NURS NCLEX Exam 2-with 100% verified solutions 2023-2024

NURS
NCLEX Exam
2-with 100%
verified
solutions 2023-2024 Cardiac
A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is
scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours
before the procedure and for 48 hours after the procedure?
Metformin
A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for
2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the
subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level
is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the
basis of these findings, the nurse would anticipate that the client is at risk for which problem?
Acute Kidney Injury
The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes
are regular. The PR interval is 0.16 seconds, and QRS complexes measure 0.06 seconds. The
overall heart rate is 64 beats/minute. Which action should the nurse take?
Continue to monitor
A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse
sees no electrocardiographic complexes on the screen. Which is the priority nursing action?
Check the client's status and lead placement.
The nurse is evaluating a client's response to cardioversion. Which assessment would be the
priority?
Status of airway
The nurse is caring for a client who has just had implantation of an automatic internal
cardioverter-defibrillator. The nurse should assess which item based on priority?
Activation status of the device, heart rate cutoff, and number of shocks it is programmed
to deliver
A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR
interval is 0.14 seconds, the QRS complex measures 0.08 seconds, and the PP and RR
intervals are regular. How should the nurse correctly interpret this rhythm?
Sinus tachycardia
The nurse is assessing the neurovascular status of a client who returned to the surgical nursing
unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the
nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission.
How should the nurse correctly interpret the client's neurovascular status?
The neurovascular status is normal because of increased blood flow through the leg.
The nurse is evaluating the condition of a client after pericardiocentesis performed to treat
cardiac tamponade. Which observation would indicate that the procedure was effective?
A rise in blood pressure
A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily.
Which statement by the client indicates the need for further teaching?
"My spouse told me that since I have developed this problem, we are going to stop
walking in the mall every morning."
The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which
assessment finding indicates the presence of this complication?
Muffled or distant heart sounds
The home care nurse is provid