NCLEX-PN : Conditions and Treatments

Study concepts, example questions & explanations for NCLEX-PN

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Example Questions

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Example Question #1 : Symptoms And Tests For Cardiovascular Conditions

The nurse works in the emergency department and assesses a patient who is complaining of mid-sternal chest pain. What is the nurse’s first action?

Possible Answers:

Examine the patient's chest and auscultate

Obtain a complete history

Order an electrocardiogram

Notify the physician

Assess the patient's vital signs

Correct answer:

Assess the patient's vital signs

Explanation:

The first nursing action for a patient arriving in distress to the emergency department is always to begin with priority assessments including vital signs. It provides a baseline for the healthcare team to use when further assessment and treatment is implemented. An electrocardiogram may be used later but is not a priority action, and is ordered by the primary care provider and not the nurse. A thorough medical history and physical assessment will be useful but is not the first action the nurse must take. The physician should be notified but the nurse must assess vital signs first.

Example Question #2 : Symptoms And Tests For Cardiovascular Conditions

Which EKG lead localizes to the base of the heart?

Possible Answers:

V6

V1

I

V5

aVF

Correct answer:

aVF

Explanation:

aVF is the main lead that points to the base of the heart (inferiorly). ST segment elevations in this lead help localize the area of infarction and can help identify the coronary artery involved. The precordial leads (V1-V6) do not point towards the base of the heart. Lead I is considered a lateral lead.

Example Question #1 : Cardiovascular Condition Follow Up

The nurse instructs the client to do which of the following to prevent dislodgment of the pacing catheter after insertion of a permanent demand pacemaker via the right subclavian vein has been made?
Possible Answers:
Do active range-of-motion exercises with right arm
Limit movement and abduction of left arm
Ask for help in getting out of bed and use walker to ambulate
Limit movement and abduction of right arm
Correct answer: Limit movement and abduction of right arm
Explanation: The nurse should instruct the patient to limit movement and abduction of right arm. The muscles and movement of the right arm most directly effect the placement of the pacing catheter.

Example Question #22 : Cardiovascular Conditions

A 57-year-old female presents to the clinic after newly diagnosed with stage one hypertension. The nurse is responsible for teaching this client about the condition. 

The nurse should include what information in teaching this client about her medications?

Possible Answers:

"Hypertension is a chronic condition, and cannot be cured but controlled with medication, diet, and exercise."

"The most optimal time to take medications is after a warm bath or exercise because blood pressure will be highest at these times."

"It is necessary to completely eliminate sodium from the diet as it may interfere with your prescribed medication."

"You should measure your blood pressure several times daily to ensure the effectiveness of prescribed medications."

"If side effects of medications arise, take stop taking the medication immediately."

Correct answer:

"Hypertension is a chronic condition, and cannot be cured but controlled with medication, diet, and exercise."

Explanation:

Hypertension is an incurable condition, and can be controlled by various interventions. Sodium should be redced but not eliminated, and blood pressure taken by the patient should be performed once daily then weekly after blood pressure has stabilized. Patient should be encouraged to report serious side effects to the physician before stopping the medications. Optimal times to take medications are on a regular basis, not after warm baths, alcohol ingestion, or strenous exercise. 

Example Question #1 : Ecg Analysis

A client has just undergone an electrocardiogram (ECG), the nurse notes that the QRS complex is measured to be 0.09 seconds. What is the first action the nurse should take?

Possible Answers:

The nurse should document this finding

Place on a cardiac monitor to check for arrhythmias

Call the physician

Administer oxygen 

Administer dopamine

Correct answer:

The nurse should document this finding

Explanation:

This is a normal finding, the QRS should have a duration between 0.6-0.12 seconds. 

Example Question #1271 : Nclex

You are taking care of an elderly patient who is hospitalized for sudden onset of severe, diffuse abdominal pain out of proportion to the patient's abdominal physical exam that is also accompanied by rectal bleeding and palpitations. You obtain an ECG and notice a tachycardic, irregularly irregular rhythm without any distinct P waves. Which of the following is the most likely cardiac rhythm seen on this patient's ECG?

Possible Answers:

Atrial fibrillation (A-fib)

Complete heart block

Sick sinus syndrome

Atrial flutter

First-degree heart block

Correct answer:

Atrial fibrillation (A-fib)

Explanation:

The most likely cardiac rhythm on this patient's ECG is atrial fibrillation

Atrial fibrillation is a tachyarrhythmia that is characterized on ECG by absence of distinct P waves, oscillating "f" waves that cause an irregular baseline rhythm, and abnormal, inconsistent R-R intervals that produce an irregularly irregular rhythm.

When a patient is in atrial fibrillation, the patient may be asymptomatic, but at other times, the patient may complain of a rapid heartbeat, or a feeling of uneasiness. The clues in this case that the patient is in atrial fibrillation are that the ECG shows the characteristic irregularly irregular rhythm, with an absence of any distinct P waves.

Clinically, the other clues are that the patient is complaining of palpitations while simultaneously experiencing sudden onset of severe, diffuse abdominal pain that is out of proportion to the abdominal physical exam, and is accompanied by rectal bleeding. This is very consistent with mesenteric ischemia (a condition in which a patient, typically in atrial fibrillation, projects a blood clot to one of the mesenteric vessels, causing ischemia to the bowel served by the affected vessel). While, this was not asked in the question explicitly, and the question could be answered without this knowledge, this helps confirm the diagnosis if you are aware of it.

The other answers are incorrect for the following reasons:

1) Atrial flutter typically presents with a "sawtooth" waveform and has more regularity in wavelength. 

2) Sick sinus syndrome is also known as tachy-brady syndrome, indicating that the patient has frequent fluctuations between tachycardia and bradycardia. In this instance, we have ECG findings that are very consistent with atrial fibrillation and show no evidence of bradycardia.

3) First-degree heart block and complete heart block are each typically characterized by bradycardia rather than tachycardia, and do not appear like atrial fibrillation on ECG.

Example Question #1 : Ecg Analysis

A patient presents with thirty minute history of substernal chest pain that radiates to his left jaw. Which of the following EKG changes would you expect in this patient if his troponin level came back positive at ?

Possible Answers:

PR widening

ST elevation

PR shortening

QT prolongation

ST depression

Correct answer:

ST elevation

Explanation:

Substernal chest pain that radiates to the jaw is classic of myocardial infarction. Elevated troponin and EKG changes help confirm the diagnosis (reference levels are about . ST segment elevation is classically seen in myocardial infarctions that result in positive troponin.

Example Question #1 : Ecg Analysis

You are a nurse taking care of a patient in the emergency room. Among other acute labwork and imaging, you obtain an electrocardiogram (ECG) of the patient. The ECG shows Osborn waves. Which of the following is the most common cause of Osborn waves on ECG?

Possible Answers:

Ethanol toxicity

Hyperthermia

Hypothermia

Carbon monoxide poisoning

Lead poisoning

Correct answer:

Hypothermia

Explanation:

The correct answer is "hypothermia." Osborn waves on electrocardiogram are the pathognomonic finding associated with hypothermia (to a core body temperature of lower than 32 C). Osborn waves are observed as upward deflections in the ECG reading between the QRS and ST intervals with an elevation at the S point (which is sometimes also referred to as the J point). While hypothermia is the most common cause of Osborn waves, they may also be observed in patients with coronary vasospasm, hypercalcemia, ventricular fibrillation, or brain trauma. 

Neither hyperthermia, ethanol toxicity, carbon monoxide poisoning, nor lead poisoning are associated with Osborn waves on ECG.

Example Question #1 : Ecg Analysis

An EKG of your patient shows peaked T-waves. This finding correlates to which electrolyte abnormality?

Possible Answers:

Low sodium

Low potassium

High calcium

High sodium

High potassium

Correct answer:

High potassium

Explanation:

Peaked T-waves are a warning sign for elevated levels of potassium in the body. On the other hand, flattened T-waves are potentially indicative of low levels of potassium. Hyperkalemia (high potassium) is a potentially dangerous condition that can lead to cardiac abnormalities and potentially death.

Example Question #1 : Ecg Analysis

What is the most common EKG finding in a patient with a pulmonary embolism?

Possible Answers:

ST elevation

Sinus bradycardia

ST depression

Sinus tachycardia

Correct answer:

Sinus tachycardia

Explanation:

Sinus tachycardia is the most common EKG finding in a pulmonary embolism. This represents the heart beating faster as an infarction occurs within the lung tissue. Peaked T waves are seen in hyperkalemia. ST elevation is seen in myocardial infarction, and ST depression is seen in myocardial ischemia. Sinus bradycardia would not be the expected finding in a PE.

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