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Home Nursing Practice Tests 50 Items NCLEX Exam: Coronary

Artery Disease and Hypertension

50 Items NCLEX Exam: Coronary Artery


Disease and Hypertension
March 30, 2015 Hung Justin

NCLEX Exam Coronary Artery Disease and Hypertension


An NCLEX practice exam dedicated to Coronary Artery Disease and Hypertension.
This exam contains 50 items about the two diseases.
Topics: Coronary Artery Disease, Hypertension.

Guidelines

Read each question carefully and choose the best answer.


You are given one minute per question. Spend your time wisely!

Answers and rationales are given below. Be sure to read them.

The NCLEX Exam: Coronary Artery Disease and Hypertension includes 50 multiple
choice questions in 2 sections.

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Exam Finished
Thank you for your time.

NCLEX Exam: Coronary Artery Disease and Hypertension (Sections 1)


When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select

all that apply.

1. Indicated electrical impulse beginning at the AV node


2. Reflects electrical impulse beginning at the SA node
3. Reflects atrial muscle depolarization
4. Identifies ventricular muscle depolarization - Given

5. Has duration of normally 0.11 seconds or less.


A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The
clients prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result

is:

1. Higher than the therapeutic range


2. The same as the clients own baseline level - Given
3. Lower than the needed therapeutic level
4. Within the therapeutic range

Which of the following factors can cause blood pressure to drop to normal levels?

1. Kidneys excretion of sodium and water


2. Kidneys retention of sodium and water - Given
3. Kidneys retention of sodium and excretion of water

4. Kidneys excretion of sodium only


A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the following

assessments is most critical before the procedure?

1. Height and weight


2. Intake and output - Given
3. Allergy to iodine or shellfish
4. Baseline peripheral pulse rates

Which of the following types of pain is most characteristic of angina?

1. Sharp
2. Shooting - Given
3. Knifelike
4. Tightness
Which of the following diagnostic tools is most commonly used to determine the location of myocardial

damage?

1. Cardiac catheterization
2. Electrocardiogram (ECG) - Given
3. Cardiac enzymes
4. Echocardiogram
Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the

client to use the drug when chest pain occurs?

1. Take one tablet every 2 to 5 minutes until the pain stops.


2. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10
minutes. - Given
3. Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call
the physician if pain persists after three tablets.

4. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5
minutes later, call the physician.
Which of the following symptoms should the nurse teach the client with unstable angina to report

immediately to her physician?

1. A change in the pattern of her pain - Given

2. Pain during sex


3. Pain during or after an activity such as lawn mowing
4. Pain during an argument with her husband

Which of the following parameters is the major determinant of diastolic blood pressure?

1. Renal function
2. Baroreceptors - Given
3. Cardiac output
4. Vascular resistance
A client with no history of cardiovascular disease comes into the ambulatory clinic with flu-like symptoms.
The client suddenly complains of chest pain. Which of the following questions would best help a nurse to

discriminate pain caused by a non-cardiac problem?

1. Can you rate the pain on a scale of 1-10, with 10 being the worst? - Given

2. Does the pain get worse when you breathe in?


3. Can you describe the pain to me?
4. Have you ever had this pain before?
A 60-year-old male client comes into the emergency department with complaints of crushing chest pain
that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction.
Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2

mg of morphine given intravenously. The nurse should first:

1. Obtain the lab work


2. Order the chest x-ray

3. Administer the morphine


4. Obtain a 12-lead ECG - Given
A client is experiencing tachycardia. The nurses understanding of the physiological basis for this symptom

is explained by which of the following statements?

1. Respirations are labored


2. The demand for oxygen is decreased because of pleural involvement
3. The heart has to pump faster to meet the demand for oxygen when there is lowered

arterial oxygen tension - Given


4. The inflammatory process causes the body to demand more oxygen to meet its needs

In order to prevent the development of tolerance, the nurse instructs the patient to:

1. Switch to sublingual nitroglycerin when the patients systolic blood pressure elevates

to >140 mm Hg - Given
2. Apply the nitroglycerin patch every other day
3. Use the nitroglycerin patch for acute episodes of angina only
4. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night
When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together,

the nurse bases teaching on the knowledge that:

1. This combination promotes diuresis but decreases the risk of hypokalemia


2. Moderate doses of two different types of diuretics are more effective than a large dose
of one type - Given
3. This combination prevents dehydration and hypovolemia
4. Using two drugs increases osmolality of plasma and the glomerular filtration rate
During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in
her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing
severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina
pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up

appointment, she is discouraged because she is experiencing pain with increasing frequency. She

state

1. Take a nitroglycerin tablet before climbing the stairs - Given

2. Lie down once she reaches the friends apartment


3. Visit her friend earlier in the day
4. Rest for at least an hour before climbing the stairs
A clients physician orders nuclear cardiography and makes an appointment for a thallium scan. The

purpose of injecting radioisotope into the bloodstream is to detect:

1. Normal vs. abnormal tissue - Given

2. Myocardial scarring and perfusion


3. Ventricular function
4. Damage in areas of the heart
A murmur is heard at the second left intercostal space along the left sternal border. Which valve is

this?

1. Tricuspid
2. Aortic - Given
3. Mitral
4. Pulmonic
A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no

electrocardiogram complexes on the screen. The first action of the nurse is to:

1. Press the recorder button on the electrocardiogram console


2. Check the client status and lead placement - Given
3. Call a code blue
4. Call the physician

The most important long-term goal for a client with hypertension would be to:

1. Make a commitment to long-term therapy


2. Learn how to avoid stress - Given
3. Explore a job change or early retirement
4. Control high blood pressure
When teaching a client about propranolol hydrochloride, the nurse should base the information on the

knowledge that propranolol hydrochloride:

1. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
2. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance
and lowers blood pressure. - Given
3. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial
contractility, and conduction.
4. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking
the conversion of angiotensin I to angiotensin II
Baroreceptors in the carotid artery walls and aorta respond to which of the following

conditions?

1. Changes in arterial oxygen tension


2. Changes in arterial carbon dioxide tension - Given
3. Changes in blood pressure
4. Changes in heart rate
A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension.

Before administered propranolol, which of the following actions should the nurse take first?

1. Question the physician about the order - Given

2. Instruct the client to take medication with food


3. Caution the client to rise slowly when standing

4. Monitor the apical pulse rate


The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the

client that this procedure is being used in this specific case to:

1. Open and dilate the blocked coronary arteries - Given

2. Bypass obstructed vessels


3. Assess the extent of arterial blockage
4. Assess the functional adequacy of the valves and heart muscle
When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the

purpose of this drug is to:

1. Prevent kidney failure


2. Help keep him well hydrated - Given
3. Dissolve clots he may have
4. Treat potential cardiac arrhythmias

Which of the following blood tests is most indicative of cardiac damage?

1. Complete blood count (CBC) - Given

2. Creatine kinase (CK)


3. Lactate dehydrogenase
4. Troponin I

NCLEX Exam: Coronary Artery Disease and Hypertension (Sections 2)


A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse

understands that leg ulcers of this nature are usually caused by:

1. Trauma to the lower extremities


2. Decreased arterial blood flow secondary to vasoconstriction
3. Atherosclerotic obstruction of the arteries

4. Decreased arterial blood flow leading to hyperemia - Given

Direct-acting vasodilators have which of the following effects on the heart rate?

1. Heart rate decreases


2. Heart rate becomes irregular - Given
3. Heart rate remains significantly unchanged
4. Heart rate increases
Which of the following instructions should be included in the discharge teaching for a patient discharged

with a transdermal nitroglycerin patch?

1. If you get chest pain, apply a second patch right next to the first patch.
2. Apply the patch to a non hairy, nonfatty area of the upper torso or arms. - Given
3. Apply the patch to the same site each day to maintain consistent drug absorption.
4. If you get a headache, remove the patch for 4 hours and then reapply.
Which of the following terms describes the force against which the ventricle must expel

blood?

1. Preload
2. Afterload - Given
3. Overload
4. Cardiac output
When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for

the:

1. Impulse to transverse the atria to the AV node


2. Impulse to begin atrial contraction
3. Impulse to travel to the ventricles - Given

4. SA node to discharge the impulse to begin atrial depolarization

A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94,
24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would

expect which cardiac enzyme to rise within the next 3 to 8 hours?

1. LDH-2
2. Lactic dehydrogenase (LDH) - Given
3. LDH-1
4. Creatine kinase (CK or CPK)
Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often
goes undetected until symptoms of other system failures occur. This may occur in the form

of:

1. Cerebrovascular accident
2. Liver disease
3. Myocardial infarction - Given

4. Pulmonary disease
A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead
ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are
returned. All of the following will be included in the nursing care plan. Which activity has the highest

priority?

1. Monitoring vital signs


2. Maintaining at least one IV access site - Given
3. Maintaining cardiac monitoring
4. Completing a physical assessment
A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was

admitted 2 days ago. The nurse would plan to do which of the following next?

1. Request a sodium restriction of 1 g/day from the physician


2. Review the intake and output records for the last 2 days - Given

3. Order daily weights starting the following morning


4. Change the time of diuretic administration from morning to evening
Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease,
which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he
says that he doesnt understand why he needs to be there because there is nothing that can be done to make

him better. The best nursing response is:

1. Cardiac rehabilitation is not a cure but can help restore you to many of your former
activities.
2. Do you feel that you will have to make some changes in your life now?
3. You are probably right but we can gradually increase your activities so that you can

live a more active life. - Given


4. Here we teach you to gradually change your lifestyle to accommodate your heart
disease.
One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of
ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances

should the nurse suspect?

1. Hypokalemia
2. Hypernatremia - Given
3. Hypermagnesemia
4. Hypocalcemia
As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg

given sublingually. This drugs principal effects are produced by:

1. Improved conductivity in the myocardium


2. Causing an increased myocardial oxygen demand - Given
3. Vasodilation of peripheral vasculature
4. Antispasmodic effect on the pericardium

Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of

the heart?

1. Inferior
2. Lateral - Given
3. Apical
4. Anterior

When do coronary arteries primarily receive blood flow?

1. During inspiration
2. During systole - Given
3. During expiration
4. During diastolic
A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures

accurate measurement by avoiding which of the following?

1. Measuring the blood pressure after the client has been seated quietly for 5 minutes.
2. Seating the client with arm bared, supported, and at heart level. - Given
3. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.
4. Using a cuff with a rubber bladder that encircles at least 80% of the limb.
A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the
nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of
indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute

per NC. The nurses next action would be to:

1. Draw blood for laboratory studies


2. Start an intravenous line - Given
3. Obtain a portable chest radiograph
4. Call for the doctor

A client is receiving spironolactone to treat hypertension. Which of the following instructions should the

nurse provide?

1. Avoid salt substitutes.


2. Eat foods high in potassium. - Given
3. Take daily potassium supplements.
4. Discontinue sodium restrictions.
The nurse receives emergency laboratory results for a client with chest pain and immediately informs the

physician. An increased myoglobin level suggests which of the following?

1. Myocardial infarction
2. Cancer - Given
3. Liver disease
4. Hypertension

Which of the following arteries primarily feeds the anterior wall of the heart?

1. Left anterior descending artery


2. Internal mammary artery
3. Circumflex artery - Given

4. Right coronary artery


To evaluate a clients condition following cardiac catheterization, the nurse will palpate the

pulse:

1. At the insertion site


2. Above the catheter insertion
3. In all extremities - Given

4. Distal to the catheter insertion

The nurse teaches the client with angina about the common expected side effects of nitroglycerin,

including:

1. Shortness of breath
2. High blood pressure
3. Headache - Given

4. Stomach cramps
A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why
both medications are being administered. In formulating a response, the nurse incorporates the

understanding that warfarin:

1. Stimulates production of the bodys own thrombolytic substances, but it takes 2-4
days for this to begin.
2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this
medication to exert an anticoagulant effect. - Given
3. Has the same mechanism of action as Heparin, and the crossover time is needed for
the serum level of warfarin to be therapeutic.
4. Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days
for this to exert an anticoagulant effect.
IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the

following medications is available on the nursing unit?

1. Aminocaproic acid
2. Protamine sulfate - Given
3. Vitamin K
4. Potassium chloride
A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit
with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client

activities?

1. Bathroom privileges and self-care activities - Given

2. Unsupervised hallway ambulation with distances under 200 feet


3. Ad lib activities because the client is monitored
4. Strict bed rest for 24 hours after transfer
Which of the following terms is used to describe the amount of stretch on the myocardium at the end of

diastole?

1. Preload
2. Cardiac index - Given
3. Cardiac output
4. Afterload

Total Points: 15 correct out of 50