RN exams cardiovascular practice questions, set 15
RN exams · cardiovascular
RN exams cardiovascular practice questionsset 15
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
Inhaled anesthetics and intravenous agents having general anesthetic properties:
A. Directly activate GABAA receptors
B. Facilitate GABA action but have no direct action on GABAA receptors
C. Reduce the excitatory glutamatergic neurotransmission
D. Increase the duration of opening of nicotine-activated potassium channels
Show answer and rationale
Correct answer: A — Directly activate GABAA receptors
Rationale: Inhaled anesthetics and intravenous agents with general anesthetic properties directly activate GABAA receptors. GABAA receptors are inhibitory neurotransmitter receptors in the brain. Activation of GABAA receptors leads to hyperpolarization of the neuron, resulting in decreased neuronal excitability and ultimately producing the anesthetic effect.
Summary:
A: Direct activation of GABAA receptors is correct as it aligns with the mechanism of action of general anesthetics.
B: Facilitating GABA action but not directly acting on GABAA receptors is incorrect as direct activation is necessary for the anesthetic effect.
C: Reducing glutamatergic neurotransmission is incorrect as it is not the primary mechanism of action for general anesthetics.
D: Increasing the duration of opening of nicotine-activated potassium channels is incorrect as it is not related to the mechanism of action of general anesthetics.
Question 2
You receive a phone call from a community pediatrician who is caring for a 2-year-old toddler with a cancer predisposition syndrome. The pediatrician describes a child at the 95th percentile for height and weight with a history of corrective oral surgery to reduce a large tongue and a history of an omphalocele in infancy. The pediatrician is currently performing ultrasound of the abdomen and laboratory evaluation for this patient every 3 months. Which tumor is this patient most at risk of developing?
A. Pleuropulmonary blastoma
B. Hepatocellular carcinoma
C. Cystic nephroma
D. Nephroblastoma
Show answer and rationale
Correct answer: D — Nephroblastoma
The correct answer is D: Nephroblastoma (Wilms tumor). This patient likely has Beckwith-Wiedemann syndrome given the features of overgrowth, macroglossia, and omphalocele. Beckwith-Wiedemann syndrome is associated with an increased risk of Wilms tumor. Wilms tumor is the most common renal malignancy in childhood. Monitoring for Wilms tumor with ultrasound and laboratory evaluations is appropriate due to the increased risk in this patient population.
Choice A: Pleuropulmonary blastoma is a rare lung tumor more commonly seen in children under 2 years old. It is not typically associated with Beckwith-Wiedemann syndrome.
Choice B: Hepatocellular carcinoma is a primary liver cancer more commonly seen in adults, not children with Beckwith-Wiedemann syndrome.
Choice C: Cystic nephroma is a benign kidney tumor typically seen in young children, but it is not associated with Beckwith-Wiedemann syndrome nor is it malignant
Question 3
What term describes the phenomenon wherein decreased BP causes a reflex SNS response with increased pulse, increased contractility, and vasoconstriction; and increased BP causes reflex vagal responses resulting in decreased heart rate and passive vasodilation in the systemic arterioles?
A. Baroreflex
B. Cheyne-Stokes breathing
C. Frank-Starling Law
D. Starling reflex
Show answer and rationale
Correct answer: A — Baroreflex
The correct answer is A: Baroreflex. The baroreflex is a physiological mechanism that helps regulate blood pressure by responding to changes in pressure. When blood pressure decreases, the baroreceptors detect this change and trigger a sympathetic nervous system (SNS) response, leading to increased heart rate, contractility, and vasoconstriction to raise blood pressure. Conversely, when blood pressure increases, the baroreceptors trigger a parasympathetic (vagal) response, resulting in decreased heart rate and vasodilation to lower blood pressure.
Summary of other choices:
B: Cheyne-Stokes breathing is a pattern of breathing characterized by periodic waxing and waning of tidal volume.
C: Frank-Starling Law describes the relationship between preload and stroke volume, not the response to changes in blood pressure.
D: Starling reflex is not a recognized physiological mechanism related to blood pressure regulation.
Question 4
An adult patient has presented to the health clinic with a complaint of a firm, painless cervical lymph node. The patient denies any recent infectious diseases. What is the nurse's most appropriate response to the patient's complaint?
A. Call 911.
B. Promptly refer the patient for medical assessment.
C. Facilitate a radiograph of the patient's neck and have the results forwarded to the patient's primary care provider.
D. Encourage the patient to track the size of the lymph node and seek care in 1 week.
Show answer and rationale
Correct answer: B — Promptly refer the patient for medical assessment.
The correct answer is B: Promptly refer the patient for medical assessment. A firm, painless cervical lymph node in an adult without recent infectious diseases raises concerns for potential underlying serious conditions such as malignancy. Referring the patient for medical assessment allows for further evaluation, including physical examination, laboratory tests, and imaging studies if necessary, to determine the cause of the lymphadenopathy. This prompt referral is crucial for timely diagnosis and appropriate management.
Summary:
A: Calling 911 is not warranted as the patient is stable and does not have an emergency medical condition.
C: Facilitating a radiograph may not provide sufficient information for evaluating the lymph node and delays definitive assessment.
D: Encouraging the patient to wait and track the lymph node size can lead to delayed diagnosis and potentially worsening of the underlying condition.
Question 5
A client has just returned from cardiac catheterization. Which nursing intervention would be most appropriate?
A. Help the client ambulate to the bathroom.
B. Restrict fluids.
C. Monitor peripheral pulses.
D. Insert an indwelling urinary catheter.
Show answer and rationale
Correct answer: C — Monitor peripheral pulses.
The correct answer is C: Monitor peripheral pulses. After cardiac catheterization, monitoring peripheral pulses is crucial to assess for any signs of complications such as decreased blood flow or vascular compromise. This intervention helps in early detection of potential issues and ensures prompt intervention if needed.
A: Helping the client ambulate to the bathroom may be appropriate but monitoring peripheral pulses takes priority for assessing immediate complications post-cardiac catheterization.
B: Fluid restriction is not indicated unless specifically prescribed by the healthcare provider. It is not a standard nursing intervention post-cardiac catheterization.
D: Inserting an indwelling urinary catheter is not a priority intervention after cardiac catheterization unless there are specific indications such as monitoring urine output closely. Monitoring peripheral pulses takes precedence in this scenario.
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Question 6
An infant is born with a 7 cm × 6 cm lesion over the upper extremity from the elbow to the shoulder. The lesion is indurated and purpuric, with some petechiae around the edges. No other areas of petechiae are noted on the skin. The infant is doing well without other systemic problems. i were 9 and 9. You are called by the pediatric nurse practitioner to the NICU. What is the most appropriate next step?
A. Do nothing because the infant is doing well and had good Apgars.
B. Obtain an ultrasound for more information about the lesion.
C. Obtain an MRI to assess the extent of the lesion.
D. Obtain labs, including a CBC with platelet count and fibrinogen.
Correct answer:
The correct answer is D: Obtain labs, including a CBC with platelet count and fibrinogen. This is the most appropriate next step because the infant's presentation with an indurated and purpuric lesion raises concern for a possible bleeding disorder or coagulopathy. By obtaining labs, including a CBC with platelet count and fibrinogen, we can assess the infant's hemostatic profile and rule out any underlying hematologic abnormalities. This step is crucial in ensuring the infant's well-being and guiding further management if any abnormalities are detected.
Why the other choices are incorrect:
A: Doing nothing is not appropriate as the presentation warrants further investigation.
B: An ultrasound may not provide useful information in this scenario as the lesion is concerning for a systemic issue.
C: An MRI is not the initial diagnostic test of choice for evaluating a possible bleeding disorder or coagulopathy.
Which of the following statements is TRUE about the symbolic politics of cannabis in colonial Jamaica?
A. The suppression of marijuana (‘kaya’) in colonial Jamaica was seen by both authorities and working class Jamaicans as a way of keeping down the Rastafarians, who were perceived as a threat to colonial social stability.
B. Bob Marley was a major figure of the Rasta anti-colonial movement who fought for Jamaican independence.
C. Cannabis was widely smoked by both working class and middle class Jamaicans, but colonial authorities only objected to its use by the working class.
D. The trade union movement arose as a popular movement to educate Jamaicans about the harms of cannabis use because it was having a negative effect on worker productivity.
Correct answer:
The correct answer is A because the suppression of marijuana in colonial Jamaica was indeed a way to oppress the Rastafarians, who were seen as a threat to colonial social stability. Rastafarians viewed marijuana (kaya) as a sacrament and a key element of their spiritual practice. Authorities perceived Rastafarians as rebellious and subversive due to their anti-colonial beliefs, hence the crackdown on marijuana.
Choice B is incorrect because while Bob Marley was associated with the Rastafarian movement and advocated for Jamaican independence, the question specifically focuses on the symbolic politics of cannabis.
Choice C is incorrect as colonial authorities objected to cannabis use across all classes, not just the working class.
Choice D is incorrect as the trade union movement in Jamaica did not specifically arise to educate about the harms of cannabis but rather focused on workers' rights and labor issues.
You examine a 10-year-old boy with severe aplastic anemia. He has no dysmorphic features and is at the 50th percentile for height and weight. Family history includes a sister with aplastic anemia unresponsive to anti-human thymocyte globulin (ATG) and cyclosporine who died early in the course of an unrelated donor hematopoietic stem cell transplant complicated by severe mucositis and transplant-related organ toxicities. There are no other siblings. A cousin died of acute myeloid leukemia at age 5 years. A peripheral blood sample test for Fanconi anemia is negative with no increased chromosomal breaks in response to diepoxybutane or mitomycin C. Which of the following is the most important next step in management?
A. Administer ATG and cyclosporine.
B. Search for a donor for matched unrelated transplant.
C. Send a bone marrow aspirate for Fanconi anemia testing.
D. Send a skin fibroblast culture for Fanconi anemia testing.
Correct answer:
The correct answer is D: Send a skin fibroblast culture for Fanconi anemia testing. This is the most important next step in management because the patient's negative peripheral blood test for Fanconi anemia does not rule out the possibility of having this condition. Skin fibroblast culture testing is more sensitive for detecting Fanconi anemia compared to peripheral blood testing. Given the family history of aplastic anemia and leukemia, along with the sister's poor response to treatment, it is crucial to definitively confirm or rule out Fanconi anemia as the underlying cause. Administering ATG and cyclosporine (choice A) without confirming the diagnosis may not be effective. Searching for a donor for matched unrelated transplant (choice B) is premature without confirming the diagnosis. Sending a bone marrow aspirate for Fanconi anemia testing (choice C) may not be as sensitive as skin fibroblast culture testing.
A 13-year-old Hispanic girl is found to have a WBC count of 6,500/mm3 with 40% Auer rod–containing granular blasts that, by flow cytometry, express very bright CD33 but are negative for human leukocyte antigen–DR isotype (HLA-DR). She is oozing blood around her peripheral IV site. Coagulation studies reveal an international normalized ratio (INR) of 3.4, a fibrinogen of 170, and a markedly elevated D-dimer. Marrow aspirate shows nearly 90% blasts with a similar morphology. You send the marrow to the fluorescence in situ hybridization (FISH) lab and request STAT testing for the most likely recurrent genetic abnormality based on the clinical presentation. How do you plan to initiate therapy?
A. Perform a lumbar puncture to determine leukemic involvement, then proceed with induction chemotherapy.
B. Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support.
C. Start dexamethasone and hydroxyurea immediately while aggressively managing coagulopathy with blood product support.
D. Start induction chemotherapy, obtain HLA typing, and start a donor search because of the poor prognosis associated with this leukemic phenotype.
Correct answer:
The correct answer is B: Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support. The patient's presentation is consistent with acute promyelocytic leukemia (APL), indicated by the presence of Auer rod-containing blasts, very bright CD33 expression, and coagulopathy (elevated INR, low fibrinogen, elevated D-dimer). APL is associated with a specific genetic abnormality involving the PML-RARA fusion gene. ATRA is the mainstay of induction therapy for APL as it induces differentiation of leukemic promyelocytes. Aggressive management of coagulopathy is crucial to prevent life-threatening bleeding complications.
Incorrect answers:
A: Performing a lumbar puncture is not necessary at this stage as the patient's symptoms and laboratory findings point towards APL, not central nervous system involvement.
C: Dexamethasone and hydroxyurea are not
A patient mentions, “My doctor told me I was going to have a PET scan that would make my brain light up. Does that mean I’m getting an electrical jolt?” The best reply would be:
A. “No, PET scans and electroconvulsive therapy are entirely different.”
B. “No, a PET scan is a diagnostic test, and electroconvulsive therapy is a treatment.”
C. “PET scans involve an injected substance that travels to the brain. Wherever brain activity is high, a bright spot shows on the scan. It is not electrical.”
D. “PET scans show us the electrical activity that occurs throughout the brain in the form of light bands that glow in measurable degrees of brightness on a computer screen.”
Correct answer:
The correct answer is C because it provides a clear and accurate explanation of what a PET scan actually does. It states that PET scans involve an injected substance that shows areas of high brain activity, not electrical activity. This response clarifies the misunderstanding and educates the patient on how PET scans work.
Choice A is incorrect because it only compares PET scans to electroconvulsive therapy without addressing the patient's specific concern about electrical jolts. Choice B is incorrect as it only distinguishes between PET scans and electroconvulsive therapy without addressing the patient's misconception about brain activity and electrical jolts.
Choice D is incorrect because it inaccurately describes PET scans as showing electrical activity in the form of light bands, which is not how PET scans work. It is essential to provide accurate information to address the patient's concerns effectively.
The principal mechanism of phentolamine-induced tachycardia is:
A. Antagonism of presynaptic alfa2 receptors enhances norepinephrine release which causes cardiac stimulation via unblocked beta receptors
B. Baroreflex mechanism
C. Direct effect on the heart by stimulation of beta1 receptors
D. Inhibition of transmitter reuptake at noradrenergic synapses
Correct answer:
The correct answer is A because phentolamine is an alpha-adrenergic antagonist that blocks presynaptic alpha2 receptors. By inhibiting these receptors, it increases norepinephrine release, leading to stimulation of unblocked beta receptors on the heart, resulting in tachycardia. This mechanism directly links the action of phentolamine to the observed tachycardia.
Choice B (Baroreflex mechanism) is incorrect because phentolamine-induced tachycardia is primarily mediated by the alpha2 receptor antagonism rather than the baroreflex mechanism.
Choice C (Direct effect on the heart by stimulation of beta1 receptors) is incorrect because phentolamine does not directly stimulate beta1 receptors on the heart; rather, it indirectly causes cardiac stimulation through enhanced norepinephrine release.
Choice D (Inhibition of transmitter reuptake at noradrenergic synapses) is incorrect because phentolamine does not inhibit
You examine a 10-year-old boy with severe aplastic anemia. He has no dysmorphic features and is at the 50th percentile for height and weight. Family history includes a sister with aplastic anemia unresponsive to anti-human thymocyte globulin (ATG) and cyclosporine who died early in the course of an unrelated donor hematopoietic stem cell transplant complicated by severe mucositis and transplant-related organ toxicities. There are no other siblings. A cousin died of acute myeloid leukemia at age 5 years. A peripheral blood sample test for Fanconi anemia is negative with no increased chromosomal breaks in response to diepoxybutane or mitomycin C. Which of the following is the most important next step in management?
A. Administer ATG and cyclosporine.
B. Search for a donor for matched unrelated transplant.
C. Send a bone marrow aspirate for Fanconi anemia testing.
D. Send a skin fibroblast culture for Fanconi anemia testing.
Correct answer:
The correct answer is D: Send a skin fibroblast culture for Fanconi anemia testing. This is the most important next step in management because the patient's negative peripheral blood test for Fanconi anemia does not rule out the possibility of having this condition. Skin fibroblast culture testing is more sensitive for detecting Fanconi anemia compared to peripheral blood testing. Given the family history of aplastic anemia and leukemia, along with the sister's poor response to treatment, it is crucial to definitively confirm or rule out Fanconi anemia as the underlying cause. Administering ATG and cyclosporine (choice A) without confirming the diagnosis may not be effective. Searching for a donor for matched unrelated transplant (choice B) is premature without confirming the diagnosis. Sending a bone marrow aspirate for Fanconi anemia testing (choice C) may not be as sensitive as skin fibroblast culture testing.
What is a chronic inflammatory disease that affects the small airways in the lungs, leading to episodes of wheezing, breathlessness, and coughing?
A. Asthma
B. COPD
C. Bronchitis
D. Lung cancer
Correct answer:
The correct answer is A: Asthma. Asthma is a chronic inflammatory disease that affects the small airways in the lungs, causing symptoms like wheezing, breathlessness, and coughing. The inflammation in the airways leads to narrowing and constriction, resulting in the characteristic symptoms of asthma. Asthma is typically triggered by various factors such as allergens, pollutants, exercise, or infections.
Summary of other choices:
B: COPD (Chronic Obstructive Pulmonary Disease) is a different condition characterized by irreversible airflow limitation due to chronic bronchitis and emphysema.
C: Bronchitis is an inflammation of the bronchial tubes, often caused by viral infections or smoking, but it does not specifically target the small airways like asthma.
D: Lung cancer is a malignancy that arises in the lungs and is not primarily associated with chronic inflammation of the small airways as seen in asthma.
A 75-year-old individual is admitted with a diagnosis of left-sided heart failure and is administered Lasix 80 mg by slow IV push. Which nursing assessment indicates that the Lasix (furosemide) is NOT having the desired effect?
A. Oliguria
B. Decrease in blood pressure
C. Absence of crackles
D. Polydipsia
Correct answer:
The correct answer is A: Oliguria. Oliguria is the decreased urine output, which is an indicator of inadequate response to Lasix in heart failure. Lasix is a diuretic used to reduce fluid overload in heart failure by promoting diuresis. In this case, a decrease in urine output suggests that the medication is not effectively removing excess fluid.
For the other choices:
B: Decrease in blood pressure - This could be an expected effect of Lasix as it helps reduce fluid volume and can lead to a decrease in blood pressure.
C: Absence of crackles - This indicates reduced pulmonary congestion, which is a desired effect of Lasix in heart failure.
D: Polydipsia - Increased thirst (polydipsia) is not directly related to the effectiveness of Lasix in treating heart failure.
In summary, the presence of oliguria indicates inadequate response to Lasix, while the decrease in blood pressure, absence of crackles, and polydips
What is the condition where the heart's mitral valve does not close properly, allowing blood to leak backward into the left atrium?
A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonary hypertension
Correct answer:
The correct answer is A: Mitral regurgitation. In this condition, the mitral valve fails to close properly, causing blood to flow back into the left atrium during ventricular contraction. This results in decreased forward blood flow and increased volume in the left atrium and ventricle. Mitral regurgitation can lead to symptoms like fatigue, shortness of breath, and heart murmur upon auscultation.
Now, let's analyze the other choices:
B: Aortic stenosis - This involves narrowing of the aortic valve, obstructing blood flow from the left ventricle to the aorta.
C: Tricuspid regurgitation - Involves backward flow of blood from the right ventricle to the right atrium due to a faulty tricuspid valve.
D: Pulmonary hypertension - Elevated blood pressure in the pulmonary arteries, usually caused by underlying conditions affecting the lungs or heart.
Therefore, the correct answer is A because it specifically describes
RN exams cardiovascular practice questions, set 15 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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