RN exams cardiovascular practice questions, set 18
RN exams · cardiovascular
RN exams cardiovascular practice questionsset 18
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
Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. To determine whether the drug is effective, the nurse will monitor for
A. decreased blood pressure and heart rate.
B. fewer complaints of having cold hands and feet.
C. improvement in the strength of the distal pulses.
D. participation in daily activities without chest pain.
Show answer and rationale
Correct answer: D — participation in daily activities without chest pain.
The correct answer is D: participation in daily activities without chest pain. This is because the effectiveness of Nadolol in treating chronic stable angina and left ventricular dysfunction is indicated by the patient's ability to engage in daily activities without experiencing chest pain, which reflects improved myocardial oxygen supply.
A: decreased blood pressure and heart rate is incorrect because Nadolol is a beta-blocker, which can lower blood pressure and heart rate as a side effect, but the primary goal is to reduce angina symptoms.
B: fewer complaints of having cold hands and feet is incorrect as it is not a direct indicator of Nadolol's effectiveness in treating angina and left ventricular dysfunction.
C: improvement in the strength of the distal pulses is incorrect as it may not directly correlate with the drug's effectiveness in managing angina and left ventricular dysfunction.
Question 2
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
Show answer and rationale
Correct answer: D — Phenothiazines; i.e. Promethazine
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
Question 3
A nurse is preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client's laboratory results indicate that the client has a sodium level of 130 mEq/L. Which of the following actions should the nurse take?
A. Clarify the prescription with the provider.
B. Administer the drug with an analgesic.
C. Administer the required dose orally.
D. Assess factor IX levels.
Show answer and rationale
Correct answer: A — Clarify the prescription with the provider.
The correct answer is A: Clarify the prescription with the provider. Desmopressin is contraindicated in clients with low sodium levels due to the risk of hyponatremia. By having a sodium level of 130 mEq/L, the client is at risk for further lowering of sodium levels if desmopressin is administered. Therefore, the nurse should clarify the prescription with the provider to ensure the safety of the client.
B: Administer the drug with an analgesic - Irrelevant and not related to the administration of desmopressin in a client with hemophilia A and low sodium levels.
C: Administer the required dose orally - The route of administration does not address the concern of potential hyponatremia with desmopressin.
D: Assess factor IX levels - While important in managing hemophilia A, assessing factor IX levels does not address the immediate concern of potential harm from desmopressin administration in a
Question 4
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.
Show answer and rationale
Correct answer: B — Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support.
The correct answer is B because the clinical presentation suggests acute promyelocytic leukemia (APL). APL is characterized by Auer rod-containing granular blasts, which are positive for CD33 and negative for HLA-DR. The presence of coagulopathy with elevated D-dimer and oozing blood indicates a high risk of disseminated intravascular coagulation (DIC), a common complication of APL. Immediate treatment with all-trans retinoic acid (ATRA) is crucial in APL to induce differentiation of the leukemic cells and prevent further coagulopathy. Aggressively managing the coagulopathy with blood product support is also important to stabilize the patient.
Choice A is incorrect because a lumbar puncture is not necessary for APL diagnosis, and immediate induction chemotherapy with ATRA is the standard of care. Choice C is incorrect because dexamethasone and hydroxyurea are not the first-line therapies for APL.
Question 5
A patient received maintenance doses of fluphenazine decanoate (Prolixin Decanoate) 25 mg IM every 2 weeks for 2 years. The clinic nurse notes the patient is grimacing and seems to be constantly smacking her lips. On the next clinic visit, the patient’s neck and shoulders twist in a slow, snakelike motion. The nurse should suspect the presence of ________ and should __________.
A. agranulocytosis…check the patient’s complete blood count for changes
B. tardive dyskinesia…administer the Abnormal Involuntary Movement Scale
C. Tourette’s syndrome…consult the patient’s physician about a neuro evaluation
D. anticholinergic effects…consult the physician about possible medication changes
Show answer and rationale
Correct answer: B — tardive dyskinesia…administer the Abnormal Involuntary Movement Scale
The correct answer is B: tardive dyskinesia...administer the Abnormal Involuntary Movement Scale. Tardive dyskinesia is a movement disorder characterized by repetitive, involuntary movements such as grimacing, lip smacking, and twisting motions. It is a known side effect of long-term antipsychotic use, like fluphenazine decanoate. Administering the Abnormal Involuntary Movement Scale can help assess the severity of the symptoms and guide further management.
Incorrect options:
A: Agranulocytosis is a serious side effect of some antipsychotic medications but does not present with the symptoms described.
C: Tourette's syndrome is a neurological disorder characterized by involuntary movements and vocalizations but is not typically associated with antipsychotic use.
D: Anticholinergic effects can cause dry mouth and constipation but do not typically present with the specific movement symptoms described.
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Question 6
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. In this scenario, the patient presents with acute promyelocytic leukemia (APL), characterized by the presence of Auer rod-containing blasts expressing CD33 and negative for HLA-DR. The presence of coagulopathy with elevated INR, D-dimer, and oozing blood suggests disseminated intravascular coagulation (DIC), a common complication in APL. Immediate treatment with ATRA is crucial to differentiate and mitigate the risk of DIC worsening. ATRA induces differentiation of APL blasts, resolving the coagulopathy. Aggressive management of coagulopathy with blood product support is essential to prevent bleeding complications. Lumbar puncture (choice A), dexamethasone and hydroxyurea (choice C), and starting a donor search (choice D) are not indicated as the
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.
Correct answer:
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.
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
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. In this scenario, the patient presents with acute promyelocytic leukemia (APL), characterized by the presence of Auer rod-containing blasts expressing CD33 and negative for HLA-DR. The presence of coagulopathy with elevated INR, D-dimer, and oozing blood suggests disseminated intravascular coagulation (DIC), a common complication in APL. Immediate treatment with ATRA is crucial to differentiate and mitigate the risk of DIC worsening. ATRA induces differentiation of APL blasts, resolving the coagulopathy. Aggressive management of coagulopathy with blood product support is essential to prevent bleeding complications. Lumbar puncture (choice A), dexamethasone and hydroxyurea (choice C), and starting a donor search (choice D) are not indicated as the
A 59-year-old woman presented with an abrupt onset of palpitations accompanied by a vague complaint of feeling ill. Subsequent Holter monitoring revealed atrial fibrillation with a ventricular response up to 152 bpm. The patient's past history included primary hyperparathyroidism and intermittent claudication for 3 years, apparently due to peripheral occlusive arteriosclerosis. Which of the following drugs would be appropriate for the chronic control of the patient's arrhythmia?
A. Digoxin
B. Propranolol
C. Verapamil
D. Lidocaine
Correct answer:
The correct answer is B: Propranolol. Propranolol is a beta-blocker that can be used for rate control in atrial fibrillation. It works by blocking the effects of adrenaline on the heart, slowing the heart rate and reducing the force of contraction. In this case, the patient has atrial fibrillation with a rapid ventricular response, and propranolol can help slow the heart rate to a more appropriate level.
A: Digoxin is primarily used for rate control in patients with heart failure, not as the first-line agent for atrial fibrillation with a rapid ventricular response.
C: Verapamil is a calcium channel blocker that can also be used for rate control in atrial fibrillation, but beta-blockers are generally preferred in patients with concomitant peripheral artery disease.
D: Lidocaine is a local anesthetic and antiarrhythmic agent used for ventricular arrhythmias, not appropriate for atrial fibrillation.
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 because the clinical presentation suggests acute promyelocytic leukemia (APL). APL is characterized by Auer rod-containing granular blasts, which are positive for CD33 and negative for HLA-DR. The presence of coagulopathy with elevated D-dimer and oozing blood indicates a high risk of disseminated intravascular coagulation (DIC), a common complication of APL. Immediate treatment with all-trans retinoic acid (ATRA) is crucial in APL to induce differentiation of the leukemic cells and prevent further coagulopathy. Aggressively managing the coagulopathy with blood product support is also important to stabilize the patient.
Choice A is incorrect because a lumbar puncture is not necessary for APL diagnosis, and immediate induction chemotherapy with ATRA is the standard of care. Choice C is incorrect because dexamethasone and hydroxyurea are not the first-line therapies for APL.
A newly admitted client has taken thioridazine (Mellaril) for 2 years, with good symptom control. Symptoms exhibited on admission included paranoia and hallucinations. The nurse should recognize which potential cause for the return of these symptoms?
A. The client has developed tolerance to the antipsychotic medication.
B. The client has not taken the medication with food.
C. The client has not taken the medication as prescribed.
D. The client has combined alcohol with the medication.
Correct answer:
The correct answer is C: The client has not taken the medication as prescribed. Nonadherence to the prescribed medication regimen can lead to the return of symptoms. In this case, the client may not have been taking the medication consistently or at the correct dosage, resulting in the resurgence of paranoia and hallucinations.
Incorrect answers:
A: The client has developed tolerance to the antipsychotic medication - Tolerance does not typically develop to antipsychotic medications in the same way it does with some other types of medications.
B: The client has not taken the medication with food - Taking the medication with food may affect absorption but is unlikely to directly cause the return of symptoms.
D: The client has combined alcohol with the medication - While alcohol can interact with antipsychotic medications, it is not the most likely reason for the return of symptoms in this scenario.
Tick the drug that can induce peripheral neuropathy and oral ulceration:
A. Acyclovire
B. Zalcitabine
C. Zidovudine
D. Saquinavir
Correct answer:
The correct answer is B: Zalcitabine. Zalcitabine is a nucleoside reverse transcriptase inhibitor commonly associated with peripheral neuropathy and oral ulceration as side effects. These adverse effects are well-documented in clinical studies and are known to be dose-dependent. Zalcitabine can cause damage to peripheral nerves leading to neuropathy and can also irritate the mucous membranes in the mouth causing oral ulceration.
Incorrect Choices:
A: Acyclovir - Acyclovir is an antiviral medication used to treat herpes infections and does not typically cause peripheral neuropathy or oral ulceration.
C: Zidovudine - Zidovudine is also a nucleoside reverse transcriptase inhibitor used in the treatment of HIV, but it is not associated with peripheral neuropathy or oral ulceration.
D: Saquinavir - Saquinavir is a protease inhibitor used to treat HIV and does not commonly induce peripheral neurop
A patient with diabetes mellitus and chronic stable angina has a new order for captopril . The nurse should teach the patient that the primary purpose of captopril is to
A. decrease the heart rate.
B. control blood glucose levels.
C. prevent changes in heart muscle.
D. reduce the frequency of chest pain.
Correct answer:
Step 1: Captopril is an angiotensin-converting enzyme (ACE) inhibitor commonly used in patients with heart conditions.
Step 2: In a patient with chronic stable angina, captopril primarily works to prevent changes in heart muscle by reducing cardiac workload and improving blood flow.
Step 3: By preventing changes in heart muscle, captopril helps to reduce the risk of complications in patients with diabetes mellitus and chronic stable angina.
Step 4: The other choices (A: decrease heart rate, B: control blood glucose levels, D: reduce frequency of chest pain) are not the primary purposes of captopril in this patient population, making them incorrect.
Summary: The correct answer is C because captopril's primary purpose in this scenario is to prevent changes in heart muscle, while the other choices do not align with the mechanism of action and intended outcomes of captopril in this patient population.
Which of the following actions best explains the potassium-sparing effect of triamterene in the 66-year-old woman with systolic cardiac failure?
A. Enhancement of K+ reabsorption in the proximal tubule
B. Blockade of Na+ channels in the collecting duct
C. Enhancement of K+ reabsorption in the loop of Henle
D. Blockade of aldosterone receptors in the collecting duct
Correct answer:
The correct answer is B: Blockade of Na+ channels in the collecting duct. Triamterene is a potassium-sparing diuretic that works by inhibiting the epithelial sodium channels (ENaC) in the collecting duct of the nephron. By blocking these channels, triamterene reduces sodium reabsorption, leading to decreased potassium excretion. This mechanism helps maintain potassium levels in the body, making it an effective treatment for conditions like systolic cardiac failure where potassium loss is a concern.
Summary:
A: Enhancement of K+ reabsorption in the proximal tubule - This is incorrect as triamterene does not act on the proximal tubule for potassium-sparing effects.
C: Enhancement of K+ reabsorption in the loop of Henle - This is incorrect as triamterene does not primarily affect potassium reabsorption in the loop of Henle.
D: Blockade of aldosterone receptors in the collecting duct - This is
RN exams cardiovascular practice questions, set 18 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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