NCLEX-RN DRILL: MEDICAL SURGICAL CARDIOVASCULAR B

Medical Surgical Nursing is a very broad area in the field of Nursing for it tackles the management of different client condition. Books in Medical Surgical Nursing are usually divided according to the Organ System of the Human Body. The Cardiovascular System is one of the most difficult areas to study and to master since any deviation in this system will affect every organ system. Mastery is needed to be able to answer board type questions pertaining to Cardiovascualr System.

1. The nurse realizes that more teaching is needed when the client on a cardiac low-cholesterol diet makes which choice from the menu?
a. Stewed chicken, green beans, and noodles
b. Liver and onions, salad with ranch dressing, and milk
c. Ham and bean soup, salad with vinaigrette dressing, and cornbread
d. Pork roast, brown rice, and beets

2. When taking a client’s medical history, which are the precipitating factors for myocardial infarction?
(Select all that apply.)
a. Hypothyroidism
b. Cigarette smoking
c. Hyperlipidemia
d. Rheumatic fever
e. Elevated serum iron level
f. High density lipids 40 mg
g. Using oral contraceptives

3. When the nurse performs an admission assessment on a client, the nurse notes that the client has xanthomas present on both eyelids. The laboratory value that the nurse would want to check based on this assessment finding is
a. triglyceride level
b. homocystine level
c. cardiac enzymes—CPK-MB, troponin, and myoglobin
d. cholesterol panel

4. A client presents to the clinic with the following symptoms: a burning sensation in the lower extremities, thickened toe nails, and pain in legs when walking. The nurse would assess the client for which additional factor consistent with Burger’s disease (thromboangitis obliterans)?
a. Bounding peripheral pulses
b. Rubor when the extremities are elevated
c. Intolerance to heat
d. Symptoms triggered by stress

5. A goal for a client with arteriosclerosis obliterans is to increase arterial blood supply to the extremities. Which of the following nursing interventions would be appropriate for this goal?
a. Elevate the extremities above the level of the heart for 15 minutes four times a day.
b. Have client perform Buerger-Allen exercises four times a day.
c. Maintain client on bed rest with legs in a neutral position.
d. Position client in high-Fowler’s position with legs straight.

6. Which of the following assessment findings are consistent with the diagnosis of venous stasis?
a. Absent or diminished peripheral pulses
b. Hair loss on the extremity
c. Moist ulcers around the malleolus
d. Edema of the extremity
e. Coolness of the extremity
f. Leathery quality of the extremity
g. Pallor of the extremity

7. A client is returned to the unit after having a repair of an abdominal aortic aneurysm. The nurse should place the client in which of the following positions?
a. High-Fowler’s
b. Sims
c. Semi-Fowler’s
d. Flat

8. The nurse is giving a client low molecular weight heparin, enoxaparin. The correct nursing interventions when administering this medication include all of the following except
a. using a TB syringe
b. injecting the medicine using Z-track method
c. not rubbing the site postinjection
d. administering the medicine in the anterolateral abdominal wall

9. In order to prevent the postoperative complication of thrombophlebitis in a client who has had mitral valve replacement, the nurse would have the client engage in which of the following activities?
a. Perform dorsiflexion of the feet several times every hour while awake
b. Cough and take deep breaths every hour while awake
c. Sit up in a chair for several hours during the afternoon
d. Eat a high-fiber, high-calorie diet

10. The nurse is caring for a client who has just arrived on the unit following a cardiac catheterization. Which of the following assessments would be most immediate?
a. Heart and lung sounds
b. Pain at the catheter insertion site
c. Pulses distal to the insertion site
d. Urine output

11. A client comes into the ER complaining of “his heart racing.” Cardiac monitor shows atrial tachycardia with a ventricular rate of 190 bpm. The nurse anticipates that the physician will order adenosine (Adenocard) to be given. Prior to giving the medication the nurse should do which of the following?
a. Determine when the client last ate
b. Ask the laboratory to draw serum BUN and creatinine levels
c. Ask the client if he/she has a history of asthma
d. Have the client sign a consent

12. Metoprolol tartrate (Lopressor) is ordered for a client who has had a myocardial infarction. The nurse would expect which therapeutic result from administration of this drug?
a. Increased urinary output
b. Decreased coronary artery spasms
c. Increased cardiac output
d. Decreased resting heart rate

13. A client’s cardiac monitor strip shows the following: HR 42/min, rhythm regular, PRI 0.16 seconds, QRS 0.06 seconds. The client is experiencing dizziness, nausea, and chest pain rated as 3 on a scale of 1–10 with 10 being the worst pain. The drug of choice to treat this dysrhythmia is
a. Lidocaine (Xylocaine)
b. Adenosine (Adenocard)
c. Atropine sulfate
d. Epinephrine (Adrenalin)

14. A client is admitted to the ER with new onset atrial fibrillation with a ventricular response of 110/min. The nurse would anticipate which of the following treatment options to be ordered. (Select all that apply.)
a. Defibrillation
b. Start oxygen at 2–4 lpm
c. Anticoagulant therapy
d. Medicate with beta blocker
e. Start Lidocaine drip
f. Atrial pacing

15. The nurse is assessing a newborn infant who is exhibiting the following signs and symptoms: elevated blood pressure, bounding brachial pulses, diminished pedal pulses, elevated Jugular venous distention (JVD), and cardiac murmur. Based on the assessment, the nurse would suspect that the client may have which of the following conditions?
a. Congestive heart failure
b. Coarctation of the aorta
c. Mitral valve prolapse
d. Transposition of the great vessels

16. The nurse has assessed a client and has determined that the client is exhibiting signs and symptoms of left heart failure. Identify which of the following are indicative of left heart failure.
a. Tachypnea, loss of appetite, ST elevation on the ECG
b. Hemoptysis, cogwheel murmur, midsternal chest pain
c. Ascites, oliguria, fatigue
d. Orthopnea, bibasilar crackles, gallop rhythm

17. The nurse is providing nutritional counseling for a client who is receiving a loop diuretic. Which meal plan would be most appropriate for this client?
a. Raisin bran cereal, tomato juice, whole grain toast
b. Boiled chicken, green beans, tossed salad
c. Vegetable soup, low-salt crackers, skim milk
d. Poached fish, beets, macaroni and cheese

18. The nurse is reading a 6-second cardiac rhythm strip and notes 9 QRS complexes in it. The client’s heart rate is
a. 54
b. 63
c. 81
d. 90

19. A client has been diagnosed with pericardial effusion. The nurse would prepare the client for which of the following procedures?
a. Myotomy
b. Pericardiectomy
c. Pericardiostomy
d. Dynamic cardiomyoplasty

20. Which instruction would be inappropriate to give a client following coronary artery bypass graft surgery?
a. No driving for 6–8 weeks
b. Avoid smoking or tobacco use for 4–6 weeks
c. No heavy lifting for 6–8 weeks
d. Can resume sexual intercourse in 3–4 weeks