RN exams cardiovascular practice questions, set 16
RN exams · cardiovascular
RN exams cardiovascular practice questionsset 16
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
While completing the history portion of an admission assessment of a client with schizophrenia, the nurse notices that the client is continually moving in the chair and frequently stands, then sits back down. The nurse knows that this client most likely is experiencing the side effect of:
A. Drug-induced parkinsonism
B. Dystonia
C. Akathisia
D. Akinesia
Show answer and rationale
Correct answer: C — Akathisia
The correct answer is C: Akathisia. Akathisia is characterized by restlessness, inability to sit still, and a constant need to move. In this scenario, the client's continual movement and inability to sit still indicate symptoms of akathisia. This side effect is commonly seen with antipsychotic medications.
Explanation:
1. Drug-induced parkinsonism (Choice A) presents with symptoms similar to Parkinson's disease, such as tremors, stiffness, and shuffling gait. The client's symptoms do not align with these characteristics.
2. Dystonia (Choice B) is characterized by involuntary muscle contractions causing abnormal movements or postures. The client's symptoms do not match the sudden, sustained muscle contractions seen in dystonia.
3. Akinesia (Choice D) refers to a lack of movement or difficulty initiating movement, which is not consistent with the client's behavior of constant movement and inability to sit still.
Question 2
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 3
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.
Question 4
The client is diabetic and is given a non-cardio-selective beta blocker. What might happen to the blood sugars?
A. The blood sugars will increase because of breakdown of glycogen.
B. The blood sugar drops due to impaired production of glucose from glycogen.
C. It does not affect the blood sugar.
D. The blood sugar drops due to increased cellular uptake of glucose.
Show answer and rationale
Correct answer: B — The blood sugar drops due to impaired production of glucose from glycogen.
Correct Answer: B - The blood sugar drops due to impaired production of glucose from glycogen.
Rationale:
1. Non-cardio-selective beta blockers inhibit beta-2 receptors in the liver.
2. Beta-2 receptors stimulate glycogenolysis, converting glycogen to glucose.
3. Inhibition of glycogenolysis leads to impaired production of glucose from glycogen.
4. Consequently, blood sugar levels decrease due to reduced availability of glucose.
Summary of Other Choices:
A: Incorrect. Non-cardio-selective beta blockers inhibit glycogenolysis, leading to decreased breakdown of glycogen and reduced glucose production, resulting in lower blood sugar levels.
C: Incorrect. Non-cardio-selective beta blockers do affect blood sugar by impairing glucose production from glycogen.
D: Incorrect. Non-cardio-selective beta blockers do not increase cellular uptake of glucose, but rather decrease glucose production from glycogen.
Question 5
An infant with a ventricular septal defect is receiving digoxin (Lanoxin). Which intervention by the nurse is most appropriate before digoxin administration?
A. Take the infant's blood pressure.
B. Check the infant's respiratory rate for 1 minute.
C. Check the infant's radial pulse for 1 minute.
D. Check the infant's apical pulse for 1 minute.
Show answer and rationale
Correct answer: D — Check the infant's apical pulse for 1 minute.
The correct answer is D: Check the infant's apical pulse for 1 minute. Before administering digoxin, it is crucial to assess the infant's apical pulse because digoxin is a medication that affects the heart rate. By checking the apical pulse, the nurse can determine the baseline heart rate and assess for any irregularities or changes that may indicate digoxin toxicity. This step is essential to ensure the medication is safe for the infant.
Incorrect choices:
A: Taking the infant's blood pressure is not necessary before administering digoxin, as the focus should be on assessing the heart rate specifically.
B: Checking the respiratory rate is not directly related to digoxin administration and does not provide crucial information about the medication's effects.
C: Checking the radial pulse is not as accurate as checking the apical pulse when assessing the heart rate, which is critical before giving digoxin.
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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 would be an appropriate therapeutic adjustment for this patient?
A. Discontinue digoxin and start milrinone
B. Add physostigmine and decrease the digoxin dose
C. Add atropine and decrease the digoxin dose
D. Discontinue digoxin and start metoprolol
Correct answer:
The correct answer is A because milrinone is a positive inotrope that can be used as an alternative to digoxin for heart failure. Discontinuing digoxin is appropriate if the patient is experiencing toxicity symptoms. Starting milrinone provides the necessary positive inotropic support without the risk of digoxin toxicity.
Option B is incorrect because physostigmine is used for anticholinergic toxicity, not digoxin toxicity. Decreasing the digoxin dose alone may not be sufficient to address toxicity symptoms.
Option C is incorrect because atropine is used for bradycardia and not for digoxin toxicity. Decreasing the digoxin dose alone may not be sufficient to address toxicity symptoms.
Option D is incorrect because metoprolol is a beta-blocker and can worsen symptoms of digoxin toxicity by further slowing the heart rate. Discontinuing digoxin is appropriate, but starting metoprolol is not recommended.
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
Which category of histamine H1 antagonists is noted for the highest local anesthetic effect?
A. Alkylamines (propylamines); i.e. Brompheniramine
B. Piperidines; i.e. Loratadine, Fexofenadine
C. Ethylenediamines; i.e. Suprastine
D. Phenothiazines; i.e. Promethazine
Correct answer:
The correct answer is D, Phenothiazines such as Promethazine, because they have the highest local anesthetic effect among histamine H1 antagonists. This is due to their structural properties that allow them to interact with sodium channels and block nerve impulses effectively. Phenothiazines have a bulky side chain that enhances their local anesthetic properties.
A, Alkylamines like Brompheniramine, are known for their sedative effects rather than local anesthetic properties.
B, Piperidines including Loratadine and Fexofenadine, are mainly used for their antihistaminic effects and do not exhibit strong local anesthetic properties.
C, Ethylenediamines like Suprastine, are not recognized for their local anesthetic effects but rather for their antihistaminic actions.
In summary, Phenothiazines stand out as having the highest local anesthetic effect compared to the other categories of histamine H
A patient who has recently started taking pravastatin (Pravachol) and niacin reports several symptoms to the nurse. Which information is most important to communicate to the health care provider?
A. Generalized muscle aches and pains
B. Dizziness with rapid position changes
C. Nausea when taking the drugs before meals
D. Flushing and pruritus after taking the drugs
Correct answer:
The correct answer is A: Generalized muscle aches and pains. This is the most important information to communicate because it could indicate a serious side effect known as rhabdomyolysis, a rare but severe condition that can be caused by statins (like pravastatin) and niacin. Rhabdomyolysis is characterized by muscle breakdown that can lead to kidney damage. It is crucial to monitor and address this symptom promptly.
Choice B (Dizziness with rapid position changes) may be related to orthostatic hypotension, a common side effect of some medications but is not as urgent as potential rhabdomyolysis. Choice C (Nausea when taking the drugs before meals) is a common side effect of niacin and may be managed by adjusting the timing of medication administration. Choice D (Flushing and pruritus after taking the drugs) is a common side effect of niacin known as flushing and is generally not considered as serious as
What is a procedure to remove fluid or air from the pleural space to help a patient breathe easier?
A. Thoracentesis
B. Bronchoscopy
C. Chest X-ray
D. CT scan
Correct answer:
Thoracentesis is the correct answer because it is a procedure used to remove fluid or air from the pleural space, which can help a patient breathe easier. The steps involved in thoracentesis include identifying the location for insertion, numbing the area with local anesthesia, inserting a needle or catheter into the pleural space, draining the fluid or air, and monitoring the patient for any complications.
Summary:
- B: Bronchoscopy is a procedure used to visualize the airways and diagnose lung conditions, not to remove fluid or air from the pleural space.
- C: Chest X-ray is an imaging test used to visualize the chest area and diagnose various conditions, but it does not involve removing fluid or air from the pleural space.
- D: CT scan is an imaging test that provides detailed images of the internal structures of the body, but it is not a procedure for removing fluid or air from the pleural space.
A nurse is caring for a client who is about to begin alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction?
A. Vitamin K
B. Aminocaproic acid
C. Protamine
D. Deferoxamine
Correct answer:
The correct answer is B: Aminocaproic acid. This drug is a fibrinolytic inhibitor that can be used to manage bleeding complications associated with alteplase therapy. It helps to prevent excessive bleeding by inhibiting the breakdown of blood clots. Having aminocaproic acid available is crucial in case the client experiences severe bleeding as a result of alteplase therapy.
A: Vitamin K is used to reverse the effects of warfarin, a blood thinner, and is not indicated for managing bleeding due to alteplase therapy.
C: Protamine is used to reverse the effects of heparin, not alteplase, and is not indicated for managing bleeding due to alteplase therapy.
D: Deferoxamine is an antidote for iron poisoning and is not indicated for managing bleeding due to alteplase therapy.
In summary, aminocaproic acid is the correct choice as it helps manage bleeding complications associated with alteplase therapy
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 laboratory study is conducted to determine the optimal usage of platelets for transfusion. The blood bank inventory along with the transfusion records and medical records of subjects who were recipients of platelet transfusion are reviewed. Which of the following conclusions is most likely to be made from this study?
A. Frozen storage of platelets helps increase the units available.
B. Platelet transfusions are rarely successful in patients with autoimmune thrombocytopenia.
C. Platelet units carry no risk for transmission of hepatitis C infection.
D. Pooled donor platelets are preferred over single-donor platelets.
Correct answer:
The correct answer is B. Platelet transfusions are rarely successful in patients with autoimmune thrombocytopenia.
Rationale:
1. Patients with autoimmune thrombocytopenia have low platelet levels due to immune destruction.
2. Platelet transfusions may not be effective as the underlying autoimmune process continues to destroy transfused platelets.
3. Reviewing transfusion records of these patients would likely show low success rates of platelet transfusions.
Summary of Incorrect Choices:
A: Frozen storage of platelets increasing units available is not directly related to the success of platelet transfusions in autoimmune thrombocytopenia.
C: Platelet units do carry a risk of transmitting hepatitis C infection, so this conclusion is incorrect.
D: Preference for pooled donor platelets over single-donor platelets does not address the success of platelet transfusions in autoimmune thrombocytopenia.
The client has a ventricular rate of 40 and P waves that are normal and unconnected to the QRS complex on a standard EKG. What is this called?
A. Normal sinus rhythm
B. Type 1 second degree AV block
C. Type 2 second degree AV block
D. Third degree AV block
Correct answer:
The correct answer is C: Type 2 second degree AV block. In this type of AV block, there is a consistent pattern of dropped QRS complexes due to intermittent failure of AV conduction. The ventricular rate of 40 indicates a slow conduction of impulses from the atria to the ventricles. The presence of normal and unconnected P waves suggests that some P waves are conducted to the ventricles (resulting in QRS complexes) while others are blocked. This pattern is characteristic of Type 2 second degree AV block.
Summary:
A: Normal sinus rhythm - Incorrect, as the EKG findings do not show a normal sinus rhythm.
B: Type 1 second degree AV block - Incorrect, as this type is characterized by a progressively prolonged PR interval leading to a dropped QRS complex, which is not seen in this case.
D: Third degree AV block - Incorrect, as in third degree AV block, there is complete dissociation between the atria and
RN exams cardiovascular practice questions, set 16 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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