NCLEX PN EXIT FINAL EXAM QUESTIONS

NCLEX PN EXIT FINAL EXAM QUESTIONS

Complication of an MI that occurs when the pumping power of the heart has diminished heart failure

Results when the infarcted myocardial wall is thin and bulges out during contraction ventricular aneurysm

Characterized by chest pain, which may vary from mild to severe, and is aggravated by inspiration, coughing, and movement of the upper body Pericarditis

A patient has a severe blockage in his right coronary artery. Which cardiac structure is mostly likely to be affected by this?

• Atrioventricular (AV) node
• Left ventricle
• Coronary sinus
• Pulmonary valve

A - The right coronary artery (RCA) supplies blood to the right atrium, the right ventricle, and a portion of the posterior wall of the left ventricle. In 90% of people, the RCA supplies blood to the AV node, the bundle of His, and part of the cardiac conduction system.

If the Purkinje system is damaged, conduction of the electrical impulse is impaired through the

• atria.
• AV node.
• ventricles.
• bundle of His.

C - VENTRICLES.

The action potential of the electrical impulse diffuses widely through the walls of both ventricles by means of Purkinje fibers.

The portion of the vascular system responsible for hemostasis is the

• thin capillary vessels.
• endothelial layer of the arteries.
• elastic middle layer of the veins.
• smooth muscle of the arterial wall.

C - The innermost lining of the arteries is the endothelium. The endothelium maintains hemostasis, promotes blood flow, and under normal conditions, inhibits blood coagulation.

When a person's blood pressure rises, the homeostatic mechanism that compensates for the elevation involves stimulation of

• baroreceptors that inhibit the sympathetic nervous system, causing

vasodilation.

• chemoreceptors that inhibit the sympathetic nervous system, causing

vasodilation.

• baroreceptors that inhibit the parasympathetic nervous system, causing

vasodilation.

• chemoreceptors that stimulate the sympathetic nervous system, increasing the

heart rate.A - baroreceptors that inhibit the SNS, causing VASODILATION

Baroreceptors in the aortic arch and carotid sinus are sensitive to stretch or pressure within the arterial system. Stimulation of these receptors sends information to the vasomotor center in the brainstem. This results in temporary inhibition of the sympathetic nervous system and enhancement of the parasympathetic influence, decreasing the heart rate and peripheral vasodilation.You are providing care for a patient who has decreased cardiac output related to heart failure. You recognize that cardiac output is

• calculated by multiplying the patient's stroke volume by the heart rate.
• the average amount of blood ejected during one complete cardiac cycle.
• determined by measuring the electrical activity of the heart and the patient's

heart rate.

• the patient's average resting heart rate multiplied by the patient's mean arterial

blood pressure.

• CO = SV x HR

Cardiac output is determined by multiplying the patient's stroke volume by heart rate, identifying how much blood is pumped by the heart over a 1-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output.Which cardiovascular effects of aging should you anticipate when providing care for older adults (select all that apply)?

• Arterial stiffening
• Increased blood pressure
• Increased maximal heart rate
• Decreased maximal heart rate
• Increased recovery time from activity

• Increased recovery time from activity

A, B, D, E.

Well-documented cardiovascular effects of the aging process include arterial stiffening, possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease rather than increase with age.The patient is positioned sitting upright and learning forward. After exhalation, you auscultate a high-pitched scratchy heart sound intermittently at the apex.What is the best interpretation of this sound?

• The patient has a I/VI heart murmur.
• An S4 atrial gallop is heard.
• Pericardial friction rub is caused by pericarditis.
• Normal splitting of the S2 cardiac sound is heard.

C - pericardial friction rub

Pericardial friction rubs are sounds caused by friction that occurs when inflamed surfaces of the pericardium (pericarditis) move against each other. They are high- pitched, scratchy sounds that are heard best at the apex with the patient upright and leaning forward and after expiration. A murmur is caused by turbulent blood flow across diseased heart values; a I/VI murmur is barely audible. An S4 heart sound is a low- frequency vibration that precedes the S1. Normal splitting of S2 is best heard at the pulmonic area during inspiration.What are considered significant findings related to cardiac disease (select all that apply)?

• Paroxysmal nocturnal dyspnea
• Body mass index (BMI) of 22 kg/m2
• History of streptococcal throat infections
• Nocturia
• Otitis media

A, C, and D Attacks of shortness of breath, especially at night, that awaken the patient are associated with heart failure. History of improperly treated streptococcal sore throat can cause heart valve damage. Nocturia is a common finding with cardiovascular patients. A BMI of 22 kg/m2 is normal. There is no relationship between otitis media and cardiac disease.The auscultatory area in the left midclavicular line at the level of the fifth intercostal space (ICS) is the

• aortic valve area.
• mitral valve area.
• tricuspid valve area.
• pulmonic valve area.

A - The mitral valve can be assessed by auscultation at the left midclavicular line at the fifth ICS.

Which is a correct aspect of a cardiac assessment?

• Auscultate the carotid artery to hear a thrill.
• The point of maximal impulse is at the fifth left intercostal space.
• Erb's point is located at the right second intercostals space.
• S1 and S2 cardiac sounds are best heard with the bell of the stethoscope.

When the patient is supine, the mitral valve area is the point of maximal impulse (PMI), which is also known as the apical pulse. It reflects the pulsation of the apex of the heart and is located at the left midclavicular line in the fifth intercostal space. A thrill is assessed by touch, a bruit is heard by auscultation, and Erb's point is located at the third left intercostal space, near the sternum. It is where the S2 heart sound is normally heard best. S1 and S2 are best heard with the diaphragm of the stethoscope because they are high-pitched sounds.What does a pulse deficit indicate?cardiac dysrhythmias When assessing the cardiovascular system of a 79-year-old patient, you expect to find

• a narrowed pulse pressure.
• diminished carotid artery pulses.
• difficulty in isolating the apical pulse.
• an increased heart rate in response to stress.

C - Myocardial hypertrophy and the downward displacement of the heart in an older adult may result in difficulty isolating the apical pulse.Auscultation of a patient's heart reveals a murmur. This assessment finding is a result of

• increased viscosity of the patient's blood.
• turbulent blood flow across a heart valve.
• friction between the heart the myocardium.
• a deficit in heart conductivity that impairs normal contractility.

B - Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium.While assessing the cardiovascular status of a patient, you perform auscultation.Which practice should you implement into the assessment during auscultation?

• Position the patient supine.
• Ask the patient to hold his or her breath.
• Palpate the radial pulse while auscultating the apical pulse.
• Use the bell of the stethoscope when auscultating S1 and S2.

C - Rationale

To detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. The diaphragm of the stethoscope is more appropriate than the bell when auscultating S1 and S2. A sitting or side-lying position is most appropriate for cardiac