NCLEX-RN PRACTICE QUESTIONS AND ANSWERS (CARDIAC) 2022

NCLEX-RN PRACTICE QUESTIONS AND ANSWERS (CARDIAC) 2022 A patient diagnosed with mild heart failure is prescribed hydrochlorothiazide (Microzide). The healthcare provider should determine the teaching about the med ...

NCLEX-RN PRACTICE QUESTIONS AND ANSWERS (CARDIAC) 2022 A patient diagnosed with mild heart failure is prescribed hydrochlorothiazide (Microzide). The healthcare provider should determine the teaching about the medication has been successful if the patient makes which of these statements? A. "I should not worry if I experience a dry cough when taking this medication." B. "It is important for me to change positions slowly because I might become dizzy." C. "This medication might cause me to have a decrease in my appetite." D. "I might experience swelling in my legs when taking this medication." - ANS-B. "It is important for me to change positions slowly because I might become dizzy." *Hydrochlorothiazide inhibits sodium reabsorption, causing sodium and water (along with potassium and hydrogen ions) to be excreted. The diuretic effect and decrease in fluid volume may cause orthostatic (postural) hypotension. Position changes should be made slowly to prevent falls. A patient diagnosed with heart failure has a pulmonary artery catheter (PAC) in place. What information about the patient's hemodynamic functioning will the healthcare provider obtain from this monitoring device? A. Pulmonary valve function B. Stroke volume C. Left ventricular functioning D. Coronary artery patency - ANS-C. Left ventricular functioning *The PAC can measure left ventricular end-diastolic pressure, which is an indication of left ventricular functioning. A patient who has a history of pulmonary valve stenosis tells the healthcare provider, "I don't have a lot of energy anymore, and both of my feet get swollen in the late afternoon." Which of these problems does the healthcare provider conclude is the likely cause of these clinical findings? A. Acute pericarditis B. Deep vein thrombosis (DVT) C. Peripheral artery disease D. Right ventricular failure - ANS-D. Right ventricular failure *A sign of right ventricular failure is peripheral edema. A patient is diagnosed with heart failure and is prescribed digoxin (Lanoxin) and furosemide (Lasix). Before administering the furosemide to the patient, which laboratory result should the healthcare provider to review? A. Serum sodium B. Serum troponin C. Serum potassium D. Blood urea nitrogen (BUN) - ANS-C. Serum potassium *Furosemide may cause hypokalemia, which increases the risk of digoxin toxicity. A patient has been admitted to the cardiac unit with a diagnosis of right ventricular failure. Which of the following assessment findings would the healthcare provider expect to observe? is most likely to be observed by the healthcare provider? A. Fatigue and hemoptysis B. Bradycardia and circumoral cyanosis C. Dyspnea and pulmonary crackles D. Peripheral edema and jugular vein distension - ANS-D. Peripheral edema and jugular vein distention *The right ventricle receives blood from the right atrium. If right ventricular pumping is impaired, blood will back up through the right atrium and into the venous system. The laboratory results of a patient diagnosed with heart failure shows a serum digoxin (Lanoxin) level of 2.1 ng/mL. Which medication is appropriate to administer at this time? A. Furosemide (Lasix) B. Digoxin immune fab (DigiFab) C. An increased dose of digoxin (Lanoxin) D. Potassium chloride (K-tab) - ANS-B. Digoxin immune fab (DigiFab) *A therapeutic digoxin serum concentration for heart failure is 0.5 - 0.9 ng/mL. *A level of 2.1 ng/mL is considered toxic so the antidote, digoxin immune fab, is appropriate to administer at this time. When considering physiological changes common in geriatric patients, the healthcare provider understands that which of these factors may increase the risk of heart failure in older patients? A. Increased myocardial contractility B. Increased stroke volume C. Impaired diastolic filling D. Decreased sympathetic activity - ANS-C. Impaired diastolic filling *Impaired filling during diastole may result in diastolic heart failure. A patient is being assessed for possible heart failure. Which of these laboratory results will provide support this diagnosis? A. Decreased serum sodium B. Increased creatine kinase C. Decreased C-reactive protein D. Increased brain natriuretic peptide (BNP) - ANS-D. Increase brain natriuretic peptide (BNP) *Increased fluid volume causes an increased stretch of the myocardium, causing the cells to release BNP. BNP is a peptide that opposes the actions of the reninangiotensin system. When obtaining a health history of a patient admitted with a diagnosis of heart failure, which statement made by the patient supports the diagnosis of heart failure? A. "I get hot and break out in a sweat during the night." B. "I get out of breath when I go up a flight of stairs." C. "I sometimes feel pain in the middle of my chest during exercise." D. "I often feel pain in my lower legs when I take my walk." - ANS-B. "I get out of breath when I go up a flight of stairs." *Decreased pumping ability of the heart results in decreased cardiac output and pulmonary congestion, causing shortness of breath. When assessing a patient with chronic heart failure, the healthcare provider would expect to identify which of these clinical manifestations? A. Expiratory wheezing B. Asymmetrical chest expansion C. Subcutaneous crepitus D. Inspiratory crackles - ANS-D. Inspiratory crackles *When there is decreased pumping ability of the heart fluid backs up into the pulmonary system. Inspiratory crackles are caused when air collides with fluid in the lungs. The healthcare provider is reviewing health data collected on a group of patients at risk for high-output heart failure. Which of the following problems increase a patient's risk for this disorder? Choose all answers that apply: A. Cirrhosis B. Chronic anemia C. Hyperthyroidism D. Pericarditis E. Aortic valve stenosis - ANS-A. Cirrhosis B. Chronic anemia C. Hyperthyroidism *Hyperthyroidism is associated with sympathetic nervous system and adrenal activation, resulting in an increased metabolic rate. *Decreased oxygen-carrying capacity of the blood causes the heart to work harder to deliver oxygen to the tissues. *Cirrhosis can cause fluid shifts, leading to decreased circulating volume, causing the heart to work harder to circulate blood around the body. A patient diagnosed with right ventricular failure presents to the clinic with bilateral pitting edema. Which of the following circulatory changes does the healthcare provider conclude are responsible for this patient's clinical presentation? Choose all answers that apply: A. Increased plasma hydrostatic pressure B. Decreased lymphatic return to the heart C. Decreased plasma colloidal pressure D. Increased right atrial pressure E. Venous valvular incompetence - ANS-A. Increased plasma hydrostatic pressure B. Decreased lymphatic return to the heart D. Increased right atrial pressure *Plasma proteins are responsible for the colloidal pressure in the circulatory system. *Impaired right ventricular pumping causes increased pressure in the venous system. *Increased right atrial pressure interferes with lymphatic return to the central circulation. A patient diagnosed with heart failure has been prescribed digoxin (Lanoxin). Which of the following will the healthcare provider include when teaching the patient about this medication? Choose all answers that apply: A. "Call our office if you experience nausea or lack of appetite." B. "You should keep a record of your daily weights." C. "Report any visual changes to our office immediately." D. "Increase dietary sodium to maintain your fluid balance." E. "If your pulse is less than 60 beats per minute, do not take the medication." F. "If you miss a dose, you should double the dose next time." - ANS-A. "Call our office if you experience nausea or lack of appetite." B. "You should keep a record of your daily weights." C. "Report any visual changes to our office immediately." E. "If your pulse is less than 60 beats per minute, do not take the medication." *The patient needs to know how to recognize signs and symptoms of digoxin toxicity. *Doubling the dose of digoxin is not safe because it has a narrow therapeutic index. *Increased dietary sodium adds to the circulatory volume and can increase the workload on the heart. The healthcare provider is administering an angiotensin converting enzyme (ACE) inhibitor to a patient diagnosed with heart failure. Which of the following describe the ways in which the ACE inhibitor is therapeutic for the patient who has heart failure?