 60/min in an adult, under about 70/min in a child, and under about 90 to 110/min in an infant. An infant with an apical pulse of 84 is well below the limit, so the nurse holds the dose and reports the heart rate to the health care provider.

Question 5

During a heart failure clinic visit, a client with stable chronic heart failure asks the nurse about exercise at home. Which response by the nurse is most appropriate?

Accepted Answer

D: "Walk a little farther each day, and rest if you become short of breath.". Heart failure is a condition in which the heart cannot pump enough blood to meet the body's needs. Fluid then backs up in the lungs and tissues, causing breathlessness, crackles, swelling and rapid weight gain.

For stable heart failure, regular, gradually increasing activity improves exercise capacity, symptoms and quality of life. Clients are encouraged to walk daily, building time slowly, to pace activities with rest periods and to stop for breathlessness, chest pain or dizziness. Cardiac rehabilitation is recommended. Bed rest is used only during acute decompensation.

Question 6

The nurse in a cardiac clinic is reviewing four telephone messages left for the registered nurse (RN). Which message should the nurse report to the RN first?

Accepted Answer

D: A client whose chest pain began at rest 20 minutes ago and is unchanged after 2 nitroglycerin tablets. Chest pain that began at rest and has not improved after 20 minutes and two tablets could be a myocardial infarction or unstable angina. This client needs emergency care now, so the nurse reports this message to the RN first and the client is told to call 911 without delay.

Question 7

In January, during a power outage after an ice storm, the nurse makes a home health visit to a 78-year-old client with heart failure. A gasoline generator is running in the attached garage with the garage door closed. The client and the spouse both have a headache and nausea, and the client is drowsy and slow to answer questions. The client's vital signs are HR 108/min, RR 22/min, BP 136/80 mm Hg, SpO2 98% on room air and T 97.8° F (36.6° C). Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to track the client's progress.

Accepted Answer

Actions to take: Help the client and the spouse out of the house into the fresh air, Call 911 for emergency transport from outside the house; Potential conditions: Carbon monoxide poisoning; Parameters to monitor: Level of consciousness, Respiratory rate and effort. Carbon monoxide is an odorless, colorless gas from burning fuel, and a generator run in an attached garage is one of the commonest causes of poisoning after storms. Carbon monoxide binds to hemoglobin about 200 times more tightly than oxygen, so the blood carries less oxygen to the brain and heart. Headache, nausea and drowsiness in two people in the same house at the same time point to a shared exposure rather than an illness, and a client with heart failure is especially at risk.

The first action is to remove everyone from the source, because every minute inside adds to the exposure. Emergency transport is called from outside, since the client needs high-flow oxygen and testing that only a hospital can provide. While waiting, the nurse watches the level of consciousness and the breathing, because worsening drowsiness or slow, shallow breathing shows the poisoning is progressing.

Question 8

The nurse enters the room of a 69-year-old client admitted with heart failure and finds the client sitting forward with a respiratory rate of 36/min and crackles to the apices. The SpO2 is 84% on 2 L/min by nasal cannula. In which order should the nurse take these actions? Arrange from first to last.

Accepted Answer

1: Raise the head of the bed to high Fowler's with the legs dependent; 2: Change the oxygen delivery to a nonrebreather mask; 3: Report the findings to the registered nurse (RN); 4: Insert the prescribed indwelling urinary catheter. The nurse first raises the head of the bed and lets the legs hang down, which reduces venous return to the lungs and makes breathing easier right away. The second step is more oxygen under the facility's emergency oxygen protocol, because the SpO2 of 84% shows that 2 L/min is not enough. The nurse then reports to the RN, who calls the rapid response team, since the client needs an IV loop diuretic and may need noninvasive ventilation. Once the RN gives the diuretic, a large diuresis follows, and the nurse inserts the prescribed catheter so the output can be measured each hour, along with daily weights and potassium monitoring.

Question 9

A 74-year-old client with heart failure is on day 4 on the burn step-down unit after partial-thickness burns over 20% of total body surface area (TBSA). The nurse reviews the flow sheet. Which change should the nurse report to the registered nurse (RN)?

Accepted Answer

C: Respiratory rate increased from 16/min to 28/min. In the first 48 hours after a burn, the capillaries leak plasma into the tissues and the circulating volume falls. After that, the capillaries begin to seal, and the edema fluid moves back into the bloodstream. This is the fluid mobilization phase. The circulating volume rises, the kidneys clear the extra fluid, and the urine output climbs. A falling heart rate, a blood pressure creeping up toward the client's normal, and a large urine output are what the nurse expects to see.

The risk in this phase is the heart that cannot handle the returning fluid. This client has heart failure. If the left ventricle cannot pump out the extra volume, fluid backs up into the lungs, and a rising respiratory rate is often the first sign of pulmonary edema, before crackles or a falling SpO2. The nurse reports the trend to the RN, raises the head of the bed, and checks the SpO2 and the lung sounds.

Question 10

A 74-year-old resident of a long-term care facility with heart failure has a new irregular pulse. The nurse and the registered nurse (RN) measure the pulse at the same time for 1 full minute, one auscultating the apical pulse and the other palpating the radial pulse. The apical rate is 118/min and the radial rate is 92/min. What is the client's pulse deficit in beats per minute? Record your answer using a whole number.

Accepted Answer

26. A pulse deficit is the difference between the apical rate and the radial rate counted at the same time. In an irregular rhythm such as atrial fibrillation, some beats come so early that the ventricle has not had time to fill. Those beats are heard at the apex but are too weak to reach the wrist, so the radial count is lower.

This client has 26 beats every minute that do not produce a pulse at the wrist. A deficit means the heart is working without moving blood well, and a new irregular rhythm is reported to the primary health care provider, who will likely want a 12-lead ECG. Two people counting together for a full minute matters, because an irregular pulse counted for 30 seconds and doubled can be wrong by many beats, and counting one site after the other misses the beats that drop out.

NCLEX-PN cardiac practice questions.