RN exams cardiovascular practice questions, set 11
RN exams · cardiovascular
RN exams cardiovascular practice questionsset 11
You read heart failure, perfusion, and blood-pressure stems and decide what to do before the patient declines. Five of the 15 questions include the correct answer and rationale. The other ten keep answers in the study hub. Continue with the RN exams exam guide or more RN exams practice questions.
Five cardiovascular questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
Which of the oral calcium preparations is often the preparation of choice:
A. Calcium carbonate (40% calcium)
B. Calcium lactate (13% calcium)
C. Calcium phosphate (25% calcium)
D. Calcium citrate (17% calcium)
Show answer and rationale
Correct answer: A — Calcium carbonate (40% calcium)
The correct answer is A: Calcium carbonate. It is often the preparation of choice due to its high calcium content (40%). This means that a smaller dose can provide the required amount of elemental calcium compared to other options. Additionally, calcium carbonate is well-absorbed in an acidic environment, making it suitable for individuals with normal gastric acid production.
Incorrect choices:
B: Calcium lactate has a lower calcium content (13%) compared to calcium carbonate, requiring a higher dose to achieve the same calcium intake.
C: Calcium phosphate has a lower calcium content (25%) compared to calcium carbonate, making it less efficient in providing elemental calcium.
D: Calcium citrate has a lower calcium content (17%) compared to calcium carbonate and is better absorbed in individuals with low gastric acid production. However, in general, calcium carbonate is preferred for its higher calcium content and cost-effectiveness.
Question 2
A 10-year-old girl has had transfusion-dependent anemia since age 6 months. She is found to have an unstable hemoglobin by sequence analysis (Hb Indianapolis). She has jaundice, obvious bony deformity from extramedullary hematopoiesis, and hepatosplenomegaly. Which of the following statements is correct?
A. Her diagnosis should have been picked up on newborn screen by electrophoresis, isoelectric focusing, or high-performance liquid chromatography similar to other beta-hemoglobinopathies.
B. Since her spleen is intact, her peripheral blood smear cannot have nucleated red cells or Howell Jolly bodies.
C. If she undergoes splenectomy, her anemia should be entirely ameliorated.
D. Since she is transfused, she will not be at risk for gallstones.
Show answer and rationale
Correct answer: E
Rationale for Correct Answer (E): The correct statement is likely about the fact that her hemoglobinopathy, Hb Indianapolis, is associated with ineffective erythropoiesis, leading to anemia, jaundice, and extramedullary hematopoiesis. This is a rare condition and not typically detected on newborn screens. Additionally, splenectomy may not entirely resolve her anemia due to the systemic nature of the disease. Since she has transfusion-dependent anemia, she is at risk for gallstones due to chronic hemolysis.
Summary of Incorrect Choices:
A: Incorrect because Hb Indianapolis is rare and not typically detected on newborn screens.
B: Incorrect because extramedullary hematopoiesis can lead to nucleated red cells in the peripheral blood smear.
C: Incorrect because the disease is systemic, and splenectomy may not fully resolve the anemia.
D: Incorrect because chronic hemolysis from the disease increases the risk of gallstones despite transf
Question 3
The pathophysiology of venous thrombosis is often explained by Virchow's triad, which includes hypercoagulability, endothelial injury, and venous stasis. Based on Virchow's triad and your knowledge of risk factors for thrombosis, which of the following pediatric patients has the greatest risk of hospital-acquired venous thromboembolism?
A. 3-day-old full-term infant admitted to hospital pediatrics for hyperbilirubinemia
B. 6-month-old male admitted to the infectious disease unit for respiratory syncytial virus
C. Ex-28 week premature infant, requiring NICU-level care for necrotizing enterocolitis
D. 7-year-old male with acute lymphoblastic leukemia receiving maintenance chemotherapy admitted to hematology/oncology unit for fever and neutropenia
Show answer and rationale
Correct answer: C — Ex-28 week premature infant, requiring NICU-level care for necrotizing enterocolitis
The correct answer is C because the ex-28 week premature infant requiring NICU-level care for necrotizing enterocolitis has the greatest risk of hospital-acquired venous thromboembolism. Premature infants have inherent hypercoagulability due to immature coagulation factors and increased risk of endothelial injury from central lines or catheters. Necrotizing enterocolitis further increases the risk of venous stasis due to decreased gut perfusion.
Choice A: The 3-day-old full-term infant admitted for hyperbilirubinemia is less likely to have significant risk factors for thrombosis compared to a premature infant with necrotizing enterocolitis.
Choice B: The 6-month-old male admitted for respiratory syncytial virus is less likely to have prolonged immobilization or other significant risk factors compared to a premature infant in the NICU.
Choice D: The 7-year-old male with acute lymphoblastic leukemia has a higher risk of thromb
Question 4
The drug of choice for partial seizures is:
A. Carbamazepin
B. Ethosuximide
C. Diazepam
D. Lamotrigine
Show answer and rationale
Correct answer: A — Carbamazepin
The correct answer is A: Carbamazepine. This drug is the drug of choice for partial seizures due to its efficacy in controlling focal seizures and its broad spectrum of activity. Carbamazepine works by blocking voltage-gated sodium channels, reducing neuronal excitability.
Rationale:
- Carbamazepine is a common first-line treatment for partial seizures.
- It is effective in controlling focal seizures.
- It has a broad spectrum of activity against various types of seizures.
- Carbamazepine's mechanism of action involves blocking sodium channels, reducing neuronal excitability.
Summary of other choices:
- B: Ethosuximide is primarily used for absence seizures, not partial seizures.
- C: Diazepam is a short-acting benzodiazepine used for acute seizure management, not as a primary treatment for partial seizures.
- D: Lamotrigine is more commonly used for generalized seizures and may not be as effective for controlling partial seizures.
Question 5
A newborn male has severe bleeding after circumcision, resulting in the need for a blood transfusion. You are called to consult on this child, and you diagnose him with severe hemophilia A. Upon taking a family history, you note that no other family members have hemophilia, other bleeding disorders, or a bleeding diathesis. Which of the following is the most likely outcome of genotyping the Factor VIII gene?
A. No mutation will be found because there is no family history.
B. A missense mutation in the F8 gene will be identified.
C. An inversion mutation in the F8 gene will be identified.
D. A nonsense mutation in the F8 gene will be found.
Show answer and rationale
Correct answer: C — An inversion mutation in the F8 gene will be identified.
The correct answer is C: An inversion mutation in the F8 gene will be identified. In hemophilia A, about 50% of cases result from inversion mutations in the F8 gene. In this case, since there is no family history of hemophilia or other bleeding disorders, the most likely scenario is a de novo genetic mutation, such as an inversion mutation. This type of mutation can occur spontaneously and is not inherited from parents. Therefore, genotyping the Factor VIII gene in this newborn male with severe hemophilia A is likely to reveal an inversion mutation as the underlying genetic cause.
Choice A is incorrect because the absence of a family history does not rule out the presence of a de novo mutation. Choice B (missense mutation) and Choice D (nonsense mutation) are less likely in hemophilia A compared to inversion mutations. Missense and nonsense mutations are more commonly associated with other genetic conditions or types of hemophilia.
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Question 6
You have a new 7-year-old female patient with a WBC count of 6,000/mm3, hemoglobin of 7.2 g/dL, and platelet count of 30,000/mm3. A bone marrow aspirate reveals 14% blasts with a monocytic morphologic appearance that are surface marker positive for CD33. You receive a call from the fluorescence in situ hybridization (FISH) lab that the bone marrow is positive for KMT2A rearrangement in 68% of cells. Your staff asks whether this represents a diagnosis of acute leukemia in the current classification scheme for this type of hematologic malignancy. What would you say?
A. No, because for a diagnosis of acute leukemia you must have 30% or more blasts in the marrow.
B. No, because for a diagnosis of acute leukemia you must have 20% or more blasts in the marrow.
C. No, because the cytogenetics do not include +21, monosomy 7, or trisomy 8.
D. Yes, because the FISH is positive for KMT2A rearrangement.
Correct answer:
The correct answer is D: Yes, because the FISH is positive for KMT2A rearrangement. The presence of KMT2A rearrangement in 68% of cells indicates a specific genetic abnormality associated with acute leukemia. This abnormality is a known marker for acute myeloid leukemia (AML) with recurrent genetic abnormalities. The percentage of blasts in the bone marrow (14%) may not meet the traditional criteria for a diagnosis of acute leukemia based on blast percentage alone, but the presence of KMT2A rearrangement overrides this requirement in this case. Choices A and B are incorrect because blast percentage alone is not the sole determinant of a diagnosis of acute leukemia when specific genetic abnormalities are present. Choice C is incorrect because while the absence of specific cytogenetic abnormalities may be relevant for some cases, the presence of KMT2A rearrangement is sufficient to support a diagnosis of acute leukemia in this context.
The client on nitroglycerin patches reports dizziness when standing up. What is the nurse's best response?
A. Advise the client to rise slowly to prevent dizziness.
B. Instruct the client to discontinue the nitroglycerin patches.
C. Encourage the client to rest and avoid physical activity.
D. Suggest the client take an over-the-counter antiemetic.
Correct answer:
The correct response is A: Advise the client to rise slowly to prevent dizziness. Nitroglycerin patches can cause orthostatic hypotension, leading to dizziness when standing up quickly. By advising the client to rise slowly, the nurse can help prevent a sudden drop in blood pressure and reduce the risk of dizziness and falls. This response promotes client safety and addresses the underlying cause of the symptom.
Choices B, C, and D are incorrect:
B: Instructing the client to discontinue nitroglycerin patches is not appropriate without consulting the healthcare provider. Abruptly stopping nitroglycerin can lead to serious complications.
C: Encouraging the client to rest and avoid physical activity does not address the issue of orthostatic hypotension caused by nitroglycerin patches.
D: Suggesting an over-the-counter antiemetic is not indicated for dizziness related to orthostatic hypotension. It does not address the underlying cause
An oncology nurse is providing health education for a patient who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia?
A. The different leukemias all involve unregulated proliferation of WBC
B. The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function.
C. The different leukemias all result in a decrease in the production of white blood cells.
D. The different leukemias all involve the development of cancer in the lymphatic system.
Correct answer:
The correct answer is A because all subtypes of leukemia involve unregulated proliferation of white blood cells (WBC). Leukemia is a type of cancer that starts in the blood-forming tissues, leading to the production of abnormal WBCs in the bone marrow. This uncontrolled growth of WBCs interferes with the production of normal blood cells.
Choice B is incorrect because leukemia does not involve unregulated proliferation of red blood cells, but rather white blood cells. It also does not necessarily result in decreased bone marrow function as stated in the choice.
Choice C is incorrect because while some subtypes of leukemia may result in a decrease in the production of normal white blood cells, the primary issue is the unregulated proliferation of abnormal WBCs.
Choice D is incorrect because leukemia is not specifically related to cancer development in the lymphatic system. Leukemia primarily affects the bone marrow and blood.
The client is on an ADP receptor blocker for the prevention of recurrent myocardial infarction. What does the nurse expect when the client develops hemorrhaging and a low platelet count?
A. The low platelet count is the anticipated reaction to taking an ADP receptor blocker.
B. The client is taking the ADP receptor blocker with aspirin.
C. The client has developed thrombotic thrombocytopenia.
D. The client is taking too much of the ADP receptor blocker.
Correct answer:
Rationale for Correct Answer (C): The client developing hemorrhaging and a low platelet count while on an ADP receptor blocker suggests thrombotic thrombocytopenia. Thrombotic thrombocytopenia is a rare but serious adverse effect characterized by the formation of blood clots and a decrease in platelet count. This condition can lead to both bleeding and clotting issues, explaining the hemorrhaging and low platelet count in the client.
Summary of Incorrect Choices:
A: The low platelet count is not an anticipated reaction to taking an ADP receptor blocker. While some antiplatelet medications can cause decreased platelet count, thrombotic thrombocytopenia is a more specific and severe condition.
B: The combination of ADP receptor blockers with aspirin is a common therapy for preventing cardiovascular events but does not directly explain the development of thrombotic thrombocytopenia.
D: Simply taking too much of the ADP receptor blocker
You have a new 7-year-old female patient with a WBC count of 6,000/mm3, hemoglobin of 7.2 g/dL, and platelet count of 30,000/mm3. A bone marrow aspirate reveals 14% blasts with a monocytic morphologic appearance that are surface marker positive for CD33. You receive a call from the fluorescence in situ hybridization (FISH) lab that the bone marrow is positive for KMT2A rearrangement in 68% of cells. Your staff asks whether this represents a diagnosis of acute leukemia in the current classification scheme for this type of hematologic malignancy. What would you say?
A. No, because for a diagnosis of acute leukemia you must have 30% or more blasts in the marrow.
B. No, because for a diagnosis of acute leukemia you must have 20% or more blasts in the marrow.
C. No, because the cytogenetics do not include +21, monosomy 7, or trisomy 8.
D. Yes, because the FISH is positive for KMT2A rearrangement.
Correct answer:
The correct answer is D: Yes, because the FISH is positive for KMT2A rearrangement. The presence of KMT2A rearrangement in 68% of cells indicates a specific genetic abnormality associated with acute leukemia. This abnormality is a known marker for acute myeloid leukemia (AML) with recurrent genetic abnormalities. The percentage of blasts in the bone marrow (14%) may not meet the traditional criteria for a diagnosis of acute leukemia based on blast percentage alone, but the presence of KMT2A rearrangement overrides this requirement in this case. Choices A and B are incorrect because blast percentage alone is not the sole determinant of a diagnosis of acute leukemia when specific genetic abnormalities are present. Choice C is incorrect because while the absence of specific cytogenetic abnormalities may be relevant for some cases, the presence of KMT2A rearrangement is sufficient to support a diagnosis of acute leukemia in this context.
A calcium channel blocker (CCB) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. Which instruction is correct?
A. Chew the tablet for faster release of the medication.
B. To increase the effect of the drug, take it with grapefruit juice.
C. If the adverse effects of chest pain, fainting, or dyspnea occur, discontinue the medication immediately.
D. A high-fiber diet with plenty of fluids will help prevent the constipation that may occur.
Correct answer:
The correct answer is D: A high-fiber diet with plenty of fluids will help prevent the constipation that may occur.
Rationale:
1. CCBs can cause constipation as a side effect due to their action on smooth muscle.
2. A high-fiber diet and adequate fluids help prevent constipation by promoting bowel regularity.
3. Increasing fiber intake can soften stool and facilitate passage, reducing the risk of constipation.
4. Adequate fluid intake is essential to maintain hydration and support digestive function, aiding in the prevention of constipation.
Summary:
A: Chewing the tablet may alter the drug's release mechanism and is not recommended for CCBs.
B: Grapefruit juice can interact with CCBs, potentially increasing drug levels and side effects.
C: Adverse effects like chest pain, fainting, or dyspnea may indicate a serious reaction, but immediate discontinuation should be done under medical guidance, not solely based on patient judgment.
The primary care provider orders the following mechanica l ventilation settings for a patient who weighs 75 kg and whose spontaneous respiratory rate is 22 breaths/min. What arterial blood gas abnormality may occur if the patient continues taob ibrbe.c otamc/thesyt pneic at these ventilator settings? Settings: Tidal volume: 600 mL (8 mL per kg) FiO 2: 0.5 Respiratory rate: 14 breaths/min Mode assist/control Positive end-expiratory pressure: 10 cm H O
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct answer:
The correct answer is C: Respiratory acidosis may occur if the patient continues at these ventilator settings. Respiratory acidosis happens when the lungs cannot remove enough of the carbon dioxide (CO2) produced by the body. In this case, the low respiratory rate of 14 breaths/min may not be sufficient to adequately remove CO2, leading to its accumulation in the blood. This results in a decrease in blood pH, causing respiratory acidosis.
Summary of other choices:
A: Metabolic acidosis - Not the correct answer as the ventilator settings are more likely to affect the respiratory system rather than the metabolic system.
B: Metabolic alkalosis - Not the correct answer as the ventilator settings are not related to causing an increase in blood pH, which is characteristic of metabolic alkalosis.
D: Respiratory alkalosis - Not the correct answer as the low respiratory rate would not lead to excessive elimination of CO2, causing alkalosis.
The client has atrial fibrillation. What can the nurse say about the P wave?
A. It precedes a long PR interval
B. It falls on the previous T wave
C. The P wave is absent
D. It is peaked
Correct answer:
The correct answer is C because in atrial fibrillation, the chaotic and irregular electrical activity in the atria results in the absence of distinct P waves on the ECG. This is due to the disorganized depolarization of the atria, leading to the absence of a clear, identifiable P wave. Therefore, the nurse can accurately state that the P wave is absent in the ECG of a client with atrial fibrillation.
Choices A, B, and D are incorrect:
A: It precedes a long PR interval - This statement is not accurate for atrial fibrillation as the irregular electrical activity disrupts the normal conduction pathway, leading to variable PR intervals.
B: It falls on the previous T wave - This scenario would indicate an abnormality in the ECG, but it does not specifically relate to atrial fibrillation.
D: It is peaked - While peaked P waves can indicate certain conditions like right atrial enlargement, this is not a characteristic finding in atr
An otherwise healthy 18-year-old female is diagnosed with high-risk neuroblastoma after presenting with fatigue and bony pain. Imaging findings demonstrate a left adrenal mass with multiple osseous metastases. She successfully completes standard therapy for high-risk neuroblastoma, but experiences several episodes of disease recurrence and ultimately dies of her disease 10 years after her initial diagnosis. During her treatment, her tumor was sent for molecular analysis. Of the following, what molecular aberration was most likely to have been detected?
A. ETV6-NTRK3 gene fusion
B. PTPN11 mutation
C. ATRX mutation
D. WT1 mutation
Correct answer:
The correct answer is C: ATRX mutation. In neuroblastoma, ATRX mutations are associated with poor prognosis and high-risk disease. ATRX gene mutations are commonly found in cases with aggressive behavior and poor outcomes, such as in this case where the patient experienced disease recurrence and ultimately died. ATRX mutations are linked to chromosomal instability and telomere dysfunction, which can contribute to tumor progression and resistance to therapy.
A: ETV6-NTRK3 gene fusion is more commonly associated with infantile fibrosarcoma and secretory breast carcinoma, not neuroblastoma.
B: PTPN11 mutations are typically seen in juvenile myelomonocytic leukemia and Noonan syndrome, not neuroblastoma.
D: WT1 mutations are more commonly found in Wilms tumor and acute myeloid leukemia, not neuroblastoma.
In summary, the ATRX mutation is the most likely molecular aberration detected in this patient with high-risk neuroblast
The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3. Select the nurse’s best action.
A. Report these results to the health care provider immediately.
B. Give the next dose as prescribed.
C. Give aspirin and force fluids.
D. Repeat the laboratory test.
Correct answer:
The correct answer is A: Report these results to the health care provider immediately. A low white blood cell count (3000 mm3) in a patient taking clozapine (Clozaril) could indicate a potentially serious condition called agranulocytosis, which is a severe decrease in white blood cells. This condition can increase the risk of infection and is a known side effect of clozapine. Reporting these results to the health care provider immediately is crucial for prompt evaluation and appropriate management, such as discontinuing the medication or adjusting the dosage.
Summary of incorrect choices:
B: Giving the next dose as prescribed is risky without addressing the low white blood cell count first.
C: Giving aspirin and forcing fluids is unrelated to the low white blood cell count and could worsen the situation.
D: Repeating the laboratory test may delay necessary intervention for the potentially serious condition of agranulocytosis.
RN exams cardiovascular practice questions, set 11 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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