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Cardiovascular System Questions and Answers for NCLEX-PN and NCLEX-RN
Question 1: The nurse counts an adult’s apical heart beat at 110 beats per minute. The nurse describes this as:
The nurse would describe an adult’s apical heart rate of 110 beats per minute as tachycardia, which is defined as a heart rate above the normal range for adults, typically above 100 beats per minute. Tachycardia can be caused by a variety of factors, including stress, exercise, medication, and medical conditions such as hyperthyroidism or heart disease. The nurse may want to monitor the patient’s heart rate and assess for any other signs or symptoms of an underlying condition.
Question 3: A client has an elevated AST 24 hours following chest pain and shortness of breath. What dieses it may be?
An elevated AST (aspartate aminotransferase) level 24 hours following chest pain and shortness of breath may indicate an acute myocardial infarction (heart attack) or other cardiac issues. AST is an enzyme that is present in high concentrations in the liver, heart, and skeletal muscle. When these tissues are damaged, AST is released into the bloodstream, resulting in elevated levels.
In the case of chest pain and shortness of breath, an elevated AST level is often a sign of damage to the heart muscle due to reduced blood flow, which can occur during a heart attack. However, elevated AST levels can also occur in other conditions such as viral hepatitis, liver disease, and muscle injury. Therefore, additional tests and evaluations may be needed to determine the underlying cause of the elevated AST level. It is important for the client to receive prompt medical attention and evaluation to determine the cause of their symptoms and develop an appropriate treatment plan.
Question 3: An adult has a coagulation time of 20 minutes. The nurse should observe the client for which?
If an adult has a coagulation time of 20 minutes, which is longer than the normal range of 8-12 minutes, the nurse should observe the client for signs of bleeding. Prolonged coagulation time indicates a deficiency in one or more clotting factors, which can impair the body’s ability to form clots and stop bleeding.
Some signs of bleeding that the nurse should observe for may include:
- Easy bruising or bleeding from minor injuries
- Excessive bleeding from wounds or surgical sites
- Prolonged bleeding after a tooth extraction or other dental procedures
- Blood in the urine or stool
- Heavy or prolonged menstrual periods
- Frequent nosebleeds or bleeding gums
The nurse should also monitor the client’s vital signs and report any signs of hypovolemia, such as low blood pressure, rapid heart rate, or decreased urine output. If bleeding is severe, the nurse should initiate appropriate interventions, such as applying pressure to the bleeding site, administering blood products, or contacting the healthcare provider for further orders.
Question 4: A prothrombin time test should be performed regularly on persons who are taking which medication?
A prothrombin time (PT) test should be performed regularly on persons who are taking warfarin, a medication used to prevent blood clots. Warfarin works by inhibiting the production of vitamin K-dependent clotting factors, which prolongs the time it takes for blood to clot.
Regular PT testing is necessary to monitor the effectiveness of warfarin therapy and ensure that the client’s blood is not too thin, which can increase the risk of bleeding. The results of the PT test are used to adjust the client’s warfarin dosage as needed to maintain the appropriate level of anticoagulation.
The frequency of PT testing may vary depending on the client’s individual circumstances and the healthcare provider’s orders. In general, clients taking warfarin will have their PT tested at least once a month, or more frequently if their dosage is being adjusted or if they experience any signs of bleeding or clotting.
Question 5: Which prothrombin time value would be considered normal for a client who is receiving warfarin (Coumadin)?
For a client who is receiving warfarin (Coumadin), the prothrombin time (PT) value is usually monitored to assess the effectiveness of the medication. The target PT range for clients receiving warfarin therapy varies depending on the indication for treatment, but a therapeutic range of 1.5 to 2.5 times the control value is generally considered appropriate for most clients.
The normal range of PT for clients not taking warfarin is usually around 11 to 13.5 seconds, but for clients taking warfarin, the target PT range may be adjusted based on the client’s individual characteristics and medical history.
Therefore, the normal prothrombin time value for a client receiving warfarin would depend on the individual client’s target range as set by their healthcare provider, but it is typically 1.5 to 2.5 times the control value. It is important for clients receiving warfarin to have regular PT tests to monitor their response to the medication and adjust their dosage as needed to maintain the appropriate level of anticoagulation.
Question 6: The nurse is caring for a client who is receiving heparin. What drug should be readily available?
If a nurse is caring for a client who is receiving heparin, it is important to have protamine sulfate readily available as an antidote in case of heparin overdose or bleeding.
Heparin is an anticoagulant medication that works by inhibiting the activity of clotting factors, thereby preventing the formation of blood clots. However, if the dose of heparin is too high, or if the client has an underlying bleeding disorder, it can increase the risk of bleeding.
Protamine sulfate is a medication that works by neutralizing the anticoagulant effects of heparin, making it an effective antidote for heparin overdose or bleeding. The nurse should be familiar with the dose and administration of protamine sulfate and should have it readily available in case of an emergency.
In addition to having protamine sulfate available, the nurse should also monitor the client for signs of bleeding, such as easy bruising, bleeding from the gums, nosebleeds, blood in the urine or stool, or excessive bleeding from wounds or surgical sites. The nurse should report any signs of bleeding to the healthcare provider promptly and implement appropriate interventions to manage bleeding, such as applying pressure to the bleeding site or administering blood products if necessary.
Question 7: An adult who is receiving heparin asks the nurse why it cannot be given by mouth. The nurse responds that heparin is given parenterally because:
The nurse would respond to the client that heparin cannot be given by mouth because it would be destroyed by the digestive enzymes in the stomach and would not be absorbed properly into the bloodstream. Therefore, heparin is given parenterally, which means it is administered by injection or infusion into the bloodstream, usually through a vein in the arm or a central line.
Parenteral administration allows heparin to be rapidly absorbed into the bloodstream, where it can exert its anticoagulant effects. Heparin injections are typically given subcutaneously or intravenously, depending on the indication for treatment and the client’s individual needs.
Intravenous heparin is usually used for clients who require more immediate anticoagulant effects, such as those with deep vein thrombosis or pulmonary embolism. Subcutaneous heparin is typically used for clients who require longer-term prophylaxis against blood clots, such as those who are at high risk of developing blood clots after surgery or during prolonged bed rest.
Overall, the parenteral administration of heparin allows for rapid and effective anticoagulation while minimizing the risk of gastrointestinal side effects that may occur with oral anticoagulant medications.
Question 8: An adult who is admitted for a cardiac catheterization asks the nurse if she will be asleep during the cardiac catheterization. What is the best initial response for the nurse to make?
The best initial response for the nurse to make would be to explain that a cardiac catheterization is typically performed with the client under local anesthesia and conscious sedation, but that the client can be given medications to help them relax and feel more comfortable during the procedure.
The nurse could say something like: “During a cardiac catheterization, you will be given medications to help you feel more relaxed and comfortable. You will not be completely asleep, but you will be under local anesthesia and conscious sedation, which means you will be awake but may not remember much of the procedure. The healthcare provider will explain the details of the procedure and answer any questions you may have.”
It is important to provide clear and accurate information to the client and address any concerns or questions they may have about the procedure. The nurse should also explain the benefits and risks of the procedure, including potential complications such as bleeding, infection, or damage to the blood vessels or heart. The nurse should encourage the client to ask questions and voice any concerns they may have before the procedure.
Question 9: During the admission interview, a client who is admitted for a cardiac catheterization says, “Every time I eat shrimp I get a rash.” What action is essential for the nurse to take at this time?
When a client reports a possible allergic reaction during an admission interview, it is essential for the nurse to take action by notifying the healthcare provider and documenting the client’s reported symptoms and allergy history.
In this scenario, the nurse should ask the client to describe the rash in more detail, including when it occurs, how long it lasts, and any other associated symptoms. The nurse should also ask about any other food or medication allergies, as well as the client’s history of asthma, hives, or anaphylaxis.
Once the nurse has obtained this information, they should notify the healthcare provider and document the client’s reported symptoms and allergy history in the medical record. The healthcare provider may want to order further testing or precautions to prevent allergic reactions during the cardiac catheterization.
In addition to notifying the healthcare provider, the nurse should also ensure that the client’s allergy status is communicated to all members of the healthcare team who will be involved in the client’s care. This can help to prevent accidental exposure to allergens and minimize the risk of allergic reactions or other adverse events during the procedure.
Question 10: The nurse is preparing a client for a cardiac catheterization. Which action would the nurse expect to take?
The nurse preparing a client for a cardiac catheterization would be expected to take the following actions:
- Verify informed consent: The nurse should verify that the client has given informed consent for the procedure, and that they understand the risks, benefits, and alternatives.
- Assess the client’s vital signs and overall health status: The nurse should assess the client’s blood pressure, heart rate, respiratory rate, and oxygen saturation, as well as any other relevant health information that may impact the procedure or post-procedure care.
- Check for allergies: The nurse should ask the client about any known allergies or adverse reactions to medications or contrast dye, as well as any history of asthma, hives, or anaphylaxis.
- Ensure that the client is NPO: The nurse should ensure that the client has been instructed to be NPO (nothing by mouth) for a certain amount of time prior to the procedure, typically at least 6 hours.
- Administer pre-procedure medications: The nurse may administer medications to help the client relax or prevent complications, such as sedatives, anti-anxiety medications, or anticoagulants.
- Assist with pre-procedure preparations: The nurse may assist the healthcare provider with preparing the client for the procedure, such as positioning the client on the procedure table and ensuring that sterile drapes are in place.
- Monitor the client during the procedure: The nurse may monitor the client’s vital signs, oxygen saturation, and electrocardiogram (ECG) during the procedure, and communicate any changes or concerns to the healthcare provider.
- Provide post-procedure care: The nurse should monitor the client’s vital signs and assess for any complications, such as bleeding, hematoma, or allergic reactions. The nurse may also provide post-procedure instructions and discharge teaching, and ensure that the client receives appropriate follow-up care.
Question 11: A young adult with a history of rheumatic fever as a child is to have a cardiac catheterization. She asks the nurse why she must have a cardiac catheterization. What should the nurse’s response is based on the understanding that cardiac catheterization can accomplish?
If a young adult with a history of rheumatic fever as a child is scheduled to have a cardiac catheterization, the nurse’s response to why she must have the procedure would be based on the understanding that cardiac catheterization can help to identify any abnormalities or damage to the heart caused by rheumatic fever.
Rheumatic fever is a complication of streptococcal infections that can damage the heart valves and lead to rheumatic heart disease. Cardiac catheterization is a diagnostic procedure that uses a catheter to access the heart and measure various parameters, such as blood flow, pressure, and oxygen levels. It can also help to visualize the heart’s structures and identify any abnormalities or damage.
Therefore, the nurse’s response to the young adult’s question may include the following points:
Cardiac catheterization can help to assess the function and structure of the heart.
It can identify any abnormalities or damage that may have been caused by rheumatic fever.
This information can help the healthcare provider determine the best course of treatment and management for the client’s condition.
The nurse can also explain that the procedure is generally safe and well-tolerated, and that the healthcare team will take steps to minimize any discomfort or risk of complications. The nurse may also offer to provide additional information or resources to help the client feel more informed and comfortable with the procedure.
Question 12: When a client returns from undergoing a cardiac catheterization, it is most essential for the nurse to:
After a client undergoes cardiac catheterization, it is crucial for the nurse to monitor the client closely to detect any complications or adverse reactions to the procedure. The following are the essential nursing interventions:
- Assess the client’s vital signs frequently to detect any signs of hemodynamic instability, such as hypotension or tachycardia.
- Monitor the client’s puncture site for signs of bleeding, hematoma formation, or infection.
- Assess the client’s level of consciousness and neurological status, particularly if they have received sedation or anesthesia during the procedure.
- Monitor the client’s urine output and renal function to detect any potential renal complications.
- Administer prescribed medications, such as anticoagulants, antiplatelet agents, or analgesics, as ordered.
- Provide adequate hydration to prevent contrast-induced nephropathy.
- Educate the client on post-procedure care and discharge instructions.
By closely monitoring the client’s vital signs, puncture site, neurological status, renal function, medication administration, and education, the nurse can ensure the client’s safety and reduce the risk of complications.
Question 13: A male client with angina pectoris has been having an increased number of episodes of pain recently. He is admitted for observation. During the admission interview, he tells the nurse that he has been having chest pain during the last week. Which statement by the client would be of greatest concern to the nurse?
“The chest pain is more severe and lasts longer than before.”
“The chest pain occurs with less exertion than before.”
“I have been having chest pain at rest.”
“The chest pain is not relieved by nitroglycerin as it used to be.”
Question 14: The nurse responds to the call light of a client who has a history of angina pectoris. He tells the nurse that he has just taken a nitroglycerin tablet sublingually for anginal pain. What action should the nurse take next?
If a client with a history of angina pectoris tells the nurse that they have taken a nitroglycerin tablet sublingually for anginal pain, the nurse should take the following actions:
- Assess the client’s vital signs, particularly blood pressure and heart rate, to detect any changes.
- Ask the client to rate their level of pain on a scale of 0-10 to determine if the nitroglycerin has provided relief.
- Determine the time and dose of the last nitroglycerin tablet taken by the client.
- Reassure the client that the nurse will stay with them and monitor their condition.
- Document the client’s response to the nitroglycerin and any interventions provided.
- Notify the healthcare provider if the client’s pain is not relieved or if the client has taken multiple nitroglycerin tablets.
- Educate the client on the proper use of nitroglycerin and when to seek medical attention.
Nitroglycerin is a potent vasodilator and can cause a drop in blood pressure, leading to hypotension and other adverse effects. Therefore, close monitoring of the client’s vital signs and symptoms is essential to prevent complications. The nurse should also assess the client’s pain level and provide appropriate interventions to manage their symptoms.
Question 15: The nurse is teaching an adult who has angina about taking nitroglycerin. The nurse tells him he will know the nitroglycerin is effective when:
The nurse should teach the adult with angina pectoris about the use of nitroglycerin and inform them of the expected response. The client will know the nitroglycerin is effective when they experience relief from their anginal pain. Nitroglycerin works by dilating the blood vessels, increasing blood flow to the heart, and reducing the workload on the heart. This results in relief from chest pain or discomfort caused by angina. Therefore, when the client experiences relief from their anginal pain, it is an indication that the nitroglycerin is effective. The nurse should also advise the client to seek medical attention if their pain is not relieved by nitroglycerin or if they require more than three doses of nitroglycerin within 15 minutes.
Question 16: A client with angina will have to make lifestyle modifications. Which statements by the client would indicate that he understands the necessary modifications in lifestyle to prevent angina attacks?
If a client has angina, they need to make several lifestyle modifications to prevent angina attacks. The following are the statements by the client that would indicate their understanding of the necessary lifestyle modifications:
- “I will need to quit smoking completely to reduce the risk of angina attacks.”
- “I understand that I will need to limit my alcohol intake as it can trigger angina symptoms.”
- “I will need to follow a heart-healthy diet and limit my intake of saturated and trans fats, cholesterol, and sodium.”
- “I will need to engage in regular exercise as directed by my healthcare provider to improve my overall cardiovascular health.”
- “I will need to manage my stress levels through relaxation techniques or stress-reduction techniques such as yoga or meditation.”
- “I understand that I will need to take my medications as prescribed and keep regular follow-up appointments with my healthcare provider.”
- These statements demonstrate that the client understands the importance of lifestyle modifications to prevent angina attacks. The nurse should reinforce these lifestyle modifications and provide additional education and resources to support the client’s efforts to maintain a healthy lifestyle.
Question 17: A client who has been treated for angina is discharged in stable condition. At a clinic visit, he tells the nurse he has anginal pain when he has sexual intercourse with his wife. What is the best response for the nurse to make?
If a client who has been treated for angina reports anginal pain during sexual intercourse to the nurse during a clinic visit, the nurse should provide the following response:
Assess the client’s current symptoms and determine the severity of the pain.
Review the client’s current medications and ensure that they are taking their anti-anginal medications as prescribed.
Educate the client on the appropriate use of nitroglycerin before engaging in sexual activity to prevent anginal pain.
Advise the client to avoid sexual activity after a heavy meal or during periods of high stress.
Recommend alternative sexual positions that may be less physically demanding and less likely to trigger anginal pain.
Encourage the client to communicate openly with their partner about their condition and to seek medical attention if they experience prolonged or severe anginal pain during sexual activity.
Provide reassurance and support to the client and their partner and address any concerns or questions they may have.
It is essential to educate the client on the use of nitroglycerin before engaging in sexual activity to prevent anginal pain. Nitroglycerin can be taken 5-10 minutes before sexual activity to dilate blood vessels, increase blood flow to the heart, and reduce the risk of angina attacks. The nurse should also recommend alternative sexual positions that are less physically demanding and provide emotional support to the client and their partner.
Question 18: A low-sodium, low-cholesterol, weight-reducing diet is prescribed for an adult with heart disease. The nurse knows that he understands his diet when he chooses which meals?
- A low-sodium, low-cholesterol, weight-reducing diet is essential for an adult with heart disease to prevent further complications. The following meal choices indicate that the client understands the diet:
- Grilled chicken breast with a side of steamed vegetables and a small baked potato, seasoned with herbs and spices instead of salt.
- A mixed salad with leafy greens, fresh vegetables, and a vinaigrette dressing instead of a creamy or high-fat dressing. A small serving of grilled fish or chicken can be added for protein.
- A bowl of oatmeal with fresh berries and a small handful of nuts for breakfast instead of a high-fat breakfast sandwich or processed cereal.
- A vegetable and bean soup with a side of whole-grain bread instead of a high-sodium canned soup and white bread.
- A homemade turkey burger patty with a side of roasted sweet potato wedges instead of a high-fat, high-sodium fast-food burger and fries.
These meal choices are low in sodium, low in cholesterol, and low in fat, which are essential components of a heart-healthy diet. The nurse should also encourage the client to limit their intake of processed foods, fast food, and high-sugar drinks, which can lead to weight gain and increased risk of heart disease.
Question 19: An adult client is admitted with a diagnosis of left-sided congestive heart failure. Which assessment finding would most likely be present?
Left-sided congestive heart failure (CHF) occurs when the left ventricle of the heart is unable to pump blood effectively to the rest of the body. The following assessment findings would most likely be present in an adult client with left-sided CHF:
- Shortness of breath: This is one of the most common symptoms of left-sided CHF. The client may feel breathless even during rest or after mild physical activity.
- Crackles or wheezes in the lungs: Due to fluid accumulation in the lungs, the client may exhibit crackles or wheezes during auscultation of the lungs.
- Cyanosis or pallor: Reduced oxygen supply to the body tissues can lead to cyanosis or pallor, especially in the extremities.
- Tachycardia: The heart may try to compensate for the decreased cardiac output by increasing the heart rate.
- Hypertension: The body may try to compensate for the decreased cardiac output by increasing blood pressure.
- Fatigue and weakness: Due to reduced blood supply to the muscles, the client may feel fatigued and weak even with minimal exertion.
- Decreased urine output: The kidneys may be affected by the reduced cardiac output, leading to decreased urine output.
These assessment findings indicate that the client is experiencing left-sided CHF, and prompt medical intervention is required to manage the condition and prevent further complications.
Question 20: Digoxin (Lanoxin) and furosemide (Lasix) are commonly prescribed medications for the management of congestive heart failure (CHF). The nurse would also expect other medications and interventions to be ordered for this client, such as:
- ACE inhibitors: These medications can help reduce blood pressure and improve heart function.
- Beta-blockers: These medications can help reduce heart rate and blood pressure, thereby reducing the workload on the heart.
- Potassium supplements: Furosemide can cause potassium loss, so potassium supplements may be prescribed to prevent hypokalemia.
- Low-sodium diet: A low-sodium diet can help reduce fluid retention and manage blood pressure.
- Fluid restriction: The client may be instructed to restrict their fluid intake to reduce fluid overload and manage symptoms of CHF.
- Daily weight monitoring: Daily weight monitoring can help detect fluid retention and guide adjustments to medication and fluid management.
- Oxygen therapy: Supplemental oxygen may be prescribed to improve oxygenation and reduce the workload on the heart.
These interventions, along with the prescribed medications, are essential components of the management of congestive heart failure and can help improve symptoms, prevent complications, and improve overall quality of life for the client.