CARDIAC NCLEX PRACTICE EXAM NCLEX CARDIAC

CARDIAC NCLEX PRACTICE EXAM /NCLEX CARDIAC

PRACTICE EXAM 2023-2024 ACTUAL EXAM 400 QUESTIONS

AND CORRECT DETAILED ANSWERS WITH RATIONALES

(VERIFIED ANSWERS) |ALREADY GRADED A+

The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL.What should the nurse do next?

• Withhold the daily dose until the following day.
• Withhold the dose and report the potassium level.
• Give the digoxin with a salty snack, such as crackers.
• Give the digoxin with extra fluids to dilute the sodium level. - ANSWER- b.

Withhold the dose and report the potassium level.

The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the potassium level. The physician may order the digoxin to be given once the potassium level has been treated and decreases to within normal range.

What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure?

• Urine output
• Lung sounds 1 / 4

• Blood pressure
• Respiratory rate - ANSWER- c. Blood pressure

Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.

A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)?

• Administer ordered morphine sulfate.
• Position patient in a semi-Fowler's position.
• Position patient on left side with head of bed flat.
• Instruct patient on the use of relaxation techniques.
• Use a calm, reassuring approach while talking to patient. - ANSWER- a, b, d, &

e

Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety.

A male patient with a long-standing history of heart failure has recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient?

• Taper the patient off his current medications.
• Continue education for the patient and his family. 2 / 4

• Pursue experimental therapies or surgical options.
• Choose interventions to promote comfort and prevent suffering - ANSWER- d.

Choose interventions to promote comfort and prevent suffering.

The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount.Medications should be continued unless they are not tolerated. Experimental therapies and surgeries are not commonly used in the care of hospice patients.

What should the nurse recognize as an indication for the use of dopamine (Intropin) in the care of a patient with heart failure?

• Acute anxiety
• Hypotension and tachycardia
• Peripheral edema and weight gain
• Paroxysmal nocturnal dyspnea (PND) - ANSWER- b. Hypotension and

tachycardia

Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.

A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient?

• Reduce preload.
• Decrease afterload. 3 / 4

• Increase contractility.
• Promote vasodilation. - ANSWER- a. Reduce preload.

Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.

A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid?

• High-potassium foods
• Drugs to treat erectile dysfunction
• Nonsteroidal antiinflammatory drugs
• Over-the-counter H2 -receptor blockers - ANSWER- b. Drugs to treat erectile

dysfunction

The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. High-potassium foods, NSAIDs, and H2-receptor blockers do not pose a risk in combination with nitrates.

A stable patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before positioning the patient on the bedside, what should the nurse assess first?

• Urine output
• Heart rhythm
• Breath sounds
• Blood pressure - ANSWER- d. Blood pressure
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