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
The nurse is caring for a patient who has an intra-aortic balloon pump (IABP) following a massive heart attack. When assessing the patient, the nurse notices blood backing up into the IABP catheter. In which order should the nurse take the following actions?
A. Ensure that the IABP console has been turned off.
B. Assess the patient's vital signs and orientation.
C. Notify the healthcare provider of the IABP malfunction.
D. Obtain supplies for insertion of a new IABP catheter.
Show answer and rationale
Correct answer: A — Ensure that the IABP console has been turned off.
Correct Answer: A
Rationale:
1. Ensuring the IABP console is turned off is crucial to prevent further complications and stop potential harm to the patient.
2. By turning off the IABP console, the nurse can halt the pumping action, allowing assessment of the situation without interference.
3. This action takes priority over other steps as it addresses the immediate issue of blood backing up into the IABP catheter.
4. Once the console is turned off, the nurse can proceed with assessing the patient's vital signs, notifying the healthcare provider, and obtaining supplies if needed.
Summary of Incorrect Choices:
- Option B: Assessing vital signs and orientation is important, but addressing the malfunction of the IABP takes precedence to prevent harm.
- Option C: Notifying the healthcare provider is necessary, but first, the immediate issue of blood backing up into the catheter must be addressed.
- Option D: Obtaining supplies for a new catheter is premature without first addressing
Question 2
Platelet aggregation is an important event in hemostasis. Which of the following statement is true for platelet aggregation in vascular injury?
A. There will be initial vasodilation
B. Clotting factors play no role in its formation
C. Platelets change their shape during the process
D. Serotonin stimulates platelet aggregation
Show answer and rationale
Correct answer: C — Platelets change their shape during the process
The correct answer is C: Platelets change their shape during the process of platelet aggregation in vascular injury. Platelets undergo shape change from a discoid to a spiky form, leading to the exposure of their glycoprotein receptors, which then bind to fibrinogen and other platelets to form a platelet plug. This process is crucial for hemostasis and preventing excessive bleeding.
Explanation for why other choices are incorrect:
A: There will be initial vasodilation - Vasodilation is not a direct result of platelet aggregation but rather an initial response to vascular injury to increase blood flow to the area.
B: Clotting factors play no role in its formation - Clotting factors are essential for the later stages of hemostasis, but platelet aggregation is primarily driven by platelet activation and shape change.
D: Serotonin stimulates platelet aggregation - While serotonin is released from platelets upon activation, it does not directly stimulate platelet aggregation.
Question 3
The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient?
A. Women have a high risk for thrombophlebitis while on this drug.
B. A higher dose of rifampin will be necessary because of the contraceptive.
C. Oral contraceptives are less effective while the patient is taking rifampin.
D. The incidence of adverse effects is greater if the two drugs are taken together.
Show answer and rationale
Correct answer: C — Oral contraceptives are less effective while the patient is taking rifampin.
The correct answer is C: Oral contraceptives are less effective while the patient is taking rifampin. Rifampin induces hepatic enzymes, which can accelerate the metabolism of oral contraceptives, leading to decreased contraceptive efficacy. This can result in breakthrough bleeding and potential contraceptive failure. It is important to advise the patient to use additional non-hormonal contraceptive methods while on rifampin therapy to prevent unintended pregnancy.
Incorrect answer explanations:
A: Women do not have a high risk for thrombophlebitis while on rifampin. Rifampin is not known to directly increase the risk of thrombophlebitis.
B: A higher dose of rifampin is not necessary because of the contraceptive. Rifampin does not interact with oral contraceptives in a way that requires a higher dose.
D: The incidence of adverse effects is not necessarily greater if the two drugs are taken together. Adverse effects are more related to individual drug reactions rather than a
Question 4
The spouse of a patient who has just been diagnosed with cancer asks, “What do you think about the relationship of stress and the development of cancer? My spouse has been under a huge amount of stress at work, and now they’ve diagnosed cancer.†The answer that best reflects the current thinking about psychoneuroimmunology is:
A. “It’s thought that the immune system is negatively affected by high stress.â€
B. “The literature doesn’t say much, but it is believed that the mental state and the physical state affect each other to some degree.â€
C. “Your spouse’s situation may reflect a coincidence. There is little concrete evidence that stress makes one prone to physical illness.â€
D. “Grief and depression are known to cause physical illness, but other types of stress have not been implicated as illness producers.â€
Show answer and rationale
Correct answer: A — “It’s thought that the immune system is negatively affected by high stress.â€
The correct answer is A: "It’s thought that the immune system is negatively affected by high stress." This answer aligns with the current understanding in psychoneuroimmunology that high levels of stress can indeed weaken the immune system, making individuals more susceptible to illnesses like cancer. Chronic stress can lead to dysregulation of the immune system, increasing inflammation and impairing immune responses.
Choice B is incorrect because there is substantial evidence supporting the impact of stress on the immune system. Choice C is inaccurate as numerous studies have demonstrated the link between stress and physical health outcomes. Choice D is misleading as various types of stress, not just grief and depression, can contribute to physical illness.
Therefore, the correct answer is A as it accurately reflects the relationship between stress and the immune system, which is crucial in understanding the potential impact of stress on the development of cancer.
Question 5
A patient is admitted to your acute coronary care unit with the diagnosis of ACS. The nurse has seen ECG changes that are indicative of an anterior wall infarction and is observing the patient for signs/symptoms of complications. The nurse has noted the following vital sign trends: 1100-HR 92, RR 24, BP 140/88, Cardiac rhythm NSR 1115-HR 96, RR 26, BP 128/82, Cardiac rhythm NSR 1130-HR 104, RR 28, BP 102/68, Cardiac rhythm ST 1145-HR 120, RR 32, BP 80/52, Cardiac rhythm ST with frequent PVC's The nurse should be alert for which of the following complications? Choose all that apply.
A. Syncope
B. Pericarditis
C. Cardiogenic shock
D. Cardiac tamponade
Show answer and rationale
Correct answer: C — Cardiogenic shock
The correct answer is C: Cardiogenic shock. In this scenario, the patient with ACS is showing vital sign trends of decreasing blood pressure (BP) along with an increase in heart rate (HR) and respiratory rate (RR), indicating poor cardiac output. Cardiogenic shock occurs when the heart cannot pump enough blood to meet the body's demands. The decreasing BP and increasing HR are signs of impending cardiogenic shock, a serious complication of anterior wall infarction due to decreased cardiac output.
Choice A: Syncope is not the most appropriate complication to be alert for in this case, as the vital signs are indicating a more severe condition than just fainting.
Choice B: Pericarditis is unlikely to cause the significant changes in vital signs observed in this scenario. While pericarditis can occur following an MI, the vital sign trends are more indicative of cardiogenic shock.
Choice D: Cardiac tamponade is also unlikely based on the vital sign trends provided. Card
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Question 6
A 13-year-old girl presents with acute myeloid leukemia (AML) and a WBC count of 120,000/mm3. Cytogenetics reveals a normal karyotype, and fluorescence in situ hybridization (FISH) tests for inv(16), t(8;21), t(15;17); 11q23 abnormalities; monosomy 7; and 5q deletion are negative. Molecular testing is negative for mutations in FLT3, NPM1, and CEBPA. She is treated with 10 days of daunorubicin, AraC, and gemtuzumab for induction therapy. On day 30, she recovers counts, and a bone marrow aspiration shows 2.2% leukemic blasts by flow cytometry. She receives a second course of treatment with daunorubicin and AraC, and her marrow is now in morphologic remission and is MRD-negative by flow cytometry. She has no HLA-matched siblings, but an unrelated donor search reveals a large number of potential matches. Which course of treatment is most likely to result in the best outcome?
A. Give two more courses of intensification chemotherapy.
B. Perform an autologous hematopoietic stem cell transplant (HSCT).
C. Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT.
D. Give one more course of intensification chemotherapy and then 1 year of maintenance chemotherapy.
Correct answer:
The correct answer is C: Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT.
Rationale:
1. The patient achieved morphologic remission and MRD-negative status after the second course of chemotherapy, indicating good response.
2. Given the high-risk AML with negative cytogenetics and molecular markers, HSCT from a matched unrelated donor offers the best chance for long-term remission.
3. HSCT provides a curative option by replacing the patient's diseased bone marrow with healthy donor cells, reducing the risk of relapse.
4. The presence of a large number of potential matched unrelated donors increases the likelihood of finding a suitable donor for the transplant.
Summary:
- Option A: Giving more courses of intensification chemotherapy may not address the high-risk nature of the disease and may not provide a curative outcome.
- Option B: Autologous HSCT uses the patient's own stem cells, which may carry the risk of relapse due
What test measures the electrical activity of the heart over a period of time, typically 24 to 48 hours?
A. Holter monitor
B. Echocardiogram
C. Stress test
D. Arterial blood gas (ABG)
Correct answer:
The correct answer is A: Holter monitor. A Holter monitor is a device that measures the electrical activity of the heart over an extended period, usually 24 to 48 hours. It is used to detect abnormal heart rhythms and assess how the heart responds to daily activities.
Explanation:
1. The Holter monitor records the heart's electrical activity continuously, providing a detailed analysis of any irregularities.
2. Unlike an echocardiogram, which uses sound waves to create images of the heart, the Holter monitor focuses on monitoring electrical signals.
3. A stress test evaluates the heart's performance under physical stress, not over an extended period like the Holter monitor.
4. Arterial blood gas (ABG) measures oxygen and carbon dioxide levels in the blood, not the heart's electrical activity.
In summary, the Holter monitor is the correct choice as it specifically measures the heart's electrical activity over an extended timeframe, distinguishing it from the other options.
Platelet aggregation is an important event in hemostasis. Which of the following statement is true for platelet aggregation in vascular injury?
A. There will be initial vasodilation
B. Clotting factors play no role in its formation
C. Platelets change their shape during the process
D. Serotonin stimulates platelet aggregation
Correct answer:
The correct answer is C: Platelets change their shape during the process of platelet aggregation in vascular injury. Platelets undergo shape change from a discoid to a spiky form, leading to the exposure of their glycoprotein receptors, which then bind to fibrinogen and other platelets to form a platelet plug. This process is crucial for hemostasis and preventing excessive bleeding.
Explanation for why other choices are incorrect:
A: There will be initial vasodilation - Vasodilation is not a direct result of platelet aggregation but rather an initial response to vascular injury to increase blood flow to the area.
B: Clotting factors play no role in its formation - Clotting factors are essential for the later stages of hemostasis, but platelet aggregation is primarily driven by platelet activation and shape change.
D: Serotonin stimulates platelet aggregation - While serotonin is released from platelets upon activation, it does not directly stimulate platelet aggregation.
The registered nurse has finished reviewing the 7:00 a.m shift report on a telemetry unit. Which of the following clients would be the best for the RN to assign to the licensed practical nurse?
A. A 7-day postoperative CABG client with an infection in the sternal surgical incision, requiring dressings and irrigation.
B. A client who has just arrived on the unit from the emergency room for observation to rule out a myocardial infarction.
C. A client who has had successful valve replacement therapy and will be discharged this morning.
D. A client who is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) at 10:00 a.m.
Correct answer:
The correct answer is A because the 7-day postoperative CABG client with an infection in the sternal surgical incision requires ongoing wound care, dressings, and irrigation, which are within the scope of practice for a licensed practical nurse.
Choice B is incorrect because a client who has just arrived from the emergency room for observation to rule out a myocardial infarction may require immediate assessment and interventions beyond the scope of a licensed practical nurse.
Choice C is incorrect because a client who has had successful valve replacement therapy and will be discharged this morning may require coordination of care, discharge teaching, and documentation, which are typically the responsibilities of a registered nurse.
Choice D is incorrect because a client scheduled for a percutaneous transluminal coronary angioplasty at 10:00 a.m may require pre-procedure preparations, monitoring, and post-procedure care that are best handled by a registered nurse.
Which of the following actions most likely contribute to mortality reduction obtained by beta-blockers in myocardial infarction?
A. Increased myocardial oxygen supply
B. Decreased atrioventricular conduction
C. Decreased myocardial remodeling
D. Increased systemic vascular resistance
Correct answer:
The correct answer is C: Decreased myocardial remodeling. Beta-blockers decrease the workload of the heart by reducing heart rate and contractility, which in turn decreases myocardial oxygen demand and reduces the risk of further damage to the heart muscle post-myocardial infarction. This leads to a decrease in adverse remodeling of the heart, improving overall cardiac function and reducing mortality.
Incorrect Choices:
A: Increased myocardial oxygen supply - Beta-blockers do not directly increase myocardial oxygen supply but rather decrease oxygen demand.
B: Decreased atrioventricular conduction - While beta-blockers can slow atrioventricular conduction, this is not the primary mechanism for mortality reduction in myocardial infarction.
D: Increased systemic vascular resistance - Beta-blockers actually decrease systemic vascular resistance, which can be beneficial in certain conditions but is not the primary reason for mortality reduction in myocardial infarction.
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.
Correct answer:
The correct answer is D: Check the infant's apical pulse for 1 minute. Before administering digoxin, it is crucial to assess the apical pulse for a full minute to ensure the heart rate is within the appropriate range (usually above 100 bpm in infants). Digoxin can cause bradycardia, so monitoring the apical pulse is essential to prevent potential adverse effects.
A: Taking the infant's blood pressure is not the most appropriate intervention before administering digoxin as the focus should be on assessing the heart rate specifically.
B: Checking the infant's respiratory rate is not directly related to the administration of digoxin, and assessing the pulse rate is more relevant.
C: Checking the infant's radial pulse is not as accurate as assessing the apical pulse when monitoring for potential digoxin-induced changes in heart rate.
In summary, the most appropriate intervention before digoxin administration is to check the infant's apical pulse for 1 minute to
A patient with ST-segment elevation in three contiguous electrocardiographic leads is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction. Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy?
A. “Do you have any allergies?”
B. “Do you take aspirin on a daily basis?”
C. “What time did your chest pain begin?”
D. “Can you rate your chest pain using a 0 to 10 scale?”
Correct answer:
The correct answer is C, “What time did your chest pain begin?” This question is crucial in determining if the patient is within the time window for thrombolytic therapy, which is typically within the first 12 hours of symptom onset. This therapy is most effective when administered early after symptom onset to dissolve the blood clot causing the myocardial infarction. Asking about the time of chest pain onset helps assess if the patient falls within this critical treatment window.
Choice A, “Do you have any allergies?” is not directly relevant to the decision of thrombolytic therapy administration. Choice B, “Do you take aspirin on a daily basis?” is important for the patient’s medical history but does not directly impact the decision for thrombolytic therapy. Choice D, “Can you rate your chest pain using a 0 to 10 scale?” may provide information about the severity of pain but does not help in determining the eligibility for thrombolytic therapy based on the treatment
A patient is admitted to your acute coronary care unit with the diagnosis of ACS. The nurse has seen ECG changes that are indicative of an anterior wall infarction and is observing the patient for signs/symptoms of complications. The nurse has noted the following vital sign trends: 1100-HR 92, RR 24, BP 140/88, Cardiac rhythm NSR 1115-HR 96, RR 26, BP 128/82, Cardiac rhythm NSR 1130-HR 104, RR 28, BP 102/68, Cardiac rhythm ST 1145-HR 120, RR 32, BP 80/52, Cardiac rhythm ST with frequent PVC's The nurse should be alert for which of the following complications? Choose all that apply.
A. Syncope
B. Pericarditis
C. Cardiogenic shock
D. Cardiac tamponade
Correct answer:
The correct answer is C: Cardiogenic shock. In this scenario, the patient with ACS is showing vital sign trends of decreasing blood pressure (BP) along with an increase in heart rate (HR) and respiratory rate (RR), indicating poor cardiac output. Cardiogenic shock occurs when the heart cannot pump enough blood to meet the body's demands. The decreasing BP and increasing HR are signs of impending cardiogenic shock, a serious complication of anterior wall infarction due to decreased cardiac output.
Choice A: Syncope is not the most appropriate complication to be alert for in this case, as the vital signs are indicating a more severe condition than just fainting.
Choice B: Pericarditis is unlikely to cause the significant changes in vital signs observed in this scenario. While pericarditis can occur following an MI, the vital sign trends are more indicative of cardiogenic shock.
Choice D: Cardiac tamponade is also unlikely based on the vital sign trends provided. Card
The spouse of a patient who has just been diagnosed with cancer asks, “What do you think about the relationship of stress and the development of cancer? My spouse has been under a huge amount of stress at work, and now they’ve diagnosed cancer.” The answer that best reflects the current thinking about psychoneuroimmunology is:
A. “It’s thought that the immune system is negatively affected by high stress.”
B. “The literature doesn’t say much, but it is believed that the mental state and the physical state affect each other to some degree.”
C. “Your spouse’s situation may reflect a coincidence. There is little concrete evidence that stress makes one prone to physical illness.”
D. “Grief and depression are known to cause physical illness, but other types of stress have not been implicated as illness producers.”
Correct answer:
The correct answer is A: "It’s thought that the immune system is negatively affected by high stress." This answer aligns with the current understanding in psychoneuroimmunology that high levels of stress can indeed weaken the immune system, making individuals more susceptible to illnesses like cancer. Chronic stress can lead to dysregulation of the immune system, increasing inflammation and impairing immune responses.
Choice B is incorrect because there is substantial evidence supporting the impact of stress on the immune system. Choice C is inaccurate as numerous studies have demonstrated the link between stress and physical health outcomes. Choice D is misleading as various types of stress, not just grief and depression, can contribute to physical illness.
Therefore, the correct answer is A as it accurately reflects the relationship between stress and the immune system, which is crucial in understanding the potential impact of stress on the development of cancer.
A 3-year-old boy with X-linked chronic granulomatosis disease is day +25 after haploidentical bone marrow transplant (father donor) using posttransplant cyclophosphamide as graft-versus-host disease (GVHD) prophylaxis. He engrafted on day +16 and was preparing for discharge when cytomegalovirus (CMV) was noted to be positive on PCR, and he developed a fever and mild rash. His counts have fallen to a WBC of 0.1 and he remains transfusion dependent. What diagnostic evaluations/treatments should you pursue?
A. Rule out infection by sending blood cultures, start broad spectrum antibiotics, and obtain other diagnostic workup as appropriate. Consider skin biopsy and treat with steroids for likely acute GVHD (aGHVD).
B. Initiate an infectious workup and treat with broad-spectrum antibiotics. Consult with the PICU team because the low blood counts are likely a preseptic presentation.
C. Test for possible rejection with rapid FISH chimerism and consider withdrawal of immune suppression if donor chimerism is low.
D. Send blood cultures, start antibiotics, and treat his CMV with foscarnet. Send rapid chimerism by STR to assess for possible rejection. If donor chimerism is low or absent, work on obtaining an alternative donor for a second procedure.
Correct answer:
Step-by-step rationale for why answer D is correct:
1. Send blood cultures: To rule out bacterial infection as a potential cause of fever and rash.
2. Start antibiotics: To cover for possible bacterial infection given the clinical presentation.
3. Treat CMV with foscarnet: As the patient is CMV positive on PCR and has developed symptoms, indicating active CMV infection.
4. Send rapid chimerism by STR: To assess for possible rejection post-transplant. Low or absent donor chimerism may indicate rejection.
5. If donor chimerism is low or absent: Consider the need for alternative donor for a second procedure to address rejection.
Summary:
- Choice A is incorrect because steroids for aGHVD are not indicated without confirming the diagnosis first.
- Choice B is incorrect as the low blood counts are more suggestive of a different underlying cause rather than sepsis.
- Choice C is incorrect as rapid FISH chimerism is not the standard method for assessing rejection
RN exams cardiovascular practice questions, set 5 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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