QUIZ MEDSURG LECTURE 7.

Because the client has repeated episodes of angina that

1. A 55-year-old client comes to the emergency room and have not been relieved with sublingual nitroglycerin, the
states that he had chest pain lasting for 10 minutes after physician prescribes nitroglycerin transdermal patch Which
walking up the steps. After resting, his pain subsided. Which nursing action is most appropriate when applying a new
of the following is the client experiencing? transdermal patch?
A) MI A) Rotate the application site.
B) Angina B) Clean the skin with alcohol.
C) Pneumothorax C) Take the blood pressure afterward.
D) Cardiac tamponade
8. Because the client is exhibiting signs and symptoms of
2. A 64 year old male client with a long history of congestive heart failure (CHF), which position suggested by
cardiovascular including angina is to be scheduled for cardiac the nurse is most beneficial for the client at this time?
catheterization. During pre cardiac catheterization teaching, A) Supine with knees slightly bent
nurse Zoe should inform the client that the primary purpose of B) Side-lying on the right side
the procedure is C) Side-lying on the left side
A) To determine the existence of CHF: D)semi fowlers position
B) To visualize the disease process in the coronary atery.
C) To obtain the heart chambers of the heart. 9. Before administering the digoxin (Lanoxin) to the
D) To measure oxygen content of different heart chambers. Client, what nursing assessment is essential?
A) The clients heart rate
3. A client with CAD experiences periodic chest pain and is B) The clients blood pressure
diagnosed with angina pectoris. If the client is typical of others C) The clients heart sounds
who have angina pectoris the nurse would expect the client to D) The clients breath sounds
report that chest pain is best relieved by which
nonpharmacological measure? 10. Before the cardiac catheterization, it is essential for the
A) Taking a deep breath nurse to ask the client about any allergy to iodine or which
B) Resting in a chair other substance?
C) Applying heat to the chest A) Penicillin
D) Rubbing the ches B) Morphine
C) Shellfish
4. After the acute phase of CHF, the nurse should expect the D) Eggs
dietary management of the client to include the restriction of
A) Potassium 11. If the chest pain is not relieved after taking one
B) Calcium nitroglycerin tablet the nurse should teach the client to take
C) Sodium what action?
D) Magnesium A) take another tablet in 5 minutes
B) drive to the emergency department
5. After the femoral artery has been cannulated during cardiac C) Call the physician immediately.
catheterization and the client is returned to the room what D) Swallow two additional tablets.
should the nurse plan to do first?
A) Palpate the clients distal peripheral pulses. 12. If the client develops digoxin toxicity, what would the nurse
B) Auscultate the clients heart and breath sounds. expect the client to exhibit?
C) Percuss all four quadrants of the clients abdomen. A) Anorexia and nausea
D) Inspect the skin integrity in the clients groin. B) Dizziness and insomnia
C) Pinpoint pupils and double vision
6. Based on the results of the cardiac catheterization, the D) Ringing in the ears and itchy skin
physician recommends that the client undergo percutaneous
transluminal coronary angioplasty (PTCA). The nurse knows 13. If the clients pain is due to a myocardial infarction.(MI),
that the client understands the physician's explanation of which prescribed medication would be most helpful?
the PTCA procedure when the client makes which statement? A) A nonsteroidal anti-inflammatory drug such
(A) A balloon-tipped catheter will be inserted into my ibuprofen (Advil
coronary artery, B) A nonsalicylate such as acetaminophen (Tylenol)
B) A Tefl on graft will be used to replace an area of weakened C) A salicylate such as aspirin
heart muscle. D) An opioid such as morphine sulfate
C) A section of my leg vein will be grafted around a narrowed
coronary artery.
14. If the clients severe chest pain is typical of other people
who experience myocardial infarction (MI). the client is most
likely to tell the nurse that the discomfort radiates to which
area?
A) Flank
B) Groin
C) Abdomen
D Shoulder
15. Mr. Atienza, 65-year-old client with severe chest pain is
evaluated in the emergency department. A tentative diagnosis
of myocardial infarction (MI) is made. Which assessment
finding is most closely correlated with an evolving MI?
A) Profuse sweating
B) Facial fiushing
C) Severe headache
D) Coughing up pink-tinged mucus
1 6. Mr. Fu has been experiencing an increased number of
anginal episodes, the physician orders a cardiac
catheterization. Which nursing action can best help reduce the
clients anxiety in this situation?
A) Teach the client how coronary artery disease is
usually treated.
B) Explain that the procedure has been very helpful- for other
clients,
C) Avoid discussing the heart catheterization until the client
has relaxed.
D) Listen to the clients feelings about this condition.
17. Mr. Gonzales asks the nurse how propranolol
helps to prevent angina, what is the best response
of the nurse.
A) Propranolol promotes excretion of body fluid.
B) Propranolol reduces the rate of heart contraction.
C) Propranolol alters pain receptors in the heart.
D) Propranolol dilates the major coronary arteries.
18. Mr. Mario complains of chest pain that increases in
frequency and severity and the pain is not relieved by rest and
nitroglycerin. As a nurse, she knows that the patient has
A) Stable angina
B) Intractable angina
C) Unstable angina
D) Variant angina
19. Mr. Miller is admitted to the hospital with a diagnosis of left
sided heart failure. During the assessment, the nurse should
expect to find
A) Crushing chest pain
B) Dyspnea on exertion
C Extensive peripheral edema
D) Jugular vein distention
20. Mr. Minia, a 78-year-old client is admitted to the
hospital with left sided heart failure. When obtaining
a health history from the client, the nurse would
expect to leam that which of the following was the
clients earliest symptom?
A) Anorexia
B) Dyspnea
C) Nausea
D) Headaches
21. Mr. Ping with CHF has been receiving cardiac glycoside,
diuretics and a vasodilator drugs. His apical pulse is 44. The
nurse concludes that his pulse rate is most likely the result of
the
A) Diuretic
B) Vasodilator
C) Cardiac glycoside
D) All of the above
22. Mrs. Chua, a 78- year old client is admitted with a
diagnosis of heart failure. The nurse expects to hear when
listening to clients lungs indicative of heart failure would be
A) Stridor
B) Crackles
C) Wheezes
D) Friction rubs
23. Nurse Kaye who is working on a medical- surgical unit
identifies several clients who have been diagnosed with
coronary artery disease (CAD). Which of the following client
risk factors is most significant for developing CAD?
A) Drinking a nightly cocktail
B) History of mitral valve repair
C) Rheumatic fever during childhood
D) Weighing 25 pounds above normal
24. Nurse Michelle is obtaining clients health history, which
question about pain is least helpful?
A) How long have you been in pain?
B) Where is your pain located?
C) What were you doing when your pain started?
D) What medications do you take for pain?
25. Nurse Trisha teaches a client with heart failure to take oral
furosemide in the morning. The reason for this is to help
A) Retard rapid drug absorption
B) Excrete excessive fluids accumulated at night
C) Prevent sleep disturbances during the night
D) Prevent electrolyte imbalance
26. The client informs the nurse that the physician just
prescribed sublingual nitroglycerin tablets to take whenever
chest pain is experienced. The nurse informs the client that
the correct way to administer nitroglycerin is to place one
tablet where?
A) Between the gum and cheek
B) At the back of the throat
C) Under the tongue
D) Between the teeth
27. The client is one- day post- operative coronary artery
bypass surgery. The client complains of chest pain. Which
intervention should the nurse implement first?
A) Check the telemetry monitor
B) Turn the patient every 2 hours
C) Administer morphine sulfate
28. The clients left-sided heart failure worsens with
severe pulmonary edema. The nurse prepares to
transfer the client to the intensive care unit (ICU). The client
tells the nurse of being extremely frightened. What is the most
appropriate action for the nurse to take at this time?
A) Stay with the client.
B) Notify the physician.
C) Tell the client it will be fine.
D) Record the collected data.
29. Which of the following laboratory data would
indicate that the patient is in severe congestive
heart failure?
A) A positive ventilation/perfusion scan
B) A positive D dimer
C) An elevated creatinine kinase
D) An elevated B type natriuretic peptide.
30. Which of the following results is the primary
treatment goal for angina?
A) Reduction of associated risk factors.
B) Reduction of stress and anxiety.
C) Reversal of infarction
D) Reversal of ischemia
31 Which of the following statements by the patient requires
the nurse to re educate the patient on how to take the
prescribed metoprolol?
A) I will monitor my heart rate while I am taking this
medication.
B) I will change my position slowly.
C) I will take this medication with my breakfast.
D) After I stop taking this medication, I will notify the
physician.
32. Which of the following statements by the patient would
indicate the he understands the necessary modifications in
lifestyle to prevent angina attacks?
A) I know that I will need to eat less, so I will only eat one meal
a day.
B) I will need to walk more slowly and rest frequently to
avoid angina.
(C)I will stop what I am doing whenever I have pain and take
a pill.
D) I will need to stay in bed all the time so I wont have the
pain.
33. Which of the following statements is true regarding the
mechanism of atherosclerosis?
A) Hardened vessels dilate to allow blood to flow.
B) Blood clots form outside the vessel wall.
C) Plaques obstruct the artery.
D) Arteries become thick and stiff.
34. Which of the following statements show that the 59-year-
old male patient diagnosed with congestive heart failure
understands your teaching about hydrochlorothiazide?
(A) Dizziness is a common side effect of this drug, so I
need to get up the bed or chair slowly.
B) My legs might get swollen when taking the medications.
C) I should contact my doctor if I develop a cough with this
medication.
D) I might get constipated because of this medication, so I
need to drink more fluids.
35. Which signs and symptoms would the nurse expect to find
when assessing a patient diagnosed with acute exacerbation
of congestive heart failure.
A) Pulse rate of 90 and capillary refill time of less than 3
seconds.
B) The client sleeping with no pillows.
C) Thick white sputum and crackles that clear with cough.
D) Apical pulse of 110 and pitting edema.
36. The nurse is caring for a client diagnosed with myocardial
infarction. The patient experienced chest pain unrelieved by
nitroglycerin. The nurse on duty administers morphine as
prescribed by the physician. Following the administration of
morphine, the nurse plans to monitor
A) Blood pressure
B) Urinary output
C) Mental status
D) Respirations and blood pressure
37. The nurse is caring for a paint who is receiving heparin.
What drug should be readily available?
A) Caffeine
B) Vitamin K
C)Protamine sulfate
D) Calcium gluconate
38. To assess the apical pulse of a patient, which landmark
should the nurse use?
A) Left second intercostal space, midclavicular line.
B) Left first intercostal space, midaxillary line.
C) Left fifth intercostal space, midclavicular line
D)Left fourth intercostal space, midaxillary line.
39. When a patient returns from cardiac catheterization, it is
most important for the nurse to?
A) Start range of motion immediately.
B) Apply heat to the insertion site.
C) Maintain NPO
D) Check peripheral pulse
40. This represents ventricular depolarization.
A) T wave
B) QRS complex
C) U wave
D) P wave
41) This represents ventricular repolarization.
A) T wave
B) QRS complex
C) U wave
D) P wave
42. This represents atrial depolarization.
A) T wave
B) QRS complex
C) U wave
D)P wave
43. Another patient has an angiotension-converting enzyme
(ACE) inhibitor, enalapril (Vasotec) 10 mg daily added to the
medication regimen. Which of the following patient statements
will the nurse recognize as a potential side effect of the
medication?
A) I have noticed that I am urinating more than
normal.
B) I have a dry, hacky cough throughout the day.
C) I feel weak and lethargic in the afternoon.
D) I feel that I am having heart palpitations.
44. Christian, a nurse at Salubris Medical Center volunteers
to do blood pressure screenings among patients in the
medical ward. Which modification used by the nurse is most
appropriate when taking the blood pressure of a client who
weighs 250 pounds?
A) The nurse takes the blood pressure on the patients thigh.
B) The nurse has the client lie down during the assessment.
C) The nurse pumps the manometer up to 250 mm Hg.
D) The nurse uses an extra-large blood pressure cuff
45 Mario, 56, a patient with hypertension is willing to
implement lifestyle changes to reduce blood pressure which
changes would be most beneficial as encouraged by the
nurse? 1. Eating a diet higher in fiber 2. Balancing rest with
exercise 3! Taking time for more leisure activities 4. Giving up
smoking cigarettes 5. Pursuing measures for losing weight 6,
Assessing blood pressure in the morning and evening.
A) 1 and 2.
B) 2 and 3.
C) 4 and 5.
D) 1 and 4.
46. Mario 56, patient with hypertension will begin taking
furosemide (Lasix) 40 mg orally every day. Which observation
by the nurse is the best indication that the furosemide (Lasix)
has had a desired effect?
A) His pulse becomes slower.
B) His blood pressure stabilizes.
C) His urine output increases.
D) His anxiety is diminished.
47. Nurse Christian then obtains adult blood pressure
readings on four separate patents. Which patient should have
a follow-up blood pressure check?
A) The patient whose blood pressure is 138/88 mmHg
B) The patient whose blood pressure is 132/98 mm Hg.
C) The patient whose blood pressure is 120/80 mm Hg.
D) The patient whose blood pressure is 118/78 mm Hg.
48. Primo, a 79-year-old client comes to the hospital for
dizziness, light-headedness, fatigue, and dehydration. His
blood pressure on admission is 92/48 mmHg. As the nurse
completes the admission assessment, a list of medications is
obtained. If the patient reports taking the following drugs,
which are more than likely to have contributed to this patients
signs and symptoms? 1. Lisinopril (Zestril) 2. Valsartan
(Diovan) 3. Metoprolol (Lopressor) 4. Warfarin (Coumadin) 5.
Hydrochlorothiazide (HydroDIURIL) 6. Aspirin (Bufferin).
(A)1, 2, 3.5.
B) 1, 2. 4. 6.
C) 1, 3, 5, 6.
D) 1, 2, 5,6.
49. The nurse instructs the patient to monitor urine output
while taking furosemide (Lasix) at home because use of the
medication may lead to which condition?
A) Dehydration.
B) Fluid overload.
C) Hypernatremia.
D) Hyperkalemia.
50. When preparing discharge instructions for a patient with
hypertension, the nurses instructions should include taking
oral furosemide (Lasix) at what time of day?
A) Before bedtime.
B) when arising in the morning.
C. With the main meal.
D) In the late afternoon.
CHEST TUBE
1. You are providing care to a patient with a chest tube.
On assessment of the drainage system, you note
continuous bubbling in the water seal chamber and
oscillation. Which of the following is the CORRECT
nursing intervention for this type of finding? Check
the drainage system for an air leak
2. A patient is receiving positive pressure mechanical
ventilation and has a chest tube. When assessing the
water seal chamber what do you expect to find? The
water in the chamber will decrease during inspiration
and increase during expiration.
3. What type of chest tube system does this statement
describe? This chest drainage system has no water
column to control suction but uses a suction monitor
bellow that balances the wall suction and you can
adjust water suction pressure using the rotary
suction dial on the side of the system. It allows for
higher suction pressure levels, has no bubbling
sounds, and water does not evaporate from it as with
other systems. Dry suction chest tube system
4. The patient in room 2569 calls on the call light to tell
you something is wrong with his chest tube. When
you arrive to the room you note that the drainage
system has fallen on its side and is leaking drainage
onto the floor from a crack in the system. What is
your next PRIORITY? Disconnect the tubing from the
drainage system and insert the tubing 1 inch into a
bottle of sterile water and obtain a new system.
5. You're assessing a patient who is post-opt from a
chest tube insertion. On assessment, you note there
is 50 cc of serosanguinous fluid in the drainage
chamber, fluctuation of water in the water seal
chamber when the patient breathes in and out, and
bubbling in the suction control chamber. Which of the
following is the most appropriate nursing
intervention? Document your findings as normal.
6. A patient is recovering from a pneumothorax and has
a chest tube present. Which of the following is an
appropriate finding when assessing the chest tube
drainage system? Intermittent bubbling may be
noted in the water seal chamber.
7. While helping a patient with a chest tube reposition
in the bed, the chest tube becomes dislodged. What
is your immediate nursing intervention? Place a
sterile dressing over the site and tape it on three
sides and notify the physician.
8. A patient is about to have their chest tube removed
by the physician. As the nurse assisting with the
removal, which of the following actions will you
perform? Select-all-that-apply: Pre-medicate prior to
removal as ordered by the physician., Have the
patient take a deep breath, exhale, and bear down
during removal of the tube., Place the patient in
Semi-Fowler's position, Gather supplies needed
which will include a petroleum gauze dressing per
physician preference.
9. A patient with a chest tube has no fluctuation of water
in the water seal chamber. What could be the cause
of this? The lung may have re-expanded or there is
a kink in the system.
URINARY SYSTEM
1. A 6 year old male is diagnosed with nephrotic
syndrome. In your nursing care plan you will include
which of the following as a nursing diagnosis for this
patient? Risk for infection
2. Which patient below is NOT at risk for developing
nephrotic syndrome? A 7 year old male recently
diagnosed with Goodpasture's Syndrome
3. You're collecting a urine sample on a patient who is
experiencing proteinuria due to nephrotic syndrome.
As the nurse, you know the urine will appear: Dark
and foamy
4. The mother of a child, who was recently diagnosed
with nephrotic syndrome, asks how she can identify
early signs that her child is experiencing a relapse
with the condition. You would tell her to monitor the
child for the following: Select-all-that-apply: Protein
in the urine using an over-the-counter kit , Swelling
in the legs, hands, face, or abdomen
5. You’re providing education to a group of nursing
students about nephrotic syndrome. A student
describes the signs and symptoms of this condition.
Which signs and symptoms verbalized by the student
require you to re-educate the student about this
topic? Select-all-that-apply: Tea-colored urine
6. You're providing care to a 6 year old male patient
who is receiving treatment for nephrotic syndrome.
Which assessment finding below requires you to
notify the physician immediately? Redden area on
the patient's left leg that is swollen and warm
7. As the nurse, you know that it is important to
implement a low sodium diet for a patient with
nephrotic syndrome. However, it is important to
implement what other type of diet due to another
complication associated with this syndrome? Low-fat
8. A 5 year old male is admitted with acute
glomerulonephritis. On assessment, you note mild
edema predominately in the face and tea-colored
urine. The patient's blood pressure is 165/110, heart
rate 95, oxygen saturation 98% on room air, and
temperature 98.9 'F. In your nursing care plan, what
nursing interventions will you include in this patient's
plan of care? SELECT-ALL-THAT-APPLY: Monitor
intake and output hourly, Assess color of urine after
every void, Weigh patient every daily on a standing
scale.
9. While providing care to a pediatric patient with acute
glomerulonephritis, you note the urine output to be
10 mL/hr. The patient weighs 30 lbs. As the nurse,
you will want to limit what type of foods from the
patient's diet? Potassium-rich foods
10. A patient who is experiencing poststreptococcal
glomerulonephritis has edema mainly in the face and
around the eyes. As the nurse, you know to expect
the edema to be most prominent during the? Morning
11. Which patient below is at MOST RISK for developing
acute glomerulonephritis? A 3 year old male who has
a positive ASO titer.
12. Which of the following are NOT a sign and symptom
of acute glomerulonephritis (poststreptococcal)?
SELECT-ALL-THAT-APPLY: Hypotension,
Increased Glomerular filtration rate, Massive
proteinuria
13. TRUE or FALSE: Poststreptococcal
glomerulonephritis is a type of NEPHROTIC
SYNDROME, which means there is the leakage of
BOTH red blood cells and protein from the inflamed
glomerulus into the filtrate. FALSE
14. Within the past month, the admission rate of patients
with poststreptococcal glomerulonephritis has
doubled on your unit. You are proving an in-service
to your colleagues about this condition. Which
statement is CORRECT about this condition? "This
condition is not caused by the streptococcal bacteria
attacking the glomerulus, but by the immune
system’s response to the bacteria by creating an
antigen-antibody complex which inflames the
glomerulus."
15. True or False: One of the main causes of nephrotic
syndrome is a post streptococcal infection. FALSE
16. A patient is diagnosed nephrotic syndrome. What
signs and symptoms below are common in this
condition? Select-all-that-apply: Foamy, frothy urine,
Massive Proteinuria, Hyperlipidemia, Edema,
Hypoalbuminemia
17. In patients who are experiencing acute
glomerulonephritis, the glomerulus is permeable to
what substances? Red blood cells and protein
18. True or False: Hypertension occurs in acute
glomerulonephritis and is not a common finding with
nephrotic syndrome. TRUE
19. Select the most common type of medications that
may be ordered by a physician to treat nephrotic
syndrome: Corticosteroids, Diuretics
20. A 5 year-old male patient is experiencing acute
glomerulonephritis. What signs and symptoms may
you observe with this condition? Swelling in the face,
Tea-colored urine, Elevated BUN and creatinine
level
21. A patient is suspected of having nephrotic syndrome
due to a health history of Lupus. As the nurse you
know that what substance(s) will be present in the
urine to confirm this diagnosis? Massive protein
 Exam 4: Acute Kidney Injury NCLEX Questions
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1. a Which descriptions characterize AKI? Select all that apply

c
a. primary cause of death is infection
b. it almost always affects older people
c. disease course is potentially reversible
d. most common cause is diabetic nephropathy
e. cardiovascular disease is most common cause of death

2. b During the oliguric phase of AKI, the nurse monitors the

d patient for Select all that apply

a. hypotension
b. ECG changes
c. hypernatremia
d. pulmonary edema
e. urine with high specific gravity

3. c If a patient is in the diuretic phase of AKI, the nurse must

monitor for which serum electrolyte imbalances?

a. hyperkalemia and hyponatremia

b. hyperkalemia and hypernatremia
c. hypokalemia and hyponatremia
d. hypokalemia and hypernatremia

4. b The nurse is caring for a 68-yr-old man who had coronary

artery bypass surgery 3 weeks ago. During the oliguric
phase of acute kidney disease, which action would be
appropriate to include in the plan of care?

a. Provide foods high in potassium.

b. Restrict fluids based on urine output.
c. Monitor output from peritoneal dialysis.
d. Offer high-protein snacks between meals.

5. d When caring for a patient during the oliguric phase of

acute kidney injury (AKI), which nursing action is appro-
priate?

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 Exam 4: Acute Kidney Injury NCLEX Questions
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a. Weigh patient three times weekly.
b. Increase dietary sodium and potassium.
c. Provide a low-protein, high-carbohydrate diet.
d. Restrict fluids according to previous daily loss

6. d Which patient diagnosis or treatment is most consistent

with prerenal acute kidney injury (AKI)?

a. IV tobramycin
b. Incompatible blood transfusion
c. Poststreptococcal glomerulonephritis
d. Dissecting abdominal aortic aneurysm

7. a The patient has rapidly progressing glomerular inflamma-

tion. Weight has increased and urine output is steadily
declining. What is the priority nursing intervention?

a. Monitor the patient's cardiac status.

b. Teach the patient about hand washing.
c. Obtain a serum specimen for electrolytes.
d. Increase direct observation of the patient.

8. a Which assessment findings would alert the nurse that the

b patient has entered the diuretic phase of acute kidney
e injury (AKI)? Select all that apply

a. Dehydration
b. Hypokalemia
c. Hypernatremia
d. BUN increases
e. Urine output increases

9. a An unlicensed assistive personnel (UAP) reports to the

RN that a patient with acute kidney failure had a urine
output of 350 mL over the past 24 hours after receiving
furosemide 40 mg IV push. The UAP asks the nurse how
this can happen. What is the nurse's best response?

a. "During the oliguric phase of acute kidney failure, pa-

tients often do not respond well to either fluid challenges
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 Exam 4: Acute Kidney Injury NCLEX Questions
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or diuretics."
b. "There must be some sort of error. Someone must have
failed to record the urine output."
c. "A patient with acute kidney failure retains sodium and
water, which counteracts the action of the furosemide."
d. "The gradual accumulation of nitrogenous waste prod-
ucts results in the retention of water and sodium."

10. a The RN supervising a senior nursing student is discussing

b methods for preventing acute kidney injury (AKI). Which
d points would the RN be sure to include in this discussion?
e Select all that apply

a. Encourage patients to avoid dehydration by drinking

adequate fluids.
b. Instruct patients to drink extra fluids during periods of
strenuous exercise.
c. Immediately report a urine output of less than 2
mL/kg/hr.
d. Record intake and output and weigh patients daily.
e. Monitor laboratory values that reflect kidney function.

11. c For which patient is the nurse most concerned about the
risk for developing kidney disease?

a. A 25-year-old patient who developed a urinary tract

infection (UTI) during pregnancy
b. A 55-year-old patient with a history of kidney stones
c. A 63-year-old patient with type 2 diabetes
d. A 79-year-old patient with stress urinary incontinence

12. d A patient with acute kidney injury (AKI) has an arterial

blood pH of 7.30. The nurse will assess the patient for

a. vasodilation.
b. poor skin turgor.
c. bounding pulses.
d. rapid respirations.

13. c
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 Exam 4: Acute Kidney Injury NCLEX Questions
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A patient with severe heart failure develops elevated blood
urea nitrogen (BUN) and creatinine levels. The nurse will
plan care to meet the goal of

a. replacing fluid volume.

b. preventing hypertension.
c. maintaining cardiac output.
d. diluting nephrotoxic substances.

14. c A patient who has acute glomerulonephritis is hospitalized

with acute kidney injury (AKI) and hyperkalemia. Which
information will the nurse obtain to evaluate the effective-
ness of the prescribed calcium gluconate IV?

a. Urine output
b. Calcium level
c. Cardiac rhythm
d. Neurologic status

15. d Which information will be most useful to the nurse in

evaluating improvement in kidney function for a patient
who is hospitalized with acute kidney injury (AKI)?

a. Blood urea nitrogen (BUN) level

b. Urine output
c. Creatinine level
d. Calculated glomerular filtration rate (GFR)

16. a In a patient with acute kidney injury (AKI) who requires

hemodialysis, a temporary vascular access is obtained by
placing a catheter in the left femoral vein. Which interven-
tion will be included in the plan of care?

a. Place the patient on bed rest.

b. Start continuous pulse oximetry.
c. Discontinue the retention catheter.
d. Restrict the patients oral protein intake.

17. c Which information about a patient who was admitted 10

days previously with acute kidney injury (AKI) caused by
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 Exam 4: Acute Kidney Injury NCLEX Questions
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dehydration will be most important for the nurse to report
to the health care provider?

a. The blood urea nitrogen (BUN) level is 67 mg/dL.

b. The creatinine level is 3.0 mg/dL.
c. Urine output over an 8-hour period is 2500 mL.
d. The glomerular filtration rate is <30 mL/min/1.73m2.

18. d After noting lengthening QRS intervals in a patient with

acute kidney injury (AKI), which action should the nurse
take first?

a. Document the QRS interval.

b. Notify the patients health care provider.
c. Look at the patients current blood urea nitrogen (BUN)
and creatinine levels.
d. Check the chart for the most recent blood potassium
level.

19. b When caring for a dehydrated patient with acute kidney

injury who is oliguric, anemic, and hyperkalemic, which
of the following prescribed actions should the nurse take
first?

a. Insert a urinary retention catheter.

b. Place the patient on a cardiac monitor.
c. Administer epoetin alfa (Epogen, Procrit).
d. Give sodium polystyrene sulfonate (Kayexalate).

20. c What are intrarenal causes of AKI? Select all that apply
d
e a. anaphylaxis
b. renal stones
c. nephrotoxic drugs
d. acute glomerulonephritis
e. tubular obstruction by myoglobin

21. c An 83 year old female patient was found lying on the

e bathroom floor. She said she fell 2 days ago and has
not been able to take her heart medicine or eat or drink
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anything since then. What conditions could be causing
prerenal AKI in this patient? Select all that apply

a. anaphylaxis
b. renal calculi
c. hypovolemia
d. nephrotoxic drugs
e. decreased cardiac output

22. d ATN is the most common cause of intrarenal AKI. Which

patient is most likely to develop ATN?

a. patient with DM
b. patient with hypertensive crisis
c. patient who tried to overdose on acetaminophen
d. patient with major surgery who required a blood trans-
fusion

23. d What indicates to the nurse that a patient with oliguria has
prerenal oliguria?

a. urine testing reveals a low specific gravity

b. causative factor is malignant hypertension
c. urine testing reveals a high sodium concentration
d. reversal of oliguria occurs with fluid replacement

24. d Metabolic acidosis occurs in the oliguric phase of AKI as

a result of impairment of

a. excretion of sodium
b. excretion of bicarbonate
c. conservation of potassium
d. excretion of hydrogen ions

25. d What indicates to the nurse that a patient with AKI is in the
recovery phase?

a. a return to normal weight

b. a urine output of 3,700 mL/day

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c. decreasing sodium and potassium levels
d. decreasing BUN and creatinine levels

26. d While caring for the patient in the oliguric phase of AKI,
the nurse monitors the patient for associated collaborative
problems. When should the nurse notify the HCP?

a. urine output is 300 ml/day

b. edema occurs in the feet, legs, and sacral area
c. cardiac monitor reveals a depressed T wave and elevat-
ed ST segment
d. the patient experiences increasing muscle weakness
and abdominal cramping

27. d In caring for the patient with AKI, of what should the nurse
be aware?

a. the most common cause of death is irreversible meta-

bolic acidosis
b. during the oliguric phase, daily fluid intake is limited to
1,000 ml plus the prior day's measured fluid loss
c. dietary sodium and potassium during the oliguric phase
of AKI are managed according to the patient's urinary
output
d. one of the most important nursing measures in manag-
ing fluid balance in the patient with AKI is taking accurate
daily weights

28. b A 68 year old man with a history of HF resulting from

HTN has AKI as a result of the effects of nephrotoxic
diuretics. Currently his serum potassium is 6.2 with car-
diac changes, BUN is 108, serum creatinine 4.1, and
serum HCO3 13. He is somnolent and disoriented. Which
treatment should the nurse expect to be used for him?

a. loop diuretics
b. renal replacement therapy
c. insulin and sodium bicarbonate
d. sodium polystyrene sulfonate (kayexalate)

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29. b A patient with AKI has a serum potassium level of 6.7 and
the following ABG results: pH: 7.28, PaCO2: 30, PaO2:
86, HCO3: 18. The nurse recognizes that treatment of the
acid-base problem with sodium bicarbonate would cause
a decrease in which value?

a. pH
b. potassium level
c. bicarbonate level
d. carbon dioxide level

30. c A patient with AKI is a candidate for continuous renal

replacement therapy (CRRT). What is the most common
indication for use of CRRT?

a. pericarditis
b. hyperkalemia
c. fluid overload
d. hypernatremia

31. c A nurse is planning care for a client who has prerenal

AKI following abdominal aortic aneurysm repair. Urinary
output is 60 ml in the past 2 hours, and BP is 92/58. The
nurse should expect which of the following interventions?

a. prepare the client for a CT scan with contrast dye

b. plan to administer nitroprusside
c. prepare to administer a fluid challenge
d. plan to position the client in Trendelenburg

32. c A nurse is assessing a client who has prerenal AKI. Which

d of the following findings should the nurse expect? Select
all that apply

a. reduced BUN
b. elevated cardiac enzymes
c. reduced urine output
d. elevated blood creatinine
e. elevated blood calcium

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33. a A client has been admitted with acute renal failure. What
b should the nurse do? Select all that apply
c
d a. elevate the HOB 30-45 degrees
b. take vital signs
c. establish an IV site
d. call the admitting healthcare provider for prescriptions
e. contact the hemodialysis unit

34. d Which initial manifestation of acute renal failure is most

common?

a. dysuria
b. anuria
c. hematuria
d. oliguria

35. d The client who is in acute renal failure has an elevated

BUN. What is the likely cause of this finding?

a. fluid retention
b. hemolysis of RBCs
c. below-normal metabolic rate
d. reduced renal blood flow

36. a A client with acute renal failure has an increase in the

serum potassium level. The nurse should monitor the
client for

a. cardiac arrest
b. pulmonary edema
c. circulatory collapse
d. hemorrhage

37. d A high-carbohydrate, low-protein diet is prescribed for the

client with acute renal failure. The intended outcome of this
diet is to

a. act as a diuretic
b. reduce demands on the liver
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 Exam 4: Acute Kidney Injury NCLEX Questions
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c. help maintain urine acidity
d. prevent the development of ketosis

38. a The client with acute renal failure asks the nurse for a
snack. Because the client's potassium level is elevated,
which snack is most appropriate?

a. a gelatin dessert
b. yogurt
c. an orange
d. peanuts

39. a In the oliguric phase of acute renal failure, the nurse

should assess the client for

a. pulmonary edema
b. metabolic alkalosis
c. hypotension
d. hypokalemia

40. a The client in acute renal failure has an external cannula

inserted in the forearm for hemodialysis. Which nursing
measure is appropriate for the care of this client?

a. use the unaffected arm for blood pressure measure-

ments
b. draw blood from the cannula for routine laboratory work
c. percuss the cannula for bruits each shift
d. inject heparin into the cannula each shift

41. b During dialysis, the client has disequilibrium syndrome.

The nurse should first

a. administer oxygen per nasal cannula

b. slow the rate of dialysis
c. reassure the client that the symptoms are normal
d. place the client in Trendelenburg's position

42. c Which abnormal blood value would not be improved by

dialysis treatment?
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a. elevated serum creatinine level

b. hyperkalemia
c. decreased hemoglobin concentration
d. hypernatremia

43. a The client with acute renal failure is recovering and asks
the nurse, "will my kidneys ever function normally again?"
The nurse's response is based on the knowledge that the
client's renal status will most likely

a. continue to improve over a period of weeks

b. result in the need for permanent hemodialysis
c. improve only if the client receives a renal transplant
d. result in end-stage renal failure

44. a A client with AKI has a serum potassium level of 7.0. The
b nurse should plan which actions as a priority? Select all
d that apply

a. place the client on a cardiac monitor

b. notify the HCP
c. put the client on NPO status except for ice chips
d. review the client's medications to determine if any con-
tain or retain potassium
e. allow an extra 500 ml of IV fluid intake to dilute the
electrolyte concentration

45. b Which assessment finding is commonly found in the olig-

uric phase of acute kidney injury (AKI)?

a. Hypovolemia
b. Hyperkalemia
c. Hypernatremia
d. Thrombocytopenia

46. a Which patient has the greatest risk for prerenal AKI?

a. The patient who is hypovolemic because of hemor-

rhage.
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 Exam 4: Acute Kidney Injury NCLEX Questions
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b. The patient who relates a history of chronic urinary tract
obstruction.
c. The patient with vascular changes related to coagu-
lopathies.
d. The patient receiving antibiotics such as gentamicin.

47. a Important nursing interventions for the patient with AKI are
b Select all that apply
c
e a. careful monitoring of intake and output.
b. daily patient weights.
c. meticulous aseptic technique.
d. increase intake of vitamin A and D.
e. frequent mouth care.

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 ACUTE RENAL FAILURE PRACTICE QUESTION 8. True or False: All patients with acute renal injury will
progress through the oliguric stage of AKI but not all patients
1. ______________ is solely filtered from the bloodstream via will progress through the diuresis stage.
the glomerulus and is NOT reabsorbed back into the
bloodstream but is excreted through the urine. A. True
B. False
A. Urea
B. Creatinine 9. Which patient below with acute kidney injury is in the oliguric
C. Potassium stage of AKI:
D. Magnesium
A. A 56-year-old male who has metabolic acidosis,
2. A patient with acute renal injury has a GFR (glomerular decreased GFR, increased BUN/Creatinine,
filtration rate) of 40 mL/min. Which signs and symptoms below hyperkalemia, edema, and urinary output 350
may this patient present with? Select all that apply: mL/day.
B. A 45-year-old female with metabolic alkalosis,
A. Hypervolemia hypokalemia, normal GFR, increased BUN/creatinine,
B. Hypokalemia edema, and urinary output 600 mL/day.
C. Increased BUN level C. A 39-year-old male with metabolic acidosis,
D. Decreased Creatinine level hyperkalemia, improving GFR, resolving edema, and
urinary output 4 L/day.
3. You're assessing morning lab values on a female patient
D. A 78-year-old female with respiratory acidosis, increased
who is recovering from a myocardial infraction. Which lab
GFR, decreased BUN/creatinine, hypokalemia, and
value below requires you to notify the physician?
urinary output 550 mL/day.
A. Potassium level 4.2 mEq/L
10. You're developing a nursing care plan for a patient in the
B. Creatinine clearance 35 mL/min
diuresis stage of AKI. What nursing diagnosis would you
C. BUN 20 mg/dL
include in the care plan?
D. Blood pH 7.40
A. Excess fluid volume
4. A 55-year-old male patient is admitted with a massive GI
B. Risk for electrolyte imbalance
bleed. The patient is at risk for what type of acute kidney
C. Urinary retention
injury?
D. Acute pain
A. Post-renal
11. While educating a group of nursing students about the
B. Intra-renal
stages of acute kidney injury, a student asks how long the
C. Pre-renal
oliguric stage lasts. You explain to the student this stage can
D. Intrinsic renal
last?
5. Select all the patients below that are at risk for acute intra-
A. 1-2 weeks
renal injury?
B. 1-3 days
A. A 45-year-old male with a renal calculus. C. Few hours to 2 weeks
B. A 65-year-old male with benign prostatic hyperplasia. D. 12 months
C. A 25-year-old female receiving chemotherapy.
12. A patient with AKI has a urinary output of 350 mL/day. In
D. A 36-year-old female with renal artery stenosis.
addition, morning labs showed an increased BUN and
E. A 6-year-old male with acute glomerulonephritis.
creatinine level along with potassium level of 6 mEq/L. What
F. An 87-year-old male who is taking an
type of diet ordered by the physician is most appropriate for
aminoglycoside medication for an infection.
this patient?
6. A patient with acute kidney injury has the following labs:
A. Low-sodium, high-protein, and low-potassium
GFR 92 mL/min, BUN 17 mg/dL, potassium 4.9 mEq/L, and
B. High-protein, low-potassium, and low-sodium
creatinine 1 mg/dL. The patient's 24-hour urinary output is
C. Low-protein, low-potassium, and low-sodium
1.75 Liters. Based on these findings, what stage of AKI is this
D. High-protein and high-potassium
patient in?

A. Initiation
B. Diuresis
C. Oliguric
D. Recovery

7. A 36-year-old male patient is diagnosed with acute kidney

injury. The patient is voiding 4 L/day of urine. What
complication can arise based on the stage of AKI this patient
is in? Select all that apply:

A. Water intoxication
B. Hypotension
C. Low urine specific gravity
D. Hypokalemia
E. Normal GFR
 CHRONIC RENAL FAILURE PRACTICE QUESTION D. "This medication will help prevent my phosphate
level from increasing."
1. A 55 year old male patient is diagnosed with chronic kidney
disease. The patient's recent GFR was 25 mL/min. What 8. While assessing morning labs on your patient with CKD.
stage of chronic kidney disease is this known as? You note the patient's phosphate level is 6.2 mg/dL. As the
nurse, you expect to find the calcium level to be?
A. Stage 1
B. Stage 3 A. Elevated
C. Stage 4 B. Low
D. Stage 5 C. Normal
D. Same as the phosphate level
2. A patient with CKD has a low erythropoietin (EPO) level.
The patient is at risk for? 9. A patient with stage 4 chronic kidney disease asks what
type of diet they should follow. You explain the patient should
A. Hypercalcemia follow a:
B. Anemia
C. Blood clots A. Low protein, low sodium, low potassium, low
D. Hyperkalemia phosphate diet
B. High protein, low sodium, low potassium, high phosphate
3. A 65 year old male patient has a glomerular filtration rate of diet
55 mL/min. The patient has a history of uncontrolled C. Low protein, high sodium, high potassium, high
hypertension and coronary artery disease. You're assessing phosphate diet
the new medication orders received for this patient. Which D. Low protein, low sodium, low potassium, high phosphate
medication ordered by the physician will help treat the diet
patient's hypertension along with providing a protective
mechanism to the kidneys? 10. The kidneys are responsible for performing all the
following functions EXCEPT?
A. Lisinopril
B. Metoprolol A. Activating Vitamin D
C. Amlodipine B. Secreting Renin
D. Verapamil C. Secreting Erythropoietin
D. Maintaining cortisol production
4. Which patient below is NOT at risk for developing chronic
kidney disease?

A. A 58 year old female with uncontrolled hypertension.

B. A 69 year old male with diabetes mellitus.
C. A 45 year old female with polycystic ovarian disease.
D. A 78 year old female with an intrarenal injury.

5. A patient with Stage 5 CKD is experiencing extreme pruritus

and has several areas of crystallized white deposits on the
skin. As the nurse, you know this is due to excessive amounts
of what substance found in the blood?

A. Calcium
B. Urea
C. Phosphate
D. Erythropoietin

6. Your patient with chronic kidney disease is scheduled for

dialysis in the morning. While examining the patient's
telemetry strip, you note tall peaked T-waves. You notify the
physician who orders a STAT basic metabolic panel (BMP).
What result from the BMP confirms the EKG abnormality?

A. Phosphate 3.2 mg/dL

B. Calcium 9.3 mg/dL
C. Magnesium 2.2 mg/dL
D. Potassium 7.1 mEq/L

7. You are providing education to a patient with CKD about

calcium acetate. Which statement by the patient demonstrates
they understood your teaching about this medication? Select-
all-that-apply:

A. "This medication will help keep my calcium level normal."

B. "I will take this medication with meals or immediately
after."
C. "It is important I consume high amounts of oatmeal,
poultry, fish, and dairy products while taking this
medication."
 PRACTICE QUESTION (SIR JAKE) C. Renal failure
D. Hyperkalemia
1. For a male client in the oliguric phase of acute renal failure
(ARF), which nursing intervention is most important? 8. A history of infection specifically caused by group A beta-
hemolytic streptococci is associated with which of the
A. Encouraging coughing and deep breathing following disorders?
B. Promoting carbohydrate intake
C. Limiting fluid intake A. Acute glomerulonephritis
D. Providing pain-relief measures B. Acute renal failure
C. Chronic renal failure
2. A female client with acute renal failure is undergoing dialysis D. Nephrotic syndrome
for the first time. The nurse in charge monitors the client
closely for dialysis equilibrium syndrome, a complication that 9. Which of these drugs is nephrotoxic?
is most common during the first few dialysis sessions.
Typically, dialysis equilibrium syndrome causes: A. Diuretics
A. B.ACE inhibitors
A. Confusion, headache, and seizures. B. C.NSAIDs
B. Acute bone pain and confusion. C. Sodium bicarbonate/ Potassium bicarbonate
C. Weakness, tingling, and cardiac arrhythmias.
D. Hypotension, tachycardia, and tachypnea. 10. The client with renal failure should be on which type of
diet?
3.A female client is admitted with a diagnosis of acute renal
failure. She is awake, alert, oriented, and complaining of A. High protein, high carbohydrate, low calorie
severe back pain, nausea and vomiting and abdominal B. Adequate calorie intake, high carbohydrate, limited
cramps. Her vital signs are blood pressure 100/70 mm Hg, protein
pulse 110, respirations 30, and oral temperature 100.4°F C. Limited protein, low carbohydrate, adequate
(38°C). Her electrolytes are sodium 120 mEq/L, potassium 5.2 calorie intake
mEq/L; her urinary output for the first 8 hours is 50 ml.° The D. Low calorie, limited protein, low carbohydrate
client is displaying signs of which electrolyte imbalance?

A. Hyponatremia
B. Hyperphosphatemia
C. Hyperkalemia
D. Hypercalcemia

4. A client suffering from acute renal failure has an unexpected

increase in urinary output to 150ml/hr. The nurse assesses
that the client has entered the second phase of acute renal
failure. Nursing actions throughout this phase include
observation for signs and symptoms of

A. Hypervolemia, hypokalemia, and hypernatremia.

B. Hypervolemia, hyperkalemia, and hypernatremia.
C. Hypovolemia, wide fluctuations in serum sodium
and potassium levels.
D. Hypovolemia, no fluctuation in serum sodium and
potassium levels.

5. Nurse Tristan is caring for a male client in acute renal

failure. The nurse should expect hypertonic glucose, insulin
infusions, and sodium bicarbonate to be used to treat:

A. Hypernatremia
B. Hypokalemia
C. Hyperkalemia
D. Hypercalcemia

6. The nurse is reviewing laboratory results on a client with

acute renal failure. Which one of the following should be
reported immediately?

A. Blood urea nitrogen 50 mg/dI

B. Hemoglobin of 10.3 mg/di
C. Venous blood pH 7.30
D. Serum potassium 6 mEg/L

7. Marina with acute renal failure moves into the diuretic phase
after one week of therapy. During this phase the client must
be assessed for signs of developing:

A. Hypovolemia
B. Metabolic acidosis
 CORONARY ARTERY DISEASE NCLEX B. QRS widening
QUESTIONS C. absent P-wave
D. ST segment elevation
1. True or False: The left anterior descending coronary artery
8. A patient is receiving treatment for stable coronary artery
provides blood supply to the left ventricle, front of the septum
disease. The doctor prescribes the patient Plavix. What
and part of the right ventricle.
important information will you include in the patient's teaching?
A. True Select-all-that-apply:
B. False
A. If you are scheduled for any planned surgical
2. Which coronary artery provides blood to the left atrium and procedures, let your doctor know you are taking Plavix
left ventricle: because this medication will need to be discontinued
5-7 days prior to the procedure.
A. Right marginal artery B. A normal side effect of this medication is a dry cough.
B. Posterior descending artery C. Avoid green leafy vegetables while taking Plavix.
C. Left circumflex artery D. Notify the doctor, immediately, if you develop bruising,
D. Right coronary artery problems urinating, or fever.
3. Which patient(s) are most at risk for developing coronary 9. A patient calls the cardiac clinic you are working at and reports
artery disease? Select-all-that-apply: that they have taken 3 sublingual doses of Nitroglycerin as
prescribed for chest pain, but the chest pain is not relieved. What
A. A 25-year-old patient who exercises 3 times per week for
do you educate the patient to do next?
30 minutes a day and has a history of cervical cancer.
B. A 35-year-old male with a BMI of 30 and reports A. Take another dose of Nitroglycerin in 5 minutes.
smoking 2 packs of cigarettes a day. B. Call 911 immediately
C. A 45-year-old female that reports her father died at the C. Lie down and rest to see if that helps with relieving the pain
age of 42 from a myocardial infraction. D. Take two doses of Nitroglycerin in 5 minutes
D. A 29-year-old that has type I diabetes.
10. Lipitor is prescribed for a patient with a high cholesterol level.
4. A patient reports during a routine check-up that he is As the nurse, how do you educate the patient on how this drug
experiencing chest pain and shortness of breath while works on the body?
performing activities. He states the pain goes away when he
rests. This is known as: A. Lipitor increases LDL levels and decreases HDL levels,
total cholesterol, and triglyceride levels.
A. Unstable angina B. Lipitor decreases LDL, HDL levels, total cholesterol, and
B. Variant angina triglyceride levels.
C. Stable angina C. Lipitor increases HDL levels, total cholesterol, and
D. Prinzmetal angina triglyceride levels.
D. Lipitor increases HDL levels and decreases LDL, total
5. Keeping the patient in question 4 in mind: What type of
cholesterol, and triglyceride levels.
diagnostic tests will the physician most likely order (at first) for
this patient to evaluate the cause of the patient’s symptoms? 11. A patient taking Zocor is reporting muscle pain. You are
Select-all-that-apply: evaluating the patient’s lab work and note that which of the
following findings could cause muscle pain?
A. EKG
B. Stress test A. Elevated potassium level
C. Heart catheterization B. Elevated CPK (creatine kinase level)
D. Balloon angioplasty C. Decreased potassium level
D. Decreased CPK (creatine kinase level)
6. You're providing education to a patient who will be undergoing
a heart catheterization. Which statement by the patient requires 12. A patient who has diabetes will be started on Metoprolol for
you to re-educate the patient about this procedure? medical management of coronary artery disease. Which of the
following will you include in your discharge teaching about this
A. “The brachial artery is most commonly used for this
medication?
procedure.”
B. “A dye is injected into the coronary arteries to assess for A. Check your heart rate regularly because Metoprolol can
blockages." cause an irregular heart rate.
C. “Not all patients who have a heart catheterization will need B. Check your glucose regularly because this medication can
a stent placement.” cause hyperglycemia.
D. “I will not be completely asleep and will be able to breathe C. Check your blood pressure regularly because this
on my own during the procedure.” medication can cause hypertension.
D. Check your glucose regularly because this medication
7. A patient reports having crushing chest pain that radiates to
can mask the typical signs and symptoms of
the jaw. You administer sublingual nitroglycerin and obtain a 12
hypoglycemia.
lead EKG. Which of the following EKG findings confirms your
suspicion of a possible myocardial infraction?

A. absent Q wave
13. True or False: ACE inhibitors work to decrease the workload
on the heart by blocking the conversion of Angiotensin II to
Angiotensin I which causes vasodilation.
A. True
B. False
HEART FAILURE NCLEX QUESTIONS
1. Which of the following patients are MOST at risk for
developing heart failure? Select-all-that-apply:
A. A 69-year-old male with a history of alcohol abuse and
is recovering from a myocardial infarction.
B. A 55-year-old female with a health history of asthma and
hypoparathyroidism.
C. A 30-year-old male with a history of endocarditis and
has severe mitral stenosis.
D. A 45-year-old female with lung cancer stage 2.
E. A 58-year-old female with uncontrolled hypertension
and is being treated for influenza.
2. A patient is being discharged home after hospitalization of left
ventricular systolic dysfunction. As the nurse providing
discharge teaching to the patient, which statement is NOT a
correct statement about this condition?
A. "Signs and symptoms of this type of heart failure can
include: dyspnea, persistent cough, difficulty breathing
while lying down, and weight gain."
B. "It is important to monitor your daily weights, fluid and salt
intake."
C. "Left-sided heart failure can lead to right-sided heart failure,
if left untreated."
D. "This type of heart failure can build up pressure in the
hepatic veins and cause them to become congested
with fluid which leads to peripheral edema."
3. Which of the following are NOT typical signs and symptoms
of right-sided heart failure? Select-all-that-apply:
A. Jugular venous distention
B. Persistent cough
C. Weight gain
D. Crackles
E. Nocturia
F. Orthopnea
4. A patient is diagnosed with left-sided systolic dysfunction
heart failure. Which of the following are expected findings with
this condition?
A. Echocardiogram shows an ejection fraction of 38%.
B. Heart catheterization shows an ejection fraction of 65%.
C. Patient has frequent episodes of nocturnal paroxysmal
dyspnea.
D. Options A and C are both expected findings with left-
sided systolic dysfunction heart failure.
5. True or False: Patients with left-sided diastolic dysfunction
heart failure usually have a normal ejection fraction.
A. True
B. False
6. A patient has a history of heart failure. Which of the following
statements by the patient indicates the patient may be
experiencing heart failure exacerbation?
A. “I’ve noticed that I’ve gain 6 lbs in one week.”
B. “While I sleep, I have to prop myself up with a pillow so I
can breathe.”
C. “I haven’t noticed any swelling in my feet or hands lately.”
D. Options B and C are correct.
E. Options A and B are correct.
F. Options A, B, and C are all correct.
7. Patients with heart failure can experience episodes of
exacerbation. All of the patients below have a history of heart
failure. Which of the following patients are at MOST risk for heart
failure exacerbation?
A. A 55-year-old female who limits sodium and fluid intake
regularly.
B. A 73-year-old male who reports not taking Amiodarone
for one month and is experiencing atrial fibrillation.
C. A 67-year-old female who is being discharged home from
heart valve replacement surgery.
D. A 78-year-old male who has a health history of eczema and
cystic fibrosis.
8. A 74-year-old female presents to the ER with complaints of
dyspnea, persistent cough, and unable to sleep at night due to
difficulty breathing. On assessment, you note crackles
throughout the lung fields, respiratory rate of 25, and an oxygen
saturation of 90% on room air. Which of the following lab results
confirm your suspicions of heart failure?
A. K+ 5.6
B. BNP 820
C. BUN 9
D. Troponin <0.02
9. Which of the following tests/procedures are NOT used to
diagnose heart failure?
A. Echocardiogram
B. Brain natriuretic peptide blood test
C. Nuclear stress test
D. Holter monitoring
10. What type of heart failure does this statement describe? The
ventricle is unable to properly fill with blood because it is too stiff.
Therefore, blood backs up into the lungs causing the patient to
experience shortness of breath.
A. Left ventricular systolic dysfunction
B. Left ventricular ride-sided dysfunction
C. Right ventricular diastolic dysfunction
D. Left ventricular diastolic dysfunction
11. A patient with left-sided heart failure is having difficulty
breathing. Which of the following is the most appropriate nursing
intervention?
A. Encourage the patient to cough and deep breathe.
B. Place the patient in Semi-Fowler's position.
C. Assist the patient into High Fowler's position.
D. Perform chest percussion therapy.
12. You're providing diet discharge teaching to a patient with a 18. During your morning assessment of a patient with heart
history of heart failure. Which of the following statements made failure, the patient complains of sudden vision changes that
by the patient represents they understood the diet teaching? include seeing yellowish-green halos around the lights. Which of
the following medications do you suspect is causing this issue?
A. "I will limit my sodium intake to 5-6 grams a day."
B. "I will be sure to incorporate canned vegetables and fish A. Lisinopril
into my diet." B. Losartan
C. "I'm glad I can still eat sandwiches because I love bologna C. Lasix
and cheese sandwiches." D. Digoxin
D. "I will limit my consumption of frozen meals."
19. Select all the correct statements about the
13. Select all the correct statements about educating the patient pharmacodynamics of Beta-blockers for the treatment of heart
with heart failure: failure:

A. It is important patients with heart failure notify their A. These drugs produce a negative inotropic effect on the
physician if they gain more than 6 pounds in a day or 10 heart by increasing myocardial contraction.
pounds in a week. B. A side effect of these drugs include bradycardia.
B. Patients with heart failure should receive an annual C. These drugs are most commonly prescribed for patients
influenza vaccine and be up-to-date with the with heart failure who have COPD.
pneumonia vaccine. D. Beta-blockers are prescribed with ACE or ARBs to
C. Heart failure patients should limit sodium intake to 2-3 treat heart failure.
grams per day.
D. Heart failure is exacerbated by illness, too much fluid 20. You are assisting a patient up from the bed to the bathroom.
or sodium intake, and arrhythmias. The patient has swelling in the feet and legs. The patient is
E. Patients with heart failure should limit exercise because of receiving treatment for heart failure and is taking Hydralazine
the risks. and Isordil. Which of the following is a nursing priority for this
patient while assisting them to the bathroom?
14. A patient taking Digoxin is experiencing severe bradycardia,
nausea, and vomiting. A lab draws shows that their Digoxin level A. Measure and record the urine voided.
is 4 ng/mL. What medication do you anticipate the physician to B. Assist the patient up slowing and gradually.
order for this patient? C. Place the call light in the patient's reach while in the
bathroom.
A. Narcan D. Provide privacy for the patient.
B. Aminophylline
C. Digibind 21. A patient is taking Digoxin. Prior to administration you check
D. No medication because this is a normal Digoxin level. the patient's apical pulse and find it to be 61 bpm. Morning lab
values are the following: K+ 3.3 and Digoxin level of 5 ng/mL.
15. Which of the following is a late sign of heart failure? Which of the following is the correct nursing action?

A. Shortness of breath A. Hold this dose and administer the second dose at 1800.
B. Orthopnea B. Administer the dose as ordered.
C. Edema C. Hold the dose and notify the physician of the digoxin
D. Frothy-blood-tinged sputum level.
D. Hold this dose until the patient’s potassium level is normal.
16. These drugs are used as first-line treatment of heart failure.
They work by allowing more blood to flow to the heart which 22. Which of the following is a common side effect of
decreases the work load of the heart and allows the kidneys to Spironolactone?
secrete sodium. However, some patients can develop a nagging
cough with these types of drugs. This description describes? A. Renal failure
B. Hyperkalemia
A. Beta-blockers C. Hypokalemia
B. Vasodilators D. Dry cough
C. Angiotensin II receptor blockers
D. Angiotensin-converting-enzyme inhibitors 23. The physician’s order says to administered Lasix 40 mg IV
twice a day. The patient has the following morning labs: Na+
17. A patient with heart failure is taking Losartan and 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a
Spironolactone. The patient is having EKG changes that nursing priority?
presents with tall peaked T-waves and flat p-waves. Which of
the following lab results confirms these findings? A. Administer the Lasix as ordered
B. Notify the physician of the BNP level
A. Na+ 135 C. Assess the patient for edema
B. BNP 560 D. Hold the dose and notify the physician about the
C. K+ 8.0 potassium level
D. K+ 1.5
 MYOCARDIAL INFARCTION NCLEX 7. On an EKG, the lateral view of the heart is represented with
QUESTIONS leads?

A. V1, V2, V3
1. You're educating a patient about the causes of a myocardial
B. II, II, AVF
infarction. Which statement by the patient indicates they
C. I, AVL, V5, V6
misunderstood your teaching and requires you to re-educate
D. V1, V2, V6
them?
8. A patient is admitted with chest pain to the ER. The patient
A. Coronary artery dissection can happen spontaneously and
has been in the ER for 5 hours and is being admitted to your unit
occurs more in women.
for overnight observation. From the options below, what is the
B. The most common cause of a myocardial infarction is
most IMPORTANT information to know about this patient at this
a coronary spasm from illicit drug use or hypertension.
time?
C. Patients who have coronary artery disease are at high risk
for developing a myocardial infarction. A. Troponin result and when the next troponin level is due
D. Both A and B are incorrect. to be collected
B. Diet status
2. You note in the patient's chart that the patient recently had a
C. Last consumption of caffeine
myocardial infarction due to a blockage in the left coronary
D. CK result and when the next CK level is due to be collected
artery. You know that which of the following is true about this
type of blockage? 9. A doctor has ordered cardiac enzymes on a patient being
admitted with chest pain. You know that _____________ levels
A. A blockage in the left coronary artery causes the least
elevate 2-4 hours after injury to the heart and is the most
amount of damage to the heart muscle.
regarded marker by providers.
B. Left coronary artery blockages can cause anterior wall
death which affects the left ventricle. A. Myoglobin
C. Left coronary artery blockage can cause posterior wall B. CK-MB
death which affects the right ventricle. C. CK
D. The left anterior descending artery is least likely to be D. Troponin
affected by coronary artery disease.
10. A patient is complaining of chest pain. On the bedside
3. A patient is 36 hours status post a myocardial infarction. The cardiac monitor, you observe pronounce T-wave inversion. You
patient is starting to complain of chest pain when they lay flat or obtain the patient's vital signs and find the following: Blood
cough. You note on auscultation of the heart a grating, harsh pressure 190/98, HR 110, oxygen saturation 96% on room air,
sound. What complication is this patient mostly likely suffering and respiratory rate 20. Select-all-that-apply in regards to the
from? MOST IMPORTANT nursing interventions you will provide
based on the patient’s current status:
A. Cardiac dissection
B. Ventricular septum rupture A. Obtain a 12-lead EKG
C. Mitral valve prolapses B. Place the patient in supine position
D. Pericarditis C. Assess urinary output
D. Administer Nitroglycerin sublingual as ordered per
4. After a myocardial infraction, at what time (approximately) do
protocol
the macrophages present at the site of injury to perform
E. Collect cardiac enzymes as ordered per protocol
granulation of the tissue?
F. Encourage patient to cough and deep breath
A. 24 hours G. Administer Morphine IV as ordered per protocol
B. 2 days H. Place patient on oxygen via nasal cannula
C. 10 days I. No interventions are needed at this time
D. 6 hours
11. In regards to the patient in the previous question, after
5. 24-36 hours after a myocardial infarction _____________ administering the first dose of Nitroglycerin sublingual the
congregate at the site during the inflammation phase. patient's blood pressure is now 68/48. The patient is still having
chest pain and T-wave inversion on the cardiac monitor. What
A. Neutrophils is your next nursing intervention?
B. Eosinophils
C. Platelets A. Hold further doses of Nitroglycerin and notify the
D. Macrophages doctor immediately for further orders.
B. Administer Morphine IV and place the patient in reverse
6. A patient is complaining of chest pain. You obtain a 12-lead Trendelenburg position.
EKG and see ST elevation in leads II, III, AVF. What area of the C. Administer Nitroglycerin and monitor the patient’s blood
heart does this represent? pressure.
D. All the options are incorrect.
A. Lateral
B. Septal
C. Anterior
D. Inferior
12. A patient recovering from a myocardial infarction is D. Cardizem
complaining of the taste of blood in their mouth. On assessment,
you note there is bleeding on the anterior gums. Which 19. Which of the following EKG changes are abnormal findings
medication can cause this? that may indicate ischemia or injury to the cardiac muscle found
on a 12-lead EKG? SELECT-ALL-THAT-APPLY:
A. Coreg
B. Cardizem A. Lengthening p-waves
C. Lovenox B. ST-segment elevation
D. Lipitor C. T-wave inversion
D. Tall t-waves
13. A patient is on a Heparin drip post myocardial infarction. The E. QT interval narrowing
patient has been on the drip for 4 days. You are assessing the F. ST-segment depression
patient's morning lab work. Which of the following findings in the
patient's lab work is a potential life-threatening complication of HYPERTENSION NCLEX QUESTIONS
Heparin therapy and requires intervention?
1. A patient is being discharged home on Hydrochlorothiazide
A. K+ 3.7 (HCTZ) for treatment of hypertension. Which of the following
B. PTT 65 seconds statements by the patient indicates they understood your
C. Hgb 14.5 discharge teaching about this medication?
D. Platelets 135,000
A. I will make sure I consume foods high in potassium.
14. A patient is experiencing Heparin-Induced B. I will only take this medication if my blood pressure is high.
Thrombocytopenia from Heparin therapy. The doctor orders C. I understand a dry cough is a common side effect with this
Heparin to be discontinued. The patient will most likely be placed medication.
on what other medication? D. I will monitor my glucose levels closely because this
medication may mask symptoms of hypoglycemia.
A. Argatroban
B. Lovenox 2. Which of the following patients does not have a risk factor for
C. Levophed hypertension?
D. Tridil
A. A 25-year-old male with a BMI of 35.
15. A patient taking Lovenox is having a severe reaction. What B. A 35-year-old female with a total cholesterol level of
is the antidote for this medication? 100.
C. A 68-year-old male who reports smoking 2 packs of
A. Activated Charcoal cigarettes a day.
B. Acetylcysteine D. A 40-year-old female with a family history of hypertension
C. Narcan and diabetes.
D. Protamine sulfate
3. A patient with hypertension is started on a new medication for
16. A patient is being discharged home after receiving treatment treatment and is reporting a continuous dry cough. Which of the
for a myocardial infarction. The patient will be taking Coreg. following medications do you suspect is causing this problem?
What statement by the patient demonstrates they understood
your education material about this drug? A. Lisinopril
B. Labetalol
A. "I will take this medication at night." C. Losartan
B. "I will take this medication as needed." D. Hydrochlorothiazide
C. "I will monitor my heart rate and blood pressure while
taking this medication." 4. Which of the following patients is not a candidate for a beta
D. "I will take this medication in the morning with grapefruit blocker medication?
juice."
A. A 45-year-old male with angina.
17. A patient is complaining of a nagging cough that is B. A 39-year-old female with asthma.
continuous. Which medication below can cause this side effect? C. A 25-year-old female with migraines.
D. A 55-year-old male with a history of two heart attacks.
A. Losartan
B. Lisinopril 5. Which family of drugs are the following medications
C. Cardizem considered: Amlodipine, Verapamil, Diltiazem?
D. Lipitor
A. Beta blockers (BB)
18. A patient's morning lab work shows a potassium level of 6.3. B. ACE Inhibitors (ACEI)
The patient’s potassium level yesterday was 4.0 The patient was C. Angiotensin Receptor Blockers (ARBs)
recently started on new medications for treatment of myocardial D. Calcium Channel Blockers (CCBs)
infarction. What medication below can cause an increased
potassium level? 6. Which of the following systems of the body are affected by
hypertension?
A. Losartan
B. Norvasc A. Cardiovascular, brain, kidney, eyes
C. Aspirin B. Cardiovascular, gastrointestinal, reproductive, and kidney
C. Brain, respiratory, kidney, cardiovascular 5. All of the following are type of angina except for:
D. None of the options are correct
A. Stable angina.
7. Non-pharmacological techniques can help lower blood B. Unstable angina.
pressure. Which of the following is not considered one of these C. Refractory angina.
types of techniques? D. Direct angina.

A. Dietary changes
B. Multivitamins
C. Smoking cessation
D. Limiting caffeine

8. Which of the following drugs is NOT considered an

Angiotensin Receptor Blocker (ARBs) medication used in
hypertension?

A. Catapres
B. Losartan
C. Benicar
D. Valsartan

9. A patient is scheduled to take Captopril. When is the best time

to administer this medication?

A. 30 minutes after a meal

B. At bedtime
C. In the morning
D. 1 hour before a meal

10. True or False: Most patients with hypertension are

asymptomatic.

A. True
B. False

ANGINA PECTORIS NURSESLABS QUESTIONS

1. The pain of angina pectoris is produced primarily by:

A. Vasoconstriction.
B. Movement of thromboemboli.
C. Myocardial ischemia.
D. The presence of atheromas.

2. The nurse advises a patient that sublingual nitroglycerin

should alleviate angina pain within:

A. 3 to 4 minutes.
B. 10 to 15 minutes.
C. 30 minutes.
D. 60 minutes.

3. The scientific rationale supporting the administration of beta-

blockers is the drug’s ability to:

A. Block sympathetic impulses to the heart.

B. Elevate blood pressure.
C. Increase myocardial contractility.
D. Induce bradycardia.

4. Calcium channel blockers act by:

A. Decreasing SA node automaticity.

B. Increasing AV node conduction.
C. Increasing the heart rate.
D. Creating a positive inotropic effect.
 ARBs NCLEX QUESTIONS
1. You’re teaching a patient about how angiotensin II receptor
blockers (ARBs) work. Which statement below BEST
describes how these medications work on the body?
A. “They prevent Angiotensin II Type I Receptors from
binding with Angiotensin II.”
B. “These medications prevent the activation of Angiotensin
II Type II Receptors from binding with Angiotensin II.”
C. “They inhibit angiotensin-converting-enzyme (ACE) from
converting an Angiotensin I to Angiotensin II.”
D. “These medications prevent Angiotensin II Type I
Receptors from binding with angiotensin-converting-
enzyme (ACE).”
2. A physician writes a new medication order for a patient who
has cardiovascular disease. The medication is an angiotensin
II receptor blocker (ARB). What new medication on the
patient’s scheduled medication list is an ARB?
A. Metoprolol
B. Losartan
C. Lisinopril
D. Nicardipine
3. A patient who developed a dry, persistent cough while
taking an ACE Inhibitor is switched to an angiotensin II
receptor blocker (ARB). The patient reports the cough is now
gone, but asks you to explain how this medication helped
alleviate the cough. What is the correct response?
A. “ARBs prevent ACE (angiotensin-converting-enzyme)
from breaking down bradykinin so a dry, persistent cough
is less likely.”
B. “ARBs increase ACE (angiotensin-converting-enzyme)
which helps decrease bradykinin levels and helps
alleviate the cough.”
C. “ARBs do not inhibit ACE (angiotensin-converting-
enzyme), which is a substance that inactivates
bradykinin by breaking it down; therefore, a cough is
not likely with this medication.”
D. “ARBs prevent Angiotensin II Type I receptor sites from
activating bradykinin in the lungs.”
4. Select all the pharmacodynamic effects of angiotensin II
receptor blockers (ARBs):
7. As the nurse you know to tell the patient that the best way
to PREVENT rebound hypertension while taking an
Angiotensin II Receptor Blocker (ARB) is to?
A. assess the blood pressure daily with a self-monitoring
device
B. never abruptly stop taking the medication
C. avoid taking the medication with milk or grapefruit juice
D. avoid taking over-the-counter medications
8. You’re providing discharge teaching to a patient that will be
taking an Angiotensin II Receptor Blocker (ARB) at home.
What statement by the patient requires you to re-educate
them about this medication?
A. “This medication does not cure hypertension. Therefore,
I will need to also make lifestyle changes.”
B. “I will always stand and change positions slowly.”
C. “A persistent, dry cough is not common with this
medication.”
D. “This medication can decrease potassium levels. So,
I will consume a diet rich in potassium to help keep
my level normal.”
9. Your patient is prescribed an Angiotensin II Receptor
Blocker (ARB) for the treatment of blood pressure
management. Which statement below BEST describes how
this medication will manage blood pressure in a patient?
A. “This medication will increase systemic vascular
resistance (SVR) and decrease blood pressure, while
decreasing blood volume through the excretion of
sodium and water.”
B. “This medication will decrease systemic vascular
resistance (SVR) and decrease blood pressure, while
decreasing blood volume through the excretion of
sodium and water.”
C. “ARBs will cause vasoconstriction and increase renal
blood flow and volume.”
D. “ARBs will cause vasodilation and the kidneys to retain
sodium and water.”
ARBs NCLEX QUESTIONS
1. A 65-year-old male patient is prescribed an ACE inhibitor
for the treatment of hypertension. Which medication below is
an ACE inhibitor?

A. Vasodilation A. Metoprolol
B. Vasoconstriction B. Benazepril
C. Sodium conservation C. Losartan
D. Sodium excretion D. Amlodipine
E. Water conservation
F. Water excretion 2. Which statements below CORRECTLY describe how ACE
Inhibitors work? Select all that apply:
5. What conditions are Angiotensin II Receptor Blockers
(ARBs) used to treat? Select all that apply: A. This group of medications inhibits the renin-
angiotensin-aldosterone system (RAAS).
A. Hypertension B. ACE Inhibitors prevent the conversion of
B. Renal stenosis Angiotensin I to Angiotensin II.
C. Diabetic nephropathy in type 2 diabetics C. ACE Inhibitors prevent Angiotensinogen from converting
D. Atrial flutter to Angiotensin I.
E. Heart failure D. ACE Inhibitors have a positive chronotropic and negative
inotropic effect on the heart.
6. A patient is taking an Angiotensin II Receptor Blocker
(ARB). What finding below is an adverse side effect of this 3. Angiotensin-converting enzyme (ACE) performs what roles
medication and should be reported to the physician? in the body? Select all that apply:

A. BUN 10 A. Inactivates bradykinin by breaking it down

B. Creatinine 1 mg/dL B. Dilates vessels
C. Potassium 6.8 mEq/L C. Causes the kidneys to keep sodium and water
D. ALT 20 U/L D. Converts Angiotensin I to Angiotensin II
4. Fill in the blanks: Angiotensin II causes ___________ of the C. “I will make sure I incorporate a high amount of potatoes,
vessels and triggers the release of ____________. bananas, oranges, and tomatoes into my diet while
taking this medication”.
A. vasodilation; anti-diuretic hormone (ADH) D. “I will regularly check my blood pressure and pulse
B. vasodilation; aldosterone rate while taking this medication and report any
C. vasoconstriction; aldosterone significant changes to my doctor.”
D. vasoconstriction; anti-diuretic hormone (ADH)
11. A patient is taking an ACE Inhibitor and Spironolactone. It
5. A patient is prescribed an ACE Inhibitor after experiencing is priority the nurse teaches the patient?
a myocardial infarction. What effects on the body will this
medication achieve? Select all that apply: A. To avoid consuming alcoholic beverages
B. To limit foods high in potassium
A. Decreases SVR (systemic vascular resistance) and C. To limit salt intake
blood pressure D. To take the medications with food
B. Constriction of the vessels
C. Kidneys will excrete water and sodium
D. Kidneys will retain potassium.
E. Increases SVR (systemic vascular resistance) and blood
pressure

6. Which patient below would MOST benefit from an ACE

Inhibitor?

A. A 50-year-old female with systolic dysfunction heart

failure.
B. A 48-year-old male with severe renal failure.
C. A 35-year-old female with chronic hepatitis.
D. A 54-year-old male with hypovolemic shock.

7. Your patient is taking an ACE Inhibitor to manage blood

pressure. Which finding below requires immediate nursing
action?

A. Urinary output is 190 mL within the past 4 hours.

B. Patient has a persistent, dry cough.
C. EKG shows tall, peaked t-waves.
D. Patient has a negative Chvostek’s sign.

8. Some patients who take ACE Inhibitors may develop

angioedema. What signs and symptoms will you teach the
patient to recognize that can present with this adverse
reaction? Select all that apply:

A. Hyperkalemia
B. Persistent, dry cough
C. Swelling in the face
D. Thin and shiny skin in the lower extremities
E. Difficulty breathing

9. A patient states they are experiencing an annoying,

persistent dry cough that started once they begin taking an
ACE Inhibitor. The patient is not experiencing any other signs
and symptoms. As the nurse, your response is

A. Tell the patient to immediately stop taking the medication

and seek medical treatment.
B. Reassure the patient this is a harmless side effect of
this medication and to not abruptly stop taking the
medication.
C. Recommend the patient start taking the medication at
night to decrease the coughing.
D. Reassure the patient that the cough will disappear within
6 months of taking the medication.

10. You’re providing discharge instructions to a patient that will

be taking an ACE Inhibitor at home. Which statements by the
patient demonstrate they understood your discharge
instructions? Select all that apply:

A. “If I feel unwell, it is okay that I miss a dose.”

B. “I will avoid using salt substitutes that contain
potassium.”