Cardiovascular System and NCLEX-like Critical Thinking Questions

The client’s cardiac monitor shows ventricular tachycardia.  The nurse assesses the client and notices that the client has a pulse, but blood pressure is 69/45. What is the priority intervention?

A client is brought to the Emergency department with chest pain. Which of the following provides the greatest indication that the client is having an acute MI?

The nursing is preparing a teaching plan for a client who will be discharged on nitroglycerin paste. Which of the following is a very important teaching point that must be included?

History: The client is a 67-year-old male admitted to the Emergency Department with a complaint of palpitations x 30 minutes.  The client had a history of a CABG x 3 four months ago, diabetes, hyperlipidemia, hypertension, arthritis, gout, and BPH.

Nursing Assessment: The client is alert and oriented x4, moves all extremities equally, symmetrical facial expression. Lungs clear to auscultation bilaterally. No SOB.  S1 S2 present, no murmurs, but irregular heart rhythm auscultated at an average rate of 120. Denies chest pain, but states “I can feel my heart beating fast.”  All peripheral pulses 2+. No edema. Denies nausea. Abdomen soft with no masses. Bowel sounds active x 4 quadrants. 

Vital Signs:

• BP 110/55
• HR 139
• RR 20
• Temp 98.3° F
• Oxygen Saturation 98%

Based on the client’s assessment data, choose 2 actions to take, 1 potential condition and 2 parameters to monitor by typing an X in the corresponding gray box:

The client is a 59-year-old male who had a CABG x4 last year. He developed third degree AV block post-operatively and had a pacemaker placed. Today he comes to the ER with suspected pacemaker malfunction. Which of the following symptoms does the nurse expect in this client?

The client is admitted for exacerbation of left sided heart failure.  The physician orders furosemide 40mg IVP.  Which of the following is an expected outcome after furosemide administration?

The nurse is assessing a client with heart failure who has not been feeling well for the last week.  If the nurse can only ask one question, which of the following questions would be the best one?

The nurse is caring for a client who had an angiogram of the left leg for peripheral artery disease. Which of the following is the best position for the client after the angiogram?

The nurse is discharging a client with rheumatic heart disease who is recovering from endocarditis. Which of the following statements by the client requires further teaching?

The client is a 56-year-old female who works as a waitress at a busy restaurant.  The client complains that her legs are very painful towards the end of her shift.  The client asks the nurse what can she do to decrease the pain.  What is the best response by the nurse?

The client is a 64-year-old male with a history of a heart attack 2 years ago.  The client asks the nurse what is wrong with his legs since when he walks he experiences a lot of pain, which goes away when he rests.  Which of the following is the best response by the nurse?

The nurse admits a client with acute infective endocarditis.  What signs and symptoms should the nurse anticipate? Select 6 Choices.

The client was admitted two days ago with the diagnosis of acute myocardial infarction.  The nurse performs her initial assessment and finds that the client’s vital signs are as follow:  Temp 99.0 ° F,  BP  87/45,  HR  90, RR  24, and Oxygen saturation 93% on 4L Nasal Cannula. 

Client is alert and oriented x 3. S1, S2 with S3 heard upon auscultation. Lungs with crackles at the bases bilaterally. Skin cool to touch. Peripheral pulses +1 x 4 extremities. Urine output 250 in the last 24 hours.

The nurse reviews assessment findings and determines that the most likely condition that the client is experiencing is which of the following?

The nurse demonstrates understanding of the purpose of an arterial line when the nurse makes which of the following statements?

The client has gained 3 kg in the last 24 hours. Upon assessment, the nurse finds that the client has 2+ edema to the lower extremities, crackles to bilateral lung bases, and is complaining of shortness of breath. Vital Signs: Temp 98.2° F, BP 175/69,  HR 102,  RR 25.  The physician orders furosemide 40mg IV every 6 hours. Which of the following assessment findings shows that furosemide is being effective?

The nurse is discussing the therapeutic effects of nifedipine with a client with Raynaud’s Disease.  Which of the following points should the nurse include in the discussion?

How should the nurse interpret the above rhythm?

The nurse walks into a client’s room and see this rhythm on the monitor.  What should the nurse do FIRST?

The client is admitted to the intensive care unit with hypovolemic shock and a central catheter is inserted to monitor central venous pressure (CVP).  The nurse notifies the physician that the CVP is reading  2 mm Hg (normal 8 to 12 mm Hg), BP 88/45, and heart rate 119 bpm.  Which of the following orders should the nurse anticipate?

The nurse is giving a community presentation about the risk factors for hypertension.  Which of the following points should the nurse include?

The nurse is assessing a client.  Where should the nurse place the stethoscope to assess a murmur associated with aortic regurgitation?

After a cardiac catheterization, the client starts coughing forcefully. What is the nurse’s priority intervention?

A client has been on atrial fibrillation for 3 days with a rate that varies from 90 to 120 bpm. The client has occassional palpitations.  Which of the following are potential interventions at this point? Select all that apply.

The nurse is caring for a client who had a femoral-popliteal bypass graft 2 days ago.  The client complains of severe pain to the affected extremity.  What should the nurse do FIRST?

Which of the following teaching points should the nurse include in the teaching plan of a client with stable angina?

The nurse is caring for a 55-year-old client who had a coronary artery bypass (CABG) 4 hours ago.  The client’s chest tube output was 80 cc/hr x 3 hours.  The chest tube output in the last hour was only 10 mL.  

Vital signs: Temperature 100.4 ° F, HR 120 bpm, BP 80/62, RR on the ventilator.

Assessment: Sedated. +JVD, muffled heart tones, all peripheral pulses +1, skin cold and pale. Foley catheter with dark yellow urine 20 cc/last hour.

The nurse recognizes that the client is likely experiencing which of the following conditions?

The nurse is providing discharge teaching to a post-operative client who had a synthetic aortic valve displacement.  The client will be going home on Warfarin.  Which of the following points should the nurse include in the teaching plan? Select all that apply.

The experienced nurse is educating the new nurse about aortic aneurysms.  Which of the of the following teaching points should the experienced nurse include? Select all that apply.

The nurse is providing discharge teaching to a client with Buerger’s disease (thromboangiitis obliterans).  Which of the following statements by the client requires further teaching?

The nurse is administering Pentoxifylline (Trental) to a client with peripheral artery disease.  Which of the following is the expected outcome of this drug?

The nurse is caring for a client who had open heart surgery 4 hours ago.  Chest tube output has dropped from 110 mL/hour to nothing in the last hour and the client has developed jugular vein distension.

The client’s vital signs are as follows:

• BP 105/95 
• HR 110
• RR 16, sedated on the ventilator
• Oxygen Saturation 92% on 100% FIO2

The condition that this client is  most likely experiencing is___________________as evidenced by______________________

The emergency room nurse receives a call from a client who had outpatient elbow surgery today.  The client complains of severe pain and pale/numb fingers.  What should the nurse advise the client to do?

The nurse is caring for a client with the above rhythm.  The client’s blood pressure states “I feel anxious and like I have a hard time breathing.”  Which of the following are potential orders by the physician? Select all that apply.

The nurse is educating a client with peripheral artery disease.  Which of the following teaching points should the nurse include? Select all that apply.

• History: 58-year-old male with heart failure and Chronic Obstructive Pulmonary Disease.
• Medications: Digoxin 0.125 mg po daily, Furosemide 40 mg po daily, losartan 25 mg po daily, and aspirin 81 mg daily.
• The client complains of feeling tired, nausea, vomiting, and blurry vision.  Which of the following actions should the nurse take?

The above rhythm is from a client with symptomatic supraventricular tachycardia who received adenosine IV.  Notice how adenosine significantly slows down the heart to slow down the SVT (Sometimes adenosine can cause asystolic for a couple of seconds).  Which of the following interventions should the nurse have taken prior to administering adenosine?  Select all that apply.

Which of the following information should the nurse include in a teaching plan for a client with Raynaud Syndrome? Select all that apply.

The nurse has 4 clients with heart failure.  Which of the following clients should the nurse see first?

The physician has ordered alteplase for the client with the above EKG.  Which of the following findings in the client’s medical record should prompt the nurse to question the order?

The nurse is administering digoxin to a client with heart failure.  Which of the following findings requires follow up?

The nurse is developing a teaching plan for a client with hypertension.  Which of the following points should the nurse include? Select all that apply.

Which of the following clients is  at the highest risk for deep vein thrombosis?

The ICU nurse is caring for a client with cardiogenic shock who has a right radial arterial line.  Which of the following assessment findings is the most concerning?

The nurse is caring for a client with a heart rate of 44 bpm who is complaining of dizziness, nausea, and shortness of breath.  The nurse recognizes that which of the following medications is indicated for  this client?

The nurse is caring for a client who had an myocardial infarction and now has low urine output, decreased tissue perfusion, and altered level of consciousness.  Which of the following medication does the nurse anticipate to administer?

The nurse is caring for a client with cardiogenic shock.  Which of the following should be nurse’s priority action?

Which of the following is true of the hemodynamics of cardiogenic shock?

The nurse is caring for a client who had open heart surgery 2 hours ago.  Suddenly, the nurse notices excessive bloody drainage from the chest tube.  The nurse recognizes that the client will go into hypovolemic shock.  Which of the following hemodynamic parameters does the nurse expect?

The nurse is caring for a 9-month old client with this rhythm at a rate of 200 bpm.  What is the priority intervention for this client? 

The nurse is providing pre-operative education to a client who will have open heart surgery.  Which of the following information should the nurse include? Select all that apply. 

Which of the following interventions should the nurse include in the plan of care of a client with pheochromocytoma?

The nurse is caring for a client who had a coronary angiogram to visualize the coronary arteries.  The physician used the right femoral artery.  Which of the following assessment findings requires immediate follow up?