NCLEX-RN Med-Surg: Cardiac Practice Questions

715 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.

Topics covered

• Cardiomyopathy (80)
• Heart Failure (64)
• Acute MI & ACS (61)
• Venous Thromboembolism (59)
• Pacemakers & Defibrillators (57)
• Coronary Artery Disease (54)
• Pericarditis & Endocarditis (50)
• CABG & Cardiac Surgery (49)
• Valvular Heart Disease (40)
• Cardiac Catheterization (40)
• Arrhythmias & ECG (38)
• Hypertension (37)
• Peripheral Vascular Disease (34)
• Shock & Hemodynamic Monitoring (20)
• Cardiac Assessment & Auscultation (18)
• Cardiac: MI, Heart Failure, Dysrhythmias (6)
• Hyperkalemia (1)
• Blood Transfusion (1)
• DVT Prevention (1)
• Hypertensive Crisis (1)
• Atrial Fibrillation (1)
• Cardiogenic Shock (1)
• Pulmonary Embolism (1)
• Post-Cardiac Surgery (1)

Example questions with rationales

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.

1. 1Heart Failure

   The nurse recognizes that this patient has acute decompensated heart failure. What is the MOST LIKELY primary precipitating factor for this exacerbation?

   • Medication noncompliance - patient ran out of furosemide and has not been taking diuretics for 4 days — correct
   • Dietary noncompliance - patient admits to eating canned soups high in sodium
   • New-onset atrial fibrillation with rapid ventricular response
   • Acute myocardial infarction precipitating cardiogenic shock
   Rationale

   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).

2. 2Acute MI & ACS

   A patient presents to the emergency department with chest pain and ECG shows ST-segment depression in leads V1-V4. Cardiac troponin is elevated. Which of the following terms best describes this presentation?

   • NSTEMI (Non-ST-elevation myocardial infarction) — correct
   • STEMI (ST-elevation myocardial infarction)
   • Unstable angina
   • Stable angina
   Rationale

   NSTEMI is characterized by ST-segment depression (or T-wave inversion) on ECG plus elevated cardiac biomarkers (troponin). This differentiates it from unstable angina (which has ST changes but NO biomarker elevation) and STEMI (which has ST elevation). Stable angina occurs with predictable activity and resolves with rest.

3. 3Heart Failure

   A client with heart failure has an ejection fraction of 20% and has survived a cardiac arrest. Which intervention would most likely be recommended for this client?

   • Permanent pacemaker placement
   • Implantable cardioverter-defibrillator (ICD) — correct
   • Cardiac resynchronization therapy (CRT) only
   • Daily aspirin therapy
   Rationale

   An implantable cardioverter-defibrillator (ICD) is recommended for clients with heart failure and EF ≤35% who have survived cardiac arrest or have had symptomatic ventricular tachycardia. ICDs monitor heart rhythm and deliver shocks if life-threatening arrhythmias occur. This client has severe systolic dysfunction (EF 20%) and a history of cardiac arrest, placing them at high risk for sudden cardiac death.

4. 4Valvular Heart Disease

   A client with mild aortic regurgitation asks about activity restrictions. Which response by the nurse is most appropriate?

   • You should avoid all physical activity
   • You can participate in competitive sports
   • You may engage in low-impact activities as tolerated — correct
   • You only need to restrict swimming activities
   Rationale

   For mild valvular heart disease without symptoms or ventricular dysfunction, moderate activity is generally encouraged. Competitive sports may be restricted in significant disease due to risk of arrhythmia or hemodynamic stress, but mild AR typically allows low-impact activities as tolerated. Complete restriction is unnecessary.

5. 5Cardiomyopathy

   A client with dilated cardiomyopathy is prescribed warfarin (Coumadin) for anticoagulation. The nurse should instruct the client to report which sign of potential complication?

   • Bruising easily — correct
   • Mild seasonal allergy symptoms
   • Increased appetite
   • Improved sleep patterns
   Rationale

   Warfarin (Coumadin) is an anticoagulant -- a medicine that slows blood clotting -- so its main danger is abnormal bleeding. The client should report bruising easily, because bruises that appear with little or no bump can be an early sign that the blood is too 'thin' (over-anticoagulation) and the dose may need to be adjusted. Other bleeding signs worth reporting include blood in the urine or stool, bleeding gums, and nosebleeds. The remaining choices -- mild seasonal allergy symptoms, increased appetite, and improved sleep -- are not complications of warfarin and are not reasons to call the provider.

6. 6Venous Thromboembolism

   A client is diagnosed with massive pulmonary embolism and is hemodynamically unstable. The healthcare provider is considering inferior vena cava (IVC) filter placement. What is the primary nursing intervention following IVC filter insertion?

   • Monitor neurological status every hour
   • Assess for signs of filter migration or thrombosis — correct
   • Maintain strict bed rest for 72 hours
   • Administer anticoagulation immediately post-procedure
   Rationale

   After IVC filter placement, the nurse must monitor for complications including filter migration, filter thrombosis, IVC perforation, and insertion site infection. While anticoagulation may be held initially and neurological monitoring may occur, assessing for filter-related complications is the priority nursing intervention.

7. 7CABG & Cardiac Surgery

   The nurse is caring for a client who had CABG with a radial artery graft. Which assessment is SPECIFIC to monitoring the radial artery harvest site?

   • Assessing for Allen's test before discharge
   • Monitoring for capillary refill in the hand — correct
   • Assessing grip strength in the affected arm
   • Checking for pulses in the fingers
   Rationale

   When the radial artery is harvested, adequate ulnar artery flow must be ensured to prevent hand ischemia. Capillary refill in the hand is monitored to verify adequate collateral circulation. Allen's test is typically done preoperatively to assess collateral flow. Ongoing monitoring of circulation to the hand is essential.

8. 8Cardiac Assessment & Auscultation

   When assessing the precordial landmarks, the nurse identifies the point where the apex of the heart is located. Which intercostal space and line correspond to the point of maximum impulse (PMI)?

   • 5th intercostal space, midclavicular line — correct
   • 2nd intercostal space, left sternal border
   • 4th intercostal space, right sternal border
   • 3rd intercostal space, left sternal border
   Rationale

   The point of maximum impulse (PMI) or apex of the heart is located at the 5th intercostal space at the midclavicular line. This is the anatomical location where the left ventricle contacts the chest wall and is best felt during palpation and auscultated as the apical pulse.

9. 9Coronary Artery Disease

   A client with suspected coronary artery disease is scheduled for a cardiac stress test. Which instruction should the nurse provide the client before the test?

   • Avoid caffeine and nicotine for 24 hours before the test — correct
   • Eat a heavy meal 2 hours before the test
   • Stop taking all cardiac medications the day of the test
   • Limit fluid intake the morning of the test
   Rationale

   Caffeine and nicotine are stimulants that can increase heart rate and blood pressure, potentially causing false-positive or false-negative stress test results. Clients are typically instructed to avoid these substances for 24 hours before the test. Additionally, some cardiac medications like beta-blockers may be withheld as ordered by the provider to allow an adequate heart rate response during the test.

10. 10Pacemakers & Defibrillators

    A patient with a biventricular pacemaker (cardiac resynchronization therapy - CRT) is being assessed. Which assessment finding indicates that the device is providing effective therapy?

    • Narrowing of the QRS complex on ECG
    • Improved exercise tolerance and cardiac output — correct
    • Resolution of mitral regurgitation on echocardiogram
    • Normalization of serum potassium levels
    Rationale

    Cardiac resynchronization therapy (biventricular pacing) aims to improve ventricular contraction synchrony in patients with heart failure and bundle branch block. The primary therapeutic goals are to improve symptoms (exercise tolerance), improve cardiac output, and reduce hospitalizations. While CRT may result in some QRS narrowing (not normalization—it rarely becomes completely normal), the clinical outcome measures of improved functional status and cardiac output are the most meaningful indicators of effectiveness.

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