716 Med-Surg: Cardiac questions written for the NCLEX-RN, each with a rationale explaining why the correct answer is correct and why the others are not. Free, no account required. 10 examples are shown below.
Practice all 716 questions →Answers are shown so you can read these as worked examples. To answer them yourself and track what you get wrong, start a practice set.
The most likely precipitating factor is medication noncompliance - the patient ran out of furosemide and has not been taking diuretics for 4 days. Furosemide is essential for removing excess fluid in heart failure patients. Without it, fluid accumulates rapidly, causing the classic presentation of weight gain, dyspnea, and orthopnea seen within days. The daughter also reports the patient has been forgetful and missing doses occasionally. While dietary sodium intake can contribute, the temporal relationship with stopping furosemide makes this the primary trigger. There is no evidence of new atrial fibrillation (rate is only slightly elevated at 102, and he has chronic AF), and no evidence of acute MI (troponin only slightly elevated, no chest pain, and ECG would show changes).
The therapeutic range for unfractionated heparin is an aPTT 1.5 to 2.5 times the control value (approximately 50-70 seconds depending on the lab). This range provides therapeutic anticoagulation while minimizing bleeding risk. aPTT is monitored 6 hours after starting or changing the infusion rate.
An S3 heart sound, also called a ventricular gallop, occurs during early diastole when blood rushes rapidly into a non-compliant or overloaded ventricle. It indicates decreased ventricular compliance and volume overload, commonly seen in heart failure with reduced ejection fraction. While it can be normal in children and young adults, in adults with cardiac history it signifies pathology.
While blood cultures are essential for diagnosing and guiding treatment of infective endocarditis, visualization of vegetations on echocardiogram (especially transesophageal) is the most definitive diagnostic finding for valvular involvement. It confirms the presence of infected masses on the valve. New murmur and elevated troponins are supportive but not definitive.
Orthopnea (dyspnea when lying flat) is common in heart failure due to increased venous return to the failing heart. The client finds comfort in semi-upright positioning. A hospital bed that can be positioned at 45 degrees (or higher) allows the client to sleep in a semi-Fowler's position, which reduces orthopnea symptoms. This is a more sustainable solution than using multiple pillows or recliner chairs at home.
Superficial thrombophlebitis presents with inflammation of a superficial vein, causing pain, erythema, swelling, and a palpable cord-like vein. Unlike DVT, it typically does not cause significant swelling of the entire limb and is not associated with respiratory symptoms. The absence of respiratory symptoms also rules out PE.
Off-pump CABG (OPCAB) is performed on a beating heart using a stabilizer device, avoiding cardiopulmonary bypass. Benefits include reduced risk of stroke, decreased renal dysfunction, shorter hospital stay, and faster recovery. The client should understand that no heart-lung machine will be used.
A blood pressure of 158/98 mmHg meets Stage 2 hypertension criteria by both measures: systolic 158 mmHg is ≥ 140, and diastolic 98 mmHg is ≥ 90, per JNC 8 and ACC/AHA 2017 guidelines. Stage 1 hypertension is 130–139/80–89 mmHg; Stage 2 is ≥ 140/≥ 90 mmHg. Both values in this reading exceed the Stage 2 threshold.
The answer: B Think of it this way: of everything a person can change, smoking does the most damage to coronary arteries and stopping it produces the fastest benefit. Why B is right: smoking injures the endothelium directly, accelerates atherosclerotic plaque formation, raises LDL and lowers HDL, promotes platelet aggregation and vasoconstriction, and increases carbon monoxide so the blood carries less oxygen. It is the modifiable factor with the strongest association with developing coronary artery disease, and risk falls measurably within the first year after quitting. Why the others are wrong: - A: hypertension is a major modifiable risk factor and matters enormously, but its association with the development of coronary disease is not as strong as that of smoking. - C: physical inactivity contributes largely through its effects on weight, blood pressure, lipids and glucose tolerance. - D: obesity likewise acts mostly through the conditions it produces rather than directly on the arterial wall. Remember: smoking is the single most important modifiable coronary risk factor, and cessation is the highest-yield intervention available. Technical note: the non-modifiable factors — age, male sex, and family history of premature coronary disease — still carry substantial weight, which is why risk calculators combine both sets rather than treating modifiable factors alone.
While oversensing, lead issues, and battery depletion are possible causes of inappropriate shocks, the most likely cause in a patient on amiodarone who is still receiving frequent shocks is that the medication is not adequately suppressing the ventricular tachycardia. Amiodarone may also cause proarrhythmia (e.g., torsades de pointes) leading to appropriate shocks. The priority consideration is that the underlying arrhythmia is recurring and may need alternative therapy. The nurse should report this to the provider for further evaluation.
