RN exams cardiovascular practice questions, set 22
RN exams · cardiovascular
RN exams cardiovascular practice questionsset 22
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
An infant is born with a firm mass over the chest with a central area of purpura and a 'halo' around it. An ultrasound reveals a high-flow lesion. What is the most likely diagnosis?
A. Fibrosarcoma
B. Infantile hemangioma
C. Congenital hemangioma
D. Capillary malformation
Show answer and rationale
Correct answer: C — Congenital hemangioma
The most likely diagnosis in this case is congenital hemangioma (Choice C). This is because the description of a firm mass over the chest with central purpura and a 'halo' suggests a rapidly involuting congenital hemangioma. The high-flow lesion seen on ultrasound is characteristic of this type of hemangioma.
Choice A (Fibrosarcoma) is incorrect as fibrosarcoma typically presents differently and does not typically have a central area of purpura. Choice B (Infantile hemangioma) is incorrect as infantile hemangiomas are not usually present at birth and do not typically have a 'halo' appearance. Choice D (Capillary malformation) is incorrect as capillary malformations do not usually present as a firm mass with central purpura and a 'halo'.
In summary, the key features described in the question point towards a diagnosis of congenital hemangioma, making Choice C the most likely
Question 2
The client has a resting heart rate of 80 and a regular rhythm. What is the likely source of electrical activity in this client?
A. The sino-atrial node
B. The atrio-ventricular node
C. The Purkinje fibers
D. The bundle of HIS
Show answer and rationale
Correct answer: A — The sino-atrial node
The correct answer is A: The sino-atrial node. The SA node is the natural pacemaker of the heart, responsible for initiating the electrical impulses that regulate the heartbeat. A resting heart rate of 80 with a regular rhythm indicates normal sinus rhythm, which is typically driven by the SA node. The SA node is located in the right atrium and generates electrical impulses that spread through the atria, causing them to contract.
Choice B (The atrio-ventricular node) is incorrect because the AV node serves to delay the electrical impulse to allow the atria to contract before the ventricles. Choice C (The Purkinje fibers) is incorrect as they are responsible for rapid conduction of the electrical impulse to the ventricles. Choice D (The bundle of HIS) is incorrect as it is part of the electrical conduction system that transmits the impulse from the AV node to the bundle branches.
Question 3
When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement, the nurse obtains the following assessment data. Which data indicate the need for immediate action by the nurse?
A. Heart rate 102 beats/min
B. Pedal pulses 1+ bilaterally
C. Report of severe chest pain
D. Blood pressure 103/54 mm Hg
Show answer and rationale
Correct answer: C — Report of severe chest pain
The correct answer is C: Report of severe chest pain. Severe chest pain in a patient with acute coronary syndrome after angioplasty with stent placement can indicate a potential complication like stent thrombosis or myocardial infarction. Immediate action is required to assess the patient's condition, administer appropriate interventions, and prevent further complications.
A: Heart rate 102 beats/min - Although an elevated heart rate can indicate cardiac stress, it is not as urgent as severe chest pain in this context.
B: Pedal pulses 1+ bilaterally - While decreased pedal pulses may indicate peripheral vascular issues, it is not as critical as addressing severe chest pain in a patient with acute coronary syndrome.
D: Blood pressure 103/54 mm Hg - Although low blood pressure can be concerning, it is not as immediately life-threatening as severe chest pain in this scenario.
Question 4
A 15-year-old female presents with 1-month history of fatigue and a 3-day history of chest pain and shortness of breath. Her chest x-ray shows a large mediastinal mass that is greater than 33% of the thoracic diameter at the level of the diaphragm. A biopsy shows diffuse large B-cell lymphoma. Metastatic work-up, including a CT scan of neck, chest, abdomen, and pelvis; bone marrow biopsy; lumbar puncture; and PET scan show no other site of disease. According to the St. Jude (Murphy) staging system, what is the stage of this patient's non-Hodgkin lymphoma (NHL)?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
Show answer and rationale
Correct answer: C — Stage III
The correct answer is C: Stage III. According to the St. Jude (Murphy) staging system for non-Hodgkin lymphoma, Stage III is defined as disease that extends beyond a single region (e.g., thorax) on one side of the diaphragm. In this case, the large mediastinal mass greater than 33% of thoracic diameter indicates involvement beyond a single region. The absence of disease in other sites based on the metastatic work-up rules out Stages IV. Since there is no information provided to suggest involvement on both sides of the diaphragm, Stage III is the most appropriate stage for this patient.
Choice A (Stage I) is incorrect as the disease extends beyond a single region. Choice B (Stage II) is incorrect as it implies involvement on both sides of the diaphragm, which is not indicated. Choice D (Stage IV) is incorrect as there is no evidence of distant metastasis in the given scenario.
Question 5
A 3-month-old female presents to the emergency room with vomiting and abdominal distension. She has a left-side abdominal mass, and an abdominal ultrasound confirms an 8-cm mass arising from the left kidney. Liver lesions are also noted. Nephrectomy is performed and reveals a histologic diagnosis of malignant rhabdoid tumor of the kidney (MRTK). Which of the following is not a true statement about the management of this patient?
A. Most patients with rhabdoid tumor of the kidney present in infancy.
B. Most patients with rhabdoid tumor of the kidney present with metastatic (stage III or IV) disease.
C. She has an excellent prognosis with surgery, chemotherapy, and radiation.
D. Germline testing for SMARCB1/INI1 mutation on chromosome 22 is recommended, with brain MRI every 3 months until she is 5 years old, if testing is germline positive for SMARCB1/INI1.
Show answer and rationale
Correct answer: C — She has an excellent prognosis with surgery, chemotherapy, and radiation.
The correct answer is C: She has an excellent prognosis with surgery, chemotherapy, and radiation.
Rationale:
1. Malignant rhabdoid tumor of the kidney (MRTK) is an aggressive cancer with poor prognosis.
2. Even with aggressive treatment, including surgery, chemotherapy, and radiation, the prognosis is generally poor due to high rates of recurrence and metastasis.
3. Therefore, stating that the patient has an excellent prognosis with the mentioned treatments is not true.
Summary of other choices:
A: Most patients with rhabdoid tumor of the kidney present in infancy - True, MRTK commonly presents in infancy.
B: Most patients with rhabdoid tumor of the kidney present with metastatic (stage III or IV) disease - True, MRTK often presents with metastatic disease.
D: Germline testing for SMARCB1/INI1 mutation on chromosome 22 is recommended, with brain MRI every 3 months until she is
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Question 6
Assuming that adherence has been excellent, which of the following should have returned to normal 6 weeks following appropriate oral iron treatment for a child with severe dietary iron deficiency (hemoglobin [Hgb] 5.0 g/dL and mean corpuscular volume [MCV] 48 fL at the beginning of therapy)?
A. Hgb concentration
B. MCV
C. Red cell distribution width
D. Peripheral blood smear
Correct answer:
Rationale for Correct Answer (A): Hgb concentration reflects the amount of hemoglobin in the blood, which is directly affected by iron levels. After 6 weeks of appropriate oral iron treatment, the child's severe iron deficiency should have improved, leading to an increase in Hgb concentration back to normal levels.
Explanation of Incorrect Choices:
B: MCV measures the size of red blood cells, which is affected by iron deficiency anemia. However, it may take longer than 6 weeks for MCV to return to normal.
C: Red cell distribution width indicates the variation in red blood cell sizes and is not directly related to iron levels. It may not necessarily return to normal within 6 weeks.
D: Peripheral blood smear provides information on the morphology of red blood cells but does not directly reflect iron levels. It may not show significant changes within 6 weeks of iron treatment.
A 16-year-old female patient with severe factor XI deficiency presents with acute appendicitis and requires urgent surgery. You are called by the surgeon, who wants to know what, if any, blood products or treatments are required to reduce the risk of perioperative bleeding. The patient weighs 62 kg. What should you tell him to administer?
A. Cryoprecipitate (five units), which will likely raise her factor XI level to 20%
B. Factor XI concentrate (20 units/kg), which will raise her factor XI level to 20%
C. Fresh frozen plasma (20 mL/kg), which will raise her factor XI level to 20%
D. Prothrombin complex concentrate (40 units/kg), which will raise her factor XI level to 20%
Correct answer:
The correct answer is C: Fresh frozen plasma (20 mL/kg), which will raise her factor XI level to 20%. Fresh frozen plasma contains various clotting factors, including factor XI. In patients with severe factor XI deficiency, like this 16-year-old female, fresh frozen plasma can provide factor XI replacement and improve hemostasis. The dose of 20 mL/kg is appropriate to achieve a factor XI level of around 20%, which is sufficient for hemostasis during surgery.
Now, let's analyze the other choices:
A: Cryoprecipitate (five units), which will likely raise her factor XI level to 20% - Cryoprecipitate contains factor VIII and fibrinogen, but the amount of factor XI in cryoprecipitate is minimal and may not significantly raise factor XI levels to the required 20%.
B: Factor XI concentrate (20 units/kg), which will raise her factor XI level to 20% - While factor XI concentrate is
The nurse is caring for a patient in the critical care unit whaobi,r ba.cfotemr/ tebset ing declared brain dead, is being managed by the OPO transplant coordinator. Thir ty minutes into the shift, assessment by the nurse includes a blood pressure 75/50 mm Hg, hear t rate 85 beats/min, and respiratory rate 12 breaths/min via assist/control ventilation. The oxygen saturation (SpO ) is 99% and 2 core temperature 93.8° F. Which primary care provider ord er should the nurse implement first?
A. Apply forced air warming device to keep temperature > 96.8° F
B. Obtain basic metabolic panel every 4 hours until surgery
C. Begin phenylephrine (Neo-Synephrine) for systolic BP < 90 mm Hg
D. Draw arterial blood gas every 4 hours until surgery
Correct answer:
The correct answer is C: Begin phenylephrine (Neo-Synephrine) for systolic BP < 90 mm Hg. The nurse should implement this order first because the patient's low blood pressure (75/50 mm Hg) indicates hypotension, which can lead to inadequate perfusion to vital organs. Phenylephrine is a vasoconstrictor that can help increase the patient's blood pressure and improve perfusion. It is crucial to address hypotension promptly to prevent further complications.
Choice A is incorrect because maintaining the patient's temperature above 96.8°F is not the most urgent concern in this scenario. Choice B is incorrect as obtaining a basic metabolic panel every 4 hours is not the immediate priority when the patient is experiencing hypotension. Choice D is incorrect as drawing arterial blood gas every 4 hours is not the most urgent intervention needed to address the patient's low blood pressure.
The nurse is caring for a mechanically ventilated patient an d responds to a high inspiratory pressure alarm. Recognizing possible causes for the alarma, btihrbe.c nomu/rtesset assesses for which of the following? (Select all that apply.)
A. Coughing or attempting to talk
B. Disconnection from the ventilator
C. Kinks in the ventilator tubing
D. Need for suctioning
Correct answer:
The correct answer is B: Disconnection from the ventilator. This is the correct choice because a high inspiratory pressure alarm can indicate a disconnection, leading to inadequate ventilation and increased pressure in the circuit. This can be a life-threatening situation that requires immediate attention.
Explanation of why other choices are incorrect:
A: Coughing or attempting to talk - While coughing or talking may affect the patient's ability to ventilate properly, it is not directly related to the high inspiratory pressure alarm.
C: Kinks in the ventilator tubing - Kinks in the tubing may cause increased resistance to airflow, but they are more likely to trigger a low pressure alarm rather than a high inspiratory pressure alarm.
D: Need for suctioning - Suctioning may be necessary for airway clearance, but it is not directly related to the high inspiratory pressure alarm.
What is a strategy for preventing thromboembolism in pat ients at risk who cannot take anticoagulants?
A. Administration of two aspirin tablets every 4 hours.
B. Infusion of thrombolytics.
C. Insertion of a vena cava filter.
D. Subcutaneous heparin administration every 12 hours.
Correct answer:
The correct answer is C: Insertion of a vena cava filter. This is a strategy for preventing thromboembolism in patients at risk who cannot take anticoagulants. The vena cava filter prevents blood clots from traveling to the lungs by trapping them in the inferior vena cava. It is a mechanical device that does not interfere with the body's clotting process.
Explanation of why other choices are incorrect:
A: Administration of two aspirin tablets every 4 hours is not an effective strategy for preventing thromboembolism in high-risk patients. Aspirin is an antiplatelet agent and may not be sufficient for preventing blood clots in these patients.
B: Infusion of thrombolytics is used for breaking down blood clots that have already formed, not for prevention. It is not a suitable option for preventing thromboembolism in at-risk patients.
D: Subcutaneous heparin administration every 12
When teaching a client with an aneurysm what signs and symptoms may indicate impending rupture, the nurse considers which of the following?
A. Medication therapy the client is receiving
B. Client's usual blood pressure
C. Age and gender of the client
D. Size and location of the aneurysm
Correct answer:
The correct answer is D: Size and location of the aneurysm. Monitoring the size and location of the aneurysm is crucial in determining the risk of rupture. Larger aneurysms in critical locations are more likely to rupture. This information guides healthcare providers in making informed decisions about interventions to prevent rupture.
Explanation of other choices:
A: Medication therapy the client is receiving - While medication therapy may be important in managing symptoms or risk factors associated with an aneurysm, it does not directly indicate impending rupture.
B: Client's usual blood pressure - Blood pressure management is important in preventing complications of an aneurysm, but it does not specifically signal impending rupture.
C: Age and gender of the client - While age and gender may influence the risk of developing an aneurysm, they do not indicate impending rupture.
The nurse is preparing to measure the thermodilution cardaiabicrb o.cuomtp/tuest t (TdCO) in a patient being monitored with a pulmonary artery catheter. Which action by the nurse best ensures the safety of the patient?
A. Ensure the transducer system is zero referenced at the level of the phlebostatic axis.
B. Avoid infusing vasoactive agents in the port used to ob tain the TdCO measurement.
C. Maintain a pressure of 300 mm Hg on the flush solutioanbi rub.scionmg/t eas tp ressure bag.
D. Limit the length of the noncompliant pressure tubing to a maximum 48 inches.
Correct answer:
The correct answer is B: Avoid infusing vasoactive agents in the port used to obtain the TdCO measurement. This action ensures patient safety by preventing the introduction of vasoactive agents directly into the bloodstream during the measurement process. Infusing vasoactive agents can lead to inaccurate TdCO readings and potentially harm the patient.
Choice A is incorrect because zero referencing the transducer system at the level of the phlebostatic axis is important for accurate pressure monitoring but not directly related to TdCO measurement safety.
Choice C is incorrect as maintaining a pressure of 300 mm Hg on the flush solution bag is not directly related to the safety of TdCO measurement.
Choice D is incorrect as limiting the length of noncompliant pressure tubing is important for accurate pressure readings but not directly related to the safety of TdCO measurement.
A 10-year-old patient with aplastic anemia, who is blood type B negative, is receiving a red blood cell transfusion. About 10 minutes after the transfusion starts, the patient develops anxiety and lower back pain. The transfusion continues for another 5 minutes until it is stopped when he develops a temperature of 40 °C with chills and rigors. A transfusion reaction work-up is most likely to reveal what findings?
A. Spherocytes on peripheral blood smear
B. Gram-negative Bacillus on gram stain of remaining RBC unit
C. Chest x-ray with bilateral pulmonary infiltrates that are new compared to an x-ray done last week
D. DAT positive for C3
Correct answer:
The correct answer is D because in this scenario, the patient is experiencing symptoms of a transfusion reaction, likely a hemolytic transfusion reaction due to ABO incompatibility. The presence of a positive Direct Antiglobulin Test (DAT) for C3 indicates complement activation, supporting the diagnosis.
Choice A (Spherocytes on peripheral blood smear) is incorrect as spherocytes are seen in autoimmune hemolytic anemia, not typically in transfusion reactions.
Choice B (Gram-negative Bacillus on gram stain of remaining RBC unit) is unlikely as the symptoms are more indicative of a hemolytic reaction rather than an infection.
Choice C (Chest x-ray with bilateral pulmonary infiltrates) is suggestive of transfusion-related acute lung injury (TRALI), but the symptoms described in the question (fever, chills, rigors) are more indicative of a hemolytic reaction rather than TRALI.
Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider?
A. Complaints of incisional chest pain
B. Pallor and weakness of the right hand
C. Fine crackles heard at both lung bases
D. Redness on both sides of the sternal incision
Correct answer:
The correct answer is B: Pallor and weakness of the right hand. This finding suggests potential compromise of blood flow to the right radial artery graft, which is crucial for the patient's cardiac function. Pallor and weakness may indicate reduced perfusion, possibly due to graft occlusion or other complications. This warrants immediate attention from the healthcare provider to prevent further complications.
Incorrect choices:
A: Complaints of incisional chest pain - This is common post-surgery and may not indicate acute issues with the graft.
C: Fine crackles heard at both lung bases - This could indicate a respiratory issue, but it is not directly related to the radial artery graft.
D: Redness on both sides of the sternal incision - While redness could suggest infection, it is not as urgent as compromised blood flow to the graft, which requires immediate intervention.
A 15-year-old female presents with 1-month history of fatigue and a 3-day history of chest pain and shortness of breath. Her chest x-ray shows a large mediastinal mass that is greater than 33% of the thoracic diameter at the level of the diaphragm. A biopsy shows diffuse large B-cell lymphoma. Metastatic work-up, including a CT scan of neck, chest, abdomen, and pelvis; bone marrow biopsy; lumbar puncture; and PET scan show no other site of disease. According to the St. Jude (Murphy) staging system, what is the stage of this patient's non-Hodgkin lymphoma (NHL)?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
Correct answer:
The correct answer is C: Stage III. According to the St. Jude (Murphy) staging system for non-Hodgkin lymphoma, Stage III is defined as disease that extends beyond a single region (e.g., thorax) on one side of the diaphragm. In this case, the large mediastinal mass greater than 33% of thoracic diameter indicates involvement beyond a single region. The absence of disease in other sites based on the metastatic work-up rules out Stages IV. Since there is no information provided to suggest involvement on both sides of the diaphragm, Stage III is the most appropriate stage for this patient.
Choice A (Stage I) is incorrect as the disease extends beyond a single region. Choice B (Stage II) is incorrect as it implies involvement on both sides of the diaphragm, which is not indicated. Choice D (Stage IV) is incorrect as there is no evidence of distant metastasis in the given scenario.
RN exams cardiovascular practice questions, set 22 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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