NCLEX Nursing Practice Test On Cardiovascular System

1. A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second. and QRS complexes measure 0.06 second. The overall heart rate is 64 beats per minute. The nurse assesses the cardiac rhythm as:

Normal sinus rhythm

Sinus bradycardia

Sick sinus syndrome

First-degree heart block.

measurements are normal. measuring 0.12 to 0.20 second and 0.4 to 0.10 second. respectively.

Explanation

measurements are normal. measuring 0.12 to 0.20 second and 0.4 to 0.10 second. respectively.

2. A client with rapid rate atrial fibrillation asks a nurse why the physician is going to perform carotid massage. The nurse responds that this procedure may stimulate the:

Vagus nerve to slow the heart rate

Vagus nerve to increase the heart rate; overdriving the rhythm.

Diaphragmatic nerve to slow the heart rate

Diaphragmatic nerve to overdrive the rhythm

Carotid sinus massage is one of the maneuvers used for vagal stimulation to decrease a rapid heart rate and possibly terminate a tachydysrhythmias. The others include inducing the gag reflex and asking the client to strain or bear down. Medication therapy often is needed as an adjunct to keep the rate down or maintain the normal rhythm.

Explanation

Carotid sinus massage is one of the maneuvers used for vagal stimulation to decrease a rapid heart rate and possibly terminate a tachydysrhythmias. The others include inducing the gag reflex and asking the client to strain or bear down. Medication therapy often is needed as an adjunct to keep the rate down or maintain the normal rhythm.

3. A nurse is viewing the cardiac monitor in a client's room and notes that the client has just gone into ventricular tachycardia. The client is awake and alert and has good skin color. The nurse would prepare to do which of the following?

Immediately defibrillate

Prepare for pacemaker insertion

Administer amiodarone (Cordarone) intravenously

Administer epinephrine (Adrenaline) intravenously

First-line treatment of ventricular tachycardia in a client who is hemodynamically stable is the use of antidysrhythmics such as amiodarone (Cordarone). lidocaine (Xylocaine). and procainamide (Pronestyl). Cardioversion also may be needed to correct the rhythm (cardioversion is recommended for stable ventricular tachycardia).Option A: Defibrillation is used with pulseless ventricular tachycardia.Option D: Epinephrine would stimulate and already excitable ventricle and is contraindicated.

Explanation

First-line treatment of ventricular tachycardia in a client who is hemodynamically stable is the use of antidysrhythmics such as amiodarone (Cordarone). lidocaine (Xylocaine). and procainamide (Pronestyl). Cardioversion also may be needed to correct the rhythm (cardioversion is recommended for stable ventricular tachycardia).Option A: Defibrillation is used with pulseless ventricular tachycardia.Option D: Epinephrine would stimulate and already excitable ventricle and is contraindicated.

4. A client is having frequent premature ventricular contractions. A nurse would place priority on assessment of which of the following items?

Blood pressure and peripheral perfusion

Sensation of palpitations

Causative factors such as caffeine

Precipitating factors such as infection

Premature ventricular contractions can cause hemodynamic compromise. The shortened ventricular filling time with the ectopic beats leads to decreased stroke volume and. if frequent enough. to decreased cardiac output.Option B: The client may be asymptomatic or may feel palpitations.Options C and D: PVCs can be caused by cardiac disorders or by any number of physiological stressors. such as infection. illness. surgery. or trauma. and by the intake of caffeine. alcohol. or nicotine.

Explanation

Premature ventricular contractions can cause hemodynamic compromise. The shortened ventricular filling time with the ectopic beats leads to decreased stroke volume and. if frequent enough. to decreased cardiac output.Option B: The client may be asymptomatic or may feel palpitations.Options C and D: PVCs can be caused by cardiac disorders or by any number of physiological stressors. such as infection. illness. surgery. or trauma. and by the intake of caffeine. alcohol. or nicotine.

5. A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves. the QRS complexes are wide. and the ventricular rate is regular but over 100. The nurse determines that the client is experiencing:

Premature ventricular contractions

Ventricular tachycardia

Ventricular fibrillation

Sinus tachycardia

Ventricular tachycardia is characterized by the absence of P waves. wide QRS complexes (usually greater than 0.14 second). and a rate between 100 and 250 impulses per minute. The rhythm is usually regular.

Explanation

Ventricular tachycardia is characterized by the absence of P waves. wide QRS complexes (usually greater than 0.14 second). and a rate between 100 and 250 impulses per minute. The rhythm is usually regular.

6. A client has developed atrial fibrillation. which a ventricular rate of 150 beats per minute. A nurse assesses the client for:

Hypotension and dizziness

Nausea and vomiting

Hypertension and headache

Flat neck veins

The client with uncontrolled atrial fibrillation with a ventricular rate more than 150 beats a minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations. chest pain or discomfort. hypotension. pulse deficit. fatigue. weakness. dizziness. syncope. shortness of breath. and distended neck veins.

Explanation

The client with uncontrolled atrial fibrillation with a ventricular rate more than 150 beats a minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations. chest pain or discomfort. hypotension. pulse deficit. fatigue. weakness. dizziness. syncope. shortness of breath. and distended neck veins.

7. A nurse is caring for a client with unstable ventricular tachycardia. The nurse instructs the client to do which of the following. if prescribed. during an episode of ventricular tachycardia?

Breathe deeply. regularly. and easily.

Inhale deeply and cough forcefully every 1 to 3 seconds.

Lie down flat in bed

Remove any metal jewelry

Cough Cardiopulmonary Resuscitation (CPR) sometimes is used in the client with unstable ventricular tachycardia. The nurse tells the client to use cough CPR. if prescribed. by inhaling deeply and coughing forcefully every 1 to 3 seconds. Cough CPR may terminate the dysrhythmia or sustain the cerebral and coronary circulation for a short time until other measures can be implemented.

Explanation

Cough Cardiopulmonary Resuscitation (CPR) sometimes is used in the client with unstable ventricular tachycardia. The nurse tells the client to use cough CPR. if prescribed. by inhaling deeply and coughing forcefully every 1 to 3 seconds. Cough CPR may terminate the dysrhythmia or sustain the cerebral and coronary circulation for a short time until other measures can be implemented.

8. A nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves or definable QRS complexes. Instead. there are coarse wavy lines of varying amplitude. The nurse assesses this rhythm to be:

Ventricular tachycardia

Ventricular fibrillation

Atrial fibrillation

Asystole

Ventricular fibrillation is characterized by irregular. chaotic undulations of varying amplitudes. Ventricular fibrillation has no measurable rate and no visible P waves or QRS complexes and results from electrical chaos in the ventricles.

Explanation

Ventricular fibrillation is characterized by irregular. chaotic undulations of varying amplitudes. Ventricular fibrillation has no measurable rate and no visible P waves or QRS complexes and results from electrical chaos in the ventricles.

9. A nurse notices frequent artifact on the ECG monitor for a client whose leads are connected by cable to a console at the bedside. The nurse examines the client to determine the cause. Which of the following items is unlikely to be responsible for the artifact?

Frequent movement of the client

Tightly secured cable connections

Leads applied over hairy areas

Leads applied to the limbs

Motion artifact. or “noise.” can be caused by frequent client movement. electrode placement on limbs. and insufficient adhesion to the skin. such as placing electrodes over hairy areas of the skin. Electrode placement over bony prominences also should be avoided. Signal interference can also occur with electrode removal and cable disconnection.

Explanation

Motion artifact. or “noise.” can be caused by frequent client movement. electrode placement on limbs. and insufficient adhesion to the skin. such as placing electrodes over hairy areas of the skin. Electrode placement over bony prominences also should be avoided. Signal interference can also occur with electrode removal and cable disconnection.

10. A nurse is watching the cardiac monitor. and a client's rhythm suddenly changes. There are no P waves; instead. there are wavy lines. The QRS complexes measure 0.08 second. but they are irregular. with a rate of 120 beats a minute. The nurse interprets this rhythm as:

Sinus tachycardia

Atrial fibrillation

Ventricular tachycardia

Ventricular fibrillation

Atrial fibrillation is characterized by a loss of P waves; an undulating. wavy baseline; QRS duration that is often within normal limits; and an irregular ventricular rate. which can range from 60 to 100 beats per minute (when controlled with medications) to 100 to 160 beats per minute (when uncontrolled).

Explanation

Atrial fibrillation is characterized by a loss of P waves; an undulating. wavy baseline; QRS duration that is often within normal limits; and an irregular ventricular rate. which can range from 60 to 100 beats per minute (when controlled with medications) to 100 to 160 beats per minute (when uncontrolled).