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
A client is admitted to the hospital with a diagnosis of Type 2 diabetes mellitus and influenza. Which categories of illness should the nurse develop goals for the client's plan of care?
A. One chronic and one acute illness.
B. Two acute illnesses.
C. One acute and one infectious illness.
D. Two chronic illnesses.
Show answer and rationale
Correct answer: A — One chronic and one acute illness.
The correct answer is A: One chronic and one acute illness. This is because Type 2 diabetes mellitus is a chronic condition, while influenza is an acute illness. The nurse should develop goals addressing the management and control of the chronic condition (diabetes) as well as the treatment and recovery from the acute illness (influenza). This approach ensures comprehensive care that considers both the long-term management of the chronic illness and the immediate needs related to the acute illness.
Choices B, C, and D are incorrect because they do not address the combination of chronic and acute illnesses presented in the scenario. Choice B focuses solely on two acute illnesses, which overlooks the ongoing management required for the chronic condition. Choice C combines an acute and an infectious illness, but fails to account for the chronic illness component. Choice D involves two chronic illnesses, neglecting the immediate care needed for the acute illness.
Question 2
Artemisinin and its derivatives are used in the treatment of severe forms of chloroquine-resistant falciparum because they have:
A. Rapid gametocidal activity
B. The ability to prevent further development of hypnozoites
C. Rapid sporontocidal activity
D. Rapid schizonticidal activity
Show answer and rationale
Correct answer: D — Rapid schizonticidal activity
The correct answer is D: Rapid schizonticidal activity. Artemisinin and its derivatives target the malaria parasite at the schizont stage, which is crucial for the parasite's replication and survival. By rapidly killing schizonts, these drugs help in controlling the infection and preventing severe complications.
Choice A (Rapid gametocidal activity) is incorrect because artemisinin and its derivatives primarily target asexual stages of the parasite, not gametocytes. Choice B (The ability to prevent further development of hypnozoites) is incorrect as these drugs do not target the liver stages where hypnozoites develop. Choice C (Rapid sporontocidal activity) is incorrect as artemisinin derivatives do not primarily target the sexual stages of the parasite.
In summary, the correct answer is D because of the drugs' effectiveness against the schizont stage, while the other choices are incorrect as they do not align with the mechanism of action of artemisinin
Question 3
You examine a 10-year-old boy with severe aplastic anemia. He has no dysmorphic features and is at the 50th percentile for height and weight. Family history includes a sister with aplastic anemia unresponsive to anti-human thymocyte globulin (ATG) and cyclosporine who died early in the course of an unrelated donor hematopoietic stem cell transplant complicated by severe mucositis and transplant-related organ toxicities. There are no other siblings. A cousin died of acute myeloid leukemia at age 5 years. A peripheral blood sample test for Fanconi anemia is negative with no increased chromosomal breaks in response to diepoxylbutane or mitomycin C. Which of the following is the most important next step in management?
A. Administer ATG and cyclosporine.
B. Search for a donor for matched unrelated transplant.
C. Send a bone marrow aspirate for Fanconi anemia testing.
D. Send a skin fibroblast culture for Fanconi anemia testing.
Show answer and rationale
Correct answer: D — Send a skin fibroblast culture for Fanconi anemia testing.
The correct answer is D: Send a skin fibroblast culture for Fanconi anemia testing. This is the most important next step in management because the patient's family history, particularly the sister's unresponsiveness to ATG and cyclosporine and the cousin's history of leukemia, raises suspicion for Fanconi anemia. Testing for Fanconi anemia is crucial as it is an inherited bone marrow failure syndrome that predisposes individuals to aplastic anemia and leukemia. Skin fibroblast culture is the preferred test for diagnosing Fanconi anemia as it can detect chromosomal abnormalities indicative of the disease. Options A and B are not appropriate as the patient's sister did not respond to ATG and cyclosporine, and searching for a donor for transplant without confirming the underlying cause of aplastic anemia could lead to transplant failure. Option C is also not the best choice as the peripheral blood sample test for Fanconi anemia was already negative, and a skin fib
Question 4
A client reports substernal chest pain. Test results show electrocardiographic changes and an elevated cardiac troponin level. What should be the focus of nursing care?
A. Improving myocardial oxygenation and reducing cardiac workload.
B. Confirming a suspected diagnosis and preventing complications.
C. Reducing anxiety and relieving pain.
D. Eliminating stressors and providing a nondemanding environment.
Show answer and rationale
Correct answer: A — Improving myocardial oxygenation and reducing cardiac workload.
The correct answer is A because in a client presenting with substernal chest pain, electrocardiographic changes, and elevated cardiac troponin level, the priority is to improve myocardial oxygenation and reduce cardiac workload. This is crucial to prevent further damage to the heart muscle and potential complications like myocardial infarction. By focusing on improving oxygen supply and reducing workload, the nurse can help stabilize the client's condition and prevent further cardiac events.
Choice B is incorrect because while confirming the diagnosis and preventing complications are essential, the immediate focus should be on addressing the physiological needs of the heart. Choice C is incorrect as reducing anxiety and relieving pain are important but secondary to addressing the underlying cardiac issue. Choice D is incorrect as eliminating stressors and providing a nondemanding environment may be beneficial but not the immediate priority in this situation.
Question 5
You receive a phone call that a 3-year-old patient on long-term warfarin therapy for congenital heart disease has an international normalized ratio (INR) of 5.8. On further history, you learn the patient and several family members have had recent gastrointestinal illnesses, but the patient is recovering. His mother reports he is not experiencing bleeding symptoms. Which of the following interventions would be most reasonable in this clinical scenario?
A. Hold 1 to 2 doses of warfarin and recheck INR
B. Administer oral vitamin K therapy
C. Administer fresh frozen plasma (FFP)
D. Administer recombinant factor VIIa
Show answer and rationale
Correct answer: A — Hold 1 to 2 doses of warfarin and recheck INR
The correct answer is A: Hold 1 to 2 doses of warfarin and recheck INR. In this scenario, the high INR indicates an increased risk of bleeding due to excess anticoagulation. However, since the patient is asymptomatic and the high INR is likely due to transient factors (gastrointestinal illness), the most appropriate initial step is to temporarily hold warfarin to allow the INR to normalize. Rechecking the INR after holding the doses will guide further management.
Choice B (Administer oral vitamin K therapy) is incorrect because the patient is not experiencing bleeding symptoms and oral vitamin K should be reserved for patients with active bleeding or high INR with bleeding symptoms. Choice C (Administer fresh frozen plasma) is inappropriate as the patient is not actively bleeding and FFP is typically reserved for acute bleeding situations. Choice D (Administer recombinant factor VIIa) is also incorrect as it is reserved for severe bleeding in patients on war
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Question 6
A delayed, subacute phase, of inflammation is characterized by:
A. Local vasodilatation and increased capillary permeability (phase of damage)
B. Infiltration of leucocytes and phagocytic cells (phase of exudation)
C. Tissue degeneration and fibrosis occurrence (phase of proliferation)
D. All of the above
Correct answer:
The correct answer is B: Infiltration of leucocytes and phagocytic cells (phase of exudation). During the delayed, subacute phase of inflammation, infiltrating leukocytes, such as neutrophils and macrophages, play a crucial role in removing debris and pathogens. This phase is characterized by the migration of these cells to the site of injury, where they engulf and digest foreign substances. This process helps to clear the area of infection and promote tissue repair.
Other choices are incorrect:
A: Local vasodilatation and increased capillary permeability (phase of damage) - This describes the initial phase of inflammation, not the delayed subacute phase.
C: Tissue degeneration and fibrosis occurrence (phase of proliferation) - This describes the later stages of inflammation involving tissue repair and remodeling, not the delayed subacute phase.
D: All of the above - This is incorrect as choices A and C do not accurately describe the delayed, subacute
A 68-year-old man was diagnosed with systolic heart failure with normal ejection fraction and normal sinus rhythm at rest. A treatment with captopril was started. Which of the following actions most likely mediated the therapeutic effect of captopril in this patient?
A. Increased cardiac contractility
B. Reduction of angiotensin-mediated vasoconstriction in the kidney
C. Reduction of preload and afterload
D. Stimulation of epinephrine release from adrenergic nerves
Correct answer:
The correct answer is C: Reduction of preload and afterload. Captopril, an ACE inhibitor, reduces preload (volume of blood returning to the heart) by inhibiting the conversion of angiotensin I to angiotensin II, which decreases aldosterone secretion and fluid retention. It also reduces afterload (resistance the heart has to pump against) by decreasing peripheral vascular resistance. This dual action helps improve cardiac output and decrease workload on the heart in systolic heart failure.
Explanation for why the other choices are incorrect:
A: Increased cardiac contractility - Captopril does not directly increase cardiac contractility, it mainly affects afterload and preload.
B: Reduction of angiotensin-mediated vasoconstriction in the kidney - While captopril does inhibit angiotensin production, its primary mechanism of action is not specific to the kidney.
D: Stimulation of epinephrine release from adrenergic nerves - Captopril does not stimulate ep
The client has a heart rate of 70, a slightly irregular rhythm and P waves that come in multiples. What is this rhythm called?
A. Third degree AV block
B. Type 2 second degree AV block
C. Type 1 second degree AV block
D. Junctional escape rhythm
Correct answer:
The correct answer is C: Type 1 second degree AV block. This rhythm is characterized by a slightly irregular rhythm and P waves that come in multiples, indicating a delay in the AV node conduction. In Type 1 second degree AV block, there is a progressive prolongation of the PR interval until a P wave is blocked, resulting in a skipped QRS complex. This matches the description given in the question.
Choice A (Third degree AV block) is incorrect because in this condition, there is complete blockage of the electrical impulses between the atria and ventricles, resulting in an independent rhythm for both chambers.
Choice B (Type 2 second degree AV block) is incorrect because in this condition, there is a consistent PR interval before a blocked P wave without progressive prolongation as seen in the question.
Choice D (Junctional escape rhythm) is incorrect as it is characterized by a heart rate originating from the AV junction due to a failure of the SA node,
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
The nurse is giving the client digoxin for heart failure and recognizes that the drug has what type of effect on the heart?
A. Negative inotropic, negative chronotropic effect
B. Positive inotropic, negative chronotropic effect
C. Negative inotropic, positive chronotropic effect
D. Positive inotropic, positive chronotropic effect
Correct answer:
The correct answer is B: Positive inotropic, negative chronotropic effect. Digoxin is a positive inotrope, meaning it increases the force of myocardial contraction, which helps improve cardiac output in heart failure. It has a negative chronotropic effect, meaning it decreases the heart rate by slowing down the electrical conduction in the heart, which can be beneficial in certain heart conditions.
Choice A (Negative inotropic, negative chronotropic effect) is incorrect because digoxin is a positive inotrope, not a negative inotrope. Choice C (Negative inotropic, positive chronotropic effect) is incorrect because digoxin does not have a positive chronotropic effect. Choice D (Positive inotropic, positive chronotropic effect) is incorrect because digoxin has a negative chronotropic effect, not a positive one.
Therefore, the correct choice is B due to the combination of positive inotropic effect and negative chronotropic effect of digoxin on the heart
Artemisinin and its derivatives are used in the treatment of severe forms of chloroquine-resistant falciparum because they have:
A. Rapid gametocidal activity
B. The ability to prevent further development of hypnozoites
C. Rapid sporontocidal activity
D. Rapid schizonticidal activity
Correct answer:
The correct answer is D: Rapid schizonticidal activity. Artemisinin and its derivatives target the malaria parasite at the schizont stage, which is crucial for the parasite's replication and survival. By rapidly killing schizonts, these drugs help in controlling the infection and preventing severe complications.
Choice A (Rapid gametocidal activity) is incorrect because artemisinin and its derivatives primarily target asexual stages of the parasite, not gametocytes. Choice B (The ability to prevent further development of hypnozoites) is incorrect as these drugs do not target the liver stages where hypnozoites develop. Choice C (Rapid sporontocidal activity) is incorrect as artemisinin derivatives do not primarily target the sexual stages of the parasite.
In summary, the correct answer is D because of the drugs' effectiveness against the schizont stage, while the other choices are incorrect as they do not align with the mechanism of action of artemisinin
A nurse is caring for a patient with Hodgkin lymphoma at the oncology clinic. The nurse should be aware of what main goal of care?
A. Cure of the disease
B. Enhancing quality of life
C. Controlling symptoms
D. Palliation
Correct answer:
The correct answer is A: Cure of the disease. The main goal of care for a patient with Hodgkin lymphoma is to achieve a cure whenever possible. This is because Hodgkin lymphoma is a potentially curable cancer with appropriate treatment. Achieving a cure means eradicating the cancer cells completely and preventing its recurrence in the future. This is the most desirable outcome for the patient's long-term health and well-being.
Incorrect choices:
B: Enhancing quality of life - While improving the patient's quality of life is important, the primary goal in treating Hodgkin lymphoma is to cure the disease.
C: Controlling symptoms - Symptom management is important in providing comfort to the patient, but the main goal is to cure the disease.
D: Palliation - Palliative care focuses on relieving symptoms and improving quality of life in patients with advanced or incurable diseases. For Hodgkin lymphoma, the main goal is to aim for a cure rather than palliation.
A 12-year-old girl presents to your clinic with significant menstrual bleeding at the onset of menarche and is noted to have a hemoglobin of 9.9, although she is not symptomatic from her anemia. Her mother reports that she has a history of epistaxis when she was a child with some episodes lasting 30 minutes and that she also has heavy menstrual bleeding. Which of the following tests will lead to the most likely diagnosis?
A. Factor XI level
B. Factor X level
C. Factor XIII level
D. Ristoectin cofactor activity
Correct answer:
The correct answer is D: Ristoectin cofactor activity. This patient's history of significant menstrual bleeding, epistaxis, and low hemoglobin suggests a congenital bleeding disorder. Ristoectin cofactor activity is a test for von Willebrand disease (VWD), a common inherited bleeding disorder characterized by a deficiency or dysfunction of von Willebrand factor. VWD typically presents with mucocutaneous bleeding, such as epistaxis and menorrhagia.
Choice A: Factor XI level is not the most likely diagnosis as Factor XI deficiency (Hemophilia C) typically presents with bleeding after surgery or trauma, not mucocutaneous bleeding.
Choice B: Factor X level is not the most likely diagnosis as Factor X deficiency presents with bleeding that is more severe and can cause hemarthrosis, not typically seen in this patient.
Choice C: Factor XIII level is not the most likely diagnosis as Factor XIII deficiency leads to delayed wound healing and poor clot formation,
The client has a heart rate of 70, a slightly irregular rhythm and P waves that come in multiples. What is this rhythm called?
A. Third degree AV block
B. Type 2 second degree AV block
C. Type 1 second degree AV block
D. Junctional escape rhythm
Correct answer:
The correct answer is C: Type 1 second degree AV block. This rhythm is characterized by a slightly irregular rhythm and P waves that come in multiples, known as "grouped beating." In Type 1 AV block, there is a progressive lengthening of the PR interval until a QRS complex is dropped. This is consistent with the description provided in the question.
A: Third degree AV block is characterized by complete dissociation between the atria and ventricles, resulting in an atrial rate that is typically faster than the ventricular rate. This is not the case in the scenario described.
B: Type 2 second degree AV block is characterized by intermittent failure of conduction of P waves to the ventricles, resulting in dropped QRS complexes. This is not consistent with the description provided.
D: Junctional escape rhythm is characterized by an escape rhythm originating from the AV junction, resulting in a heart rate of 40-60 bpm. This is not the rhythm described
Tranquilizers intoxication (5-10 tablets) features include:
A. Euphoria burst of energy increase in motor activity wave warmth all over the body
B. Visual hallucinations a distorted feelling of time and space
C. Physical bliss body lightness a wish to fly motionlessness
D. Synaesthesia (the sounds can be tensed the colors can be heard)
Correct answer:
The correct answer is A because tranquilizers typically produce euphoria, burst of energy, increase in motor activity, and a warm sensation throughout the body. This is due to the sedative effects of tranquilizers, which can initially induce feelings of relaxation and well-being.
Choice B is incorrect because visual hallucinations and distorted perception of time and space are more commonly associated with hallucinogens rather than tranquilizers.
Choice C is incorrect because physical bliss, body lightness, a wish to fly, and motionlessness are not typical effects of tranquilizer intoxication.
Choice D is incorrect because synaesthesia, where senses mix and one sensory experience triggers another, is not a common effect of tranquilizers intoxication.
In summary, choice A is the correct answer as it aligns with the typical features of tranquilizers intoxication, while the other choices do not accurately describe the effects of tranquilizers.
RN exams cardiovascular practice questions, set 7 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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