critical thinking questions cardiovascular system

Cardiovascular Disorders NCLEX Practice Questions (220 Questions)

Welcome to your NCLEX reviewer and practice questions quiz for cardiovascular system disorders. This NCLEX nursing test bank tests your competence in the nursing care and management of patients with dysrhythmias, hematological disorders, hypertension , coronary artery disease, myocardial infarction , heart failure , and peripheral vascular diseases.

Cardiac Disorders Nursing Test Bank

Here are the NCLEX practice questions for cardiovascular system disorders. This nursing test bank set includes 220 NCLEX -style practice questions that cover topics like dysrhythmias, EKG interpretation , heart failure, myocardial infarction , hematologic disorders, and more. Use these questions to help you review for cardiovascular system disorders and as an alternative to Quizlet.

All questions on this set are updated to give you the most challenging questions, along with insightful rationales to reinforce learning .

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29 thoughts on “Cardiovascular Disorders NCLEX Practice Questions (220 Questions)”

Hi, thank you for these practice NCLEX styled questions! I am currently taking the “Hypertension & Coronary Artery Disease NCLEX Practice Exam #3” and one of the rationale boxes for both the incorrect and correct answers does not seem to correlate with the question nor the answer choices. The question was asking about the most important long term goal for a hypertensive patient. I was wondering is there any way to trouble shoot this so I could receive the correlating rationales? Thank you.

Hi Kat, this has been corrected. Thank you for letting us know :) Good luck!

Thank you for letting me to do this exam I hope to do very well

Thank u so much for your help.. Stay safe, healthy and happy!😊

Thanks a lot i learned many thing it is helpful for us

Hi Matt! I am very thankful for your help. God bless and may the good Lord continue to shower you with more blessings for your generosity. These practice tests would help me pass the NCLEX exam.

Thank you so much Matt! These practice tests have been very helpful!

Your time: 00:17:14

You have reached 50 of 50 point(s), (100%)

Average score 0% Your score 100%

Congratulations, you have completed this quiz!

I play with this every now and then until I finally could come out with this score, am so… looking forward to one day becoming a RN. Thanks for this educative platform

Question 18 about a 56 year old lady having chest pains while climbing stairs to her friend’s house. Some other classmates and I agree that she should probably not take a nitro tablet right before climbing the stairs because she could have a significant drop in BP, get dizzy, and fall down the stairs. We are instructed to always educate the patient to sit down before taking a nitro tablet for safety and to take caution when standing after. Other than that question, these are great and go along with my current nursing exam.

Thanks for letting me do these questions

Thank you for sharing these mind juggling practice questions. I’m preparing for the NCLEX and I use this platform to gauge my understanding in various topics.

Only God almighty will reward you for this good work. Thank you! thank you!! Thank you!!! Only God knows how much you impacted positively in my study life 😭

Very challenge but good since one is forced to think critically.

I love this site. It’s intuitive and helps provide great challenging questions with in-depth rationales. That I, as a nurse educator, love reading! Great job!

Thanks so much for your kind words, Jesi!

For question no 48, I think Cardiac tamponade includes jugular vein distention decreased urine output, not increased urine output as indicated in your answers. Can you please, revisit question no 48 and give more clarification on the answers? Thank you so much. I have learned a lot in this chapter. -Nonye.

Hi Nonye, thanks for bringing this up. I have corrected the choices. Thanks again!

Question 26 on exam 4: Correct Answer: B. Hypertrophic

Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. I thought hypertrophic cardiomyopathy leads to decreased filling (diastolic failure) which would then result in decreased stroke volume and thus decreased cardiac output?

Aspirin is an Antiplatelet drug.

Thank you so much for this!! I appreciate it so much, especially the detailed rationales. Also, I just want to note that I don’t think the Schilling test is used anymore for question 9 and 10? Just in case you want to update, but I might be wrong. Much love!!

Hello, Nitroglycerin administer during MI attack pattern is changed.

I love practicing on the questions above and the rational is completely understand.

We were taught to call for help/call code then initate CPR if we are the first person for V. Fib and someone else would bring the AED. Is that just a nursing school thing?

This question below i disagree with answer to start defib. you iniate cpr first not defib’ing the client

When ventricular fibrillation occurs in a CCU, the first person reaching the client should:

Excellent question for health student

I have enjoyed your exam Questions though I got 21/50. Thank you so much 😊

I’m glad there’s an online free reviewer like this, I hope I still have stock knowledge for me to assess myself on taking the exam. Thank you!

Leave a Comment Cancel reply

Chapter Review

19.1 heart anatomy.

The heart resides within the pericardial sac and is located in the mediastinal space within the thoracic cavity. The pericardial sac consists of two fused layers: an outer fibrous capsule and an inner parietal pericardium lined with a serous membrane. Between the pericardial sac and the heart is the pericardial cavity, which is filled with lubricating serous fluid. The walls of the heart are composed of an outer epicardium, a thick myocardium, and an inner lining layer of endocardium. The human heart consists of a pair of atria, which receive blood and pump it into a pair of ventricles, which pump blood into the vessels. The right atrium receives systemic blood relatively low in oxygen and pumps it into the right ventricle, which pumps it into the pulmonary circuit. Exchange of oxygen and carbon dioxide occurs in the lungs, and blood high in oxygen returns to the left atrium, which pumps blood into the left ventricle, which in turn pumps blood into the aorta and the remainder of the systemic circuit. The septa are the partitions that separate the chambers of the heart. They include the interatrial septum, the interventricular septum, and the atrioventricular septum. Two of these openings are guarded by the atrioventricular valves, the right tricuspid valve and the left mitral valve, which prevent the backflow of blood. Each is attached to chordae tendineae that extend to the papillary muscles, which are extensions of the myocardium, to prevent the valves from being blown back into the atria. The pulmonary valve is located at the base of the pulmonary trunk, and the left semilunar valve is located at the base of the aorta. The right and left coronary arteries are the first to branch off the aorta and arise from two of the three sinuses located near the base of the aorta and are generally located in the sulci. Cardiac veins parallel the small cardiac arteries and generally drain into the coronary sinus.

19.2 Cardiac Muscle and Electrical Activity

The heart is regulated by both neural and endocrine control, yet it is capable of initiating its own action potential followed by muscular contraction. The conductive cells within the heart establish the heart rate and transmit it through the myocardium. The contractile cells contract and propel the blood. The normal path of transmission for the conductive cells is the sinoatrial (SA) node, internodal pathways, atrioventricular (AV) node, atrioventricular (AV) bundle of His, bundle branches, and Purkinje fibers. The action potential for the conductive cells consists of a prepotential phase with a slow influx of Na + followed by a rapid influx of Ca 2+ and outflux of K + . Contractile cells have an action potential with an extended plateau phase that results in an extended refractory period to allow complete contraction for the heart to pump blood effectively. Recognizable points on the ECG include the P wave that corresponds to atrial depolarization, the QRS complex that corresponds to ventricular depolarization, and the T wave that corresponds to ventricular repolarization.

19.3 Cardiac Cycle

The cardiac cycle comprises a complete relaxation and contraction of both the atria and ventricles, and lasts approximately 0.8 seconds. Beginning with all chambers in diastole, blood flows passively from the veins into the atria and past the atrioventricular valves into the ventricles. The atria begin to contract (atrial systole), following depolarization of the atria, and pump blood into the ventricles. The ventricles begin to contract (ventricular systole), raising pressure within the ventricles. When ventricular pressure rises above the pressure in the atria, blood flows toward the atria, producing the first heart sound, S 1 or lub. As pressure in the ventricles rises above two major arteries, blood pushes open the two semilunar valves and moves into the pulmonary trunk and aorta in the ventricular ejection phase. Following ventricular repolarization, the ventricles begin to relax (ventricular diastole), and pressure within the ventricles drops. As ventricular pressure drops, there is a tendency for blood to flow back into the atria from the major arteries, producing the dicrotic notch in the ECG and closing the two semilunar valves. The second heart sound, S 2 or dub, occurs when the semilunar valves close. When the pressure falls below that of the atria, blood moves from the atria into the ventricles, opening the atrioventricular valves and marking one complete heart cycle. The valves prevent backflow of blood. Failure of the valves to operate properly produces turbulent blood flow within the heart; the resulting heart murmur can often be heard with a stethoscope.

19.4 Cardiac Physiology

Many factors affect HR and SV, and together, they contribute to cardiac function. HR is largely determined and regulated by autonomic stimulation and hormones. There are several feedback loops that contribute to maintaining homeostasis dependent upon activity levels, such as the atrial reflex, which is determined by venous return.

SV is regulated by autonomic innervation and hormones, but also by filling time and venous return. Venous return is determined by activity of the skeletal muscles, blood volume, and changes in peripheral circulation. Venous return determines preload and the atrial reflex. Filling time directly related to HR also determines preload. Preload then impacts both EDV and ESV. Autonomic innervation and hormones largely regulate contractility. Contractility impacts EDV as does afterload. CO is the product of HR multiplied by SV. SV is the difference between EDV and ESV.

19.5 Development of the Heart

The heart is the first organ to form and become functional, emphasizing the importance of transport of material to and from the developing infant. It originates about day 18 or 19 from the mesoderm and begins beating and pumping blood about day 21 or 22. It forms from the cardiogenic region near the head and is visible as a prominent heart bulge on the surface of the embryo. Originally, it consists of a pair of strands called cardiogenic cords that quickly form a hollow lumen and are referred to as endocardial tubes. These then fuse into a single heart tube and differentiate into the truncus arteriosus, bulbus cordis, primitive ventricle, primitive atrium, and sinus venosus, starting about day 22. The primitive heart begins to form an S shape within the pericardium between days 23 and 28. The internal septa begin to form about day 28, separating the heart into the atria and ventricles, although the foramen ovale persists until shortly after birth. Between weeks five and eight, the atrioventricular valves form. The semilunar valves form between weeks five and nine.

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7.2.10: Critical Thinking Questions

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How does the polygastric digestive system aid in digesting roughage?

How do birds digest their food in the absence of teeth?

What is the role of the accessory organs in digestion?

Explain how the villi and microvilli aid in absorption.

Name two components of the digestive system that perform mechanical digestion. Describe how mechanical digestion contributes to acquiring nutrients from food.

What are essential nutrients?

What is the role of minerals in maintaining good health?

Discuss why obesity is a growing epidemic.

There are several nations where malnourishment is a common occurrence. What may be some of the health challenges posed by malnutrition?

Generally describe how a piece of bread can power your legs as you walk up a flight of stairs.

In the 1990s fat-free foods became popular among people trying to lose weight. However, many dieticians now conclude that the fat-free trend made people less healthy and heavier. Describe how this could occur.

Explain why some dietary lipid is a necessary part of a balanced diet.

The gut microbiome (the bacterial colonies in the intestines) have become a popular area of study in biomedical research. How could varying gut microbiomes impact a person’s nutrition?

Many mammals become ill if they drink milk as adults even though they could consume it as babies. What causes this digestive issue?

Describe how hormones regulate digestion.

Describe one or more scenarios where loss of hormonal regulation of digestion can lead to diseases.

A scientist is studying a model that has a mutation in the receptor for somatostatin that prevents hormone binding. How would this mutation affect the structure and function of the digestive system?

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24.4: Fetal Development

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Learning Objectives

• Differentiate between the embryonic period and the fetal period
• Briefly describe the process of sexual differentiation
• Describe the fetal circulatory system and explain the role of the shunts
• Trace the development of a fetus from the end of the embryonic period to birth

As you will recall, a developing human is called a fetus from the ninth week of gestation until birth. This 30-week period of development is marked by continued cell growth and differentiation, which fully develop the structures and functions of the immature organ systems formed during the embryonic period. The completion of fetal development results in a newborn who, although still immature in many ways, is capable of survival outside the womb.

Sexual Differentiation

Sexual differentiation does not begin until the fetal period, during weeks 9–12. Embryonic males and females, though genetically distinguishable, are morphologically identical (Figure \(\PageIndex{1}\)). Bipotential gonads, or gonads that can develop into male or female sexual organs, are connected to a central cavity called the cloaca via Müllerian ducts and Wolffian ducts. (The cloaca is an extension of the primitive gut.) Several events lead to sexual differentiation during this period.

During male fetal development, the bipotential gonads become the testes and associated epididymis. The Müllerian ducts degenerate. The Wolffian ducts become the vas deferens, and the cloaca becomes the urethra and rectum.

During female fetal development, the bipotential gonads develop into ovaries. The Wolffian ducts degenerate. The Müllerian ducts become the uterine tubes and uterus, and the cloaca divides and develops into a vagina, a urethra, and a rectum.

The Fetal Circulatory System

During prenatal development, the fetal circulatory system is integrated with the placenta via the umbilical cord so that the fetus receives both oxygen and nutrients from the placenta. However, after childbirth, the umbilical cord is severed, and the newborn’s circulatory system must be reconfigured. When the heart first forms in the embryo, it exists as two parallel tubes derived from mesoderm and lined with endothelium, which then fuse together. As the embryo develops into a fetus, the tube-shaped heart folds and further differentiates into the four chambers present in a mature heart. Unlike a mature cardiovascular system, however, the fetal cardiovascular system also includes circulatory shortcuts, or shunts. A shunt is an anatomical (or sometimes surgical) diversion that allows blood flow to bypass immature organs such as the lungs and liver until childbirth.

The placenta provides the fetus with necessary oxygen and nutrients via the umbilical vein. (Remember that veins carry blood toward the heart. In this case, the blood flowing to the fetal heart is oxygenated because it comes from the placenta. The respiratory system is immature and cannot yet oxygenate blood on its own.) From the umbilical vein, the oxygenated blood flows toward the inferior vena cava, all but bypassing the immature liver, via the ductus venosus shunt (Figure \(\PageIndex{2}\)). The liver receives just a trickle of blood, which is all that it needs in its immature, semifunctional state. Blood flows from the inferior vena cava to the right atrium, mixing with fetal venous blood along the way.

Although the fetal liver is semifunctional, the fetal lungs are nonfunctional. The fetal circulation therefore bypasses the lungs by shifting some of the blood through the foramen ovale , a shunt that directly connects the right and left atria and avoids the pulmonary trunk altogether. Most of the rest of the blood is pumped to the right ventricle, and from there, into the pulmonary trunk, which splits into pulmonary arteries. However, a shunt within the pulmonary artery, the ductus arteriosus , diverts a portion of this blood into the aorta. This ensures that only a small volume of oxygenated blood passes through the immature pulmonary circuit, which has only minor metabolic requirements. Blood vessels of uninflated lungs have high resistance to flow, a condition that encourages blood to flow to the aorta, which presents much lower resistance. The oxygenated blood moves through the foramen ovale into the left atrium, where it mixes with the now deoxygenated blood returning from the pulmonary circuit. This blood then moves into the left ventricle, where it is pumped into the aorta. Some of this blood moves through the coronary arteries into the myocardium, and some moves through the carotid arteries to the brain.

The descending aorta carries partially oxygenated and partially deoxygenated blood into the lower regions of the body. It eventually passes into the umbilical arteries through branches of the internal iliac arteries. The deoxygenated blood collects waste as it circulates through the fetal body and returns to the umbilical cord. Thus, the two umbilical arteries carry blood low in oxygen and high in carbon dioxide and fetal wastes. This blood is filtered through the placenta, where wastes diffuse into the maternal circulation. Oxygen and nutrients from the mother diffuse into the placenta and from there into the fetal blood, and the process repeats.

Other Organ Systems

During weeks 9–12 of fetal development, the brain continues to expand, the body elongates, and ossification continues. Fetal movements are frequent during this period, but are jerky and not well-controlled. The bone marrow begins to take over the process of erythrocyte production—a task that the liver performed during the embryonic period. The liver now secretes bile. The fetus circulates amniotic fluid by swallowing it and producing urine. The eyes are well-developed by this stage, but the eyelids are fused shut. The fingers and toes begin to develop nails. By the end of week 12, the fetus measures approximately 9 cm (3.5 in) from crown to rump.

Weeks 13–16 are marked by sensory organ development. The eyes move closer together; blinking motions begin, although the eyes remain sealed shut. The lips exhibit sucking motions. The ears move upward and lie flatter against the head. The scalp begins to grow hair. The excretory system is also developing: the kidneys are well-formed, and meconium , or fetal feces, begins to accumulate in the intestines. Meconium consists of ingested amniotic fluid, cellular debris, mucus, and bile.

During approximately weeks 16–20, as the fetus grows and limb movements become more powerful, the mother may begin to feel quickening , or fetal movements. However, space restrictions limit these movements and typically force the growing fetus into the “fetal position,” with the arms crossed and the legs bent at the knees. Sebaceous glands coat the skin with a waxy, protective substance called  vernix caseosa that protects and moisturizes the skin and may provide lubrication during childbirth. A silky hair called lanugo also covers the skin during weeks 17–20, but it is shed as the fetus continues to grow. Extremely premature infants sometimes exhibit residual lanugo.

Developmental weeks 21–30 are characterized by rapid weight gain, which is important for maintaining a stable body temperature after birth. The bone marrow completely takes over erythrocyte synthesis, and the axons of the spinal cord begin to be myelinated, or coated in the electrically insulating glial cell sheaths that are necessary for efficient nervous system functioning. (The process of myelination is not completed until adolescence.) During this period, the fetus grows eyelashes. The eyelids are no longer fused and can be opened and closed. The lungs begin producing surfactant, a substance that reduces surface tension in the lungs and assists proper lung expansion after birth. Inadequate surfactant production in premature newborns may result in respiratory distress syndrome, and as a result, the newborn may require surfactant replacement therapy, supplemental oxygen, or maintenance in a continuous positive airway pressure (CPAP) chamber during its first days or weeks of life. In male fetuses, the testes descend into the scrotum near the end of this period. The fetus at 30 weeks measures 28 cm (11 in) from crown to rump and exhibits the approximate body proportions of a full-term newborn, but still is much leaner.

Visit this site for a summary of the stages of pregnancy, as experienced by the mother, and view the stages of development of the fetus throughout gestation. At what point in fetal development can a regular heartbeat be detected?

The fetus continues to lay down subcutaneous fat from week 31 until birth. The added fat fills out the hypodermis, and the skin transitions from red and wrinkled to soft and pink. Lanugo is shed, and the nails grow to the tips of the fingers and toes. Immediately before birth, the average crown-to-rump length is 35.5–40.5 cm (14–16 in), and the fetus weighs approximately 2.5–4 kg (5.5–8.8 lbs). Once born, the newborn is no longer confined to the fetal position, so subsequent measurements are made from head-to-toe instead of from crown-to-rump. At birth, the average length is approximately 51 cm (20 in).

DISORDERS OF THE...

Developing Fetus

Throughout the second half of gestation, the fetal intestines accumulate a tarry, greenish black meconium. The newborn’s first stools consist almost entirely of meconium; they later transition to seedy yellow stools or slightly formed tan stools as meconium is cleared and replaced with digested breast milk or formula, respectively. Unlike these later stools, meconium is sterile; it is devoid of bacteria because the fetus is in a sterile environment and has not consumed any breast milk or formula. Typically, an infant does not pass meconium until after birth. However, in 5–20 percent of births, the fetus has a bowel movement in utero, which can cause major complications in the newborn.

The passage of meconium in the uterus signals fetal distress, particularly fetal hypoxia (i.e., oxygen deprivation). This may be caused by maternal drug abuse (especially tobacco or cocaine), maternal hypertension, depletion of amniotic fluid, long labor or difficult birth, or a defect in the placenta that prevents it from delivering adequate oxygen to the fetus. Meconium passage is typically a complication of full-term or post-term newborns because it is rarely passed before 34 weeks of gestation, when the gastrointestinal system has matured and is appropriately controlled by nervous system stimuli. Fetal distress can stimulate the vagus nerve to trigger gastrointestinal peristalsis and relaxation of the anal sphincter. Notably, fetal hypoxic stress also induces a gasping reflex, increasing the likelihood that meconium will be inhaled into the fetal lungs.

Although meconium is a sterile substance, it interferes with the antibiotic properties of the amniotic fluid and makes the newborn and mother more vulnerable to bacterial infections at birth and during the perinatal period. Specifically, inflammation of the fetal membranes, inflammation of the uterine lining, or neonatal sepsis (infection in the newborn) may occur. Meconium also irritates delicate fetal skin and can cause a rash.

The first sign that a fetus has passed meconium usually does not come until childbirth, when the amniotic sac ruptures. Normal amniotic fluid is clear and watery, but amniotic fluid in which meconium has been passed is stained greenish or yellowish. Antibiotics given to the mother may reduce the incidence of maternal bacterial infections, but it is critical that meconium is aspirated from the newborn before the first breath. Under these conditions, an obstetrician will extensively aspirate the infant’s airways as soon as the head is delivered, while the rest of the infant’s body is still inside the birth canal.

Aspiration of meconium with the first breath can result in labored breathing, a barrel-shaped chest, or a low Apgar score. An obstetrician can identify meconium aspiration by listening to the lungs with a stethoscope for a coarse rattling sound. Blood gas tests and chest X-rays of the infant can confirm meconium aspiration. Inhaled meconium after birth could obstruct a newborn’s airways leading to alveolar collapse, interfere with surfactant function by stripping it from the lungs, or cause pulmonary inflammation or hypertension. Any of these complications will make the newborn much more vulnerable to pulmonary infection, including pneumonia.

Chapter Review

The fetal period lasts from the ninth week of development until birth. During this period, male and female gonads differentiate. The fetal circulatory system becomes much more specialized and efficient than its embryonic counterpart. It includes three shunts—the ductus venosus, the foramen ovale, and the ductus arteriosus—that enable it to bypass the semifunctional liver and pulmonary circuit until after childbirth. The brain continues to grow and its structures differentiate. Facial features develop, the body elongates, and the skeleton ossifies. In the womb, the developing fetus moves, blinks, practices sucking, and circulates amniotic fluid. The fetus grows from an embryo measuring approximately 3.3 cm (1.3 in) and weighing 7 g (0.25 oz) to an infant measuring approximately 51 cm (20 in) and weighing an average of approximately 3.4 kg (7.5 lbs). Embryonic organ structures that were primitive and nonfunctional develop to the point that the newborn can survive in the outside world.

Interactive Link Questions

Answer: A regular heartbeat can be detected at approximately 8 weeks.

Review Questions

Q. The foramen ovale causes the fetal circulatory system to bypass the ________.

Q. What happens to the urine excreted by the fetus when the kidneys begin to function?

A. The umbilical cord carries it to the placenta for removal.

B. The endometrium absorbs it.

C. It adds to the amniotic fluid.

D. It is turned into meconium.

Q. During weeks 9–12 of fetal development, ________.

A. bone marrow begins to assume erythrocyte production

B. meconium begins to accumulate in the intestines

C. surfactant production begins in the fetal lungs

D. the spinal cord begins to be myelinated

Critical Thinking Questions

Q. What is the physiological benefit of incorporating shunts into the fetal circulatory system?

A. Circulatory shunts bypass the fetal lungs and liver, bestowing them with just enough oxygenated blood to fulfill their metabolic requirements. Because these organs are only semifunctional in the fetus, it is more efficient to bypass them and divert oxygen and nutrients to the organs that need it more.

Q. Why would a premature infant require supplemental oxygen?

A. Premature lungs may not have adequate surfactant, a molecule that reduces surface tension in the lungs and assists proper lung expansion after birth. If the lungs do not expand properly, the newborn will develop hypoxia and require supplemental oxygen or other respiratory support.