Cardiac conditions NCLEX-RN Practice Questions help you sharpen clinical judgment for the Physiological Adaptation domain by focusing on high-yield scenarios encountered in acute and chronic cardiac care. This topic-wise set emphasizes recognition of life-threatening rhythms, prioritized interventions in myocardial infarction and heart failure, and safe medication administration, including anticoagulants, antiarrhythmics, and vasodilators. You will also review hemodynamics, complications of procedures like CABG and cardiac catheterization, and nuanced assessments such as recognizing tamponade or dissection. Designed for advanced learners, including M. Pharma students collaborating with nursing teams, these questions integrate pathophysiology, pharmacotherapy, and bedside priorities. Use them to test readiness for evidence-based care and quick decision-making in cardiology.
Q1. A patient presents with acute chest pain for 20 minutes, diaphoresis, and nausea. SpO2 is 96% on room air. Which order should the nurse implement first?
- Obtain a 12-lead ECG within 10 minutes
- Administer oxygen at 4 L/min via nasal cannula
- Administer sublingual nitroglycerin 0.4 mg
- Start an IV and draw comprehensive lab panel
Correct Answer: Obtain a 12-lead ECG within 10 minutes
Q2. Which assessment finding is most consistent with right-sided heart failure?
- Bibasilar crackles and pink frothy sputum
- Jugular venous distention and peripheral edema
- Orthopnea and paroxysmal nocturnal dyspnea
- New S3 with pulmonary congestion
Correct Answer: Jugular venous distention and peripheral edema
Q3. A patient with acute decompensated heart failure develops severe dyspnea, tachypnea, and pink frothy sputum. What is the nurse’s immediate priority?
- Administer IV morphine
- Place the patient in high Fowler’s position and apply high-flow oxygen
- Obtain a STAT chest X-ray
- Start continuous IV nitroglycerin infusion
Correct Answer: Place the patient in high Fowler’s position and apply high-flow oxygen
Q4. A patient with atrial fibrillation has a heart rate of 160/min, BP 78/48 mm Hg, and altered mental status. What is the best immediate intervention?
- Administer IV amiodarone bolus
- Perform synchronized cardioversion
- Attempt vagal maneuvers
- Give IV diltiazem push
Correct Answer: Perform synchronized cardioversion
Q5. Which lab finding places a patient at greatest risk for digoxin toxicity?
- Serum potassium 2.9 mEq/L
- Serum sodium 132 mEq/L
- Serum magnesium 2.0 mg/dL
- Serum creatinine 0.8 mg/dL
Correct Answer: Serum potassium 2.9 mEq/L
Q6. Which assessment most strongly supports a diagnosis of acute pericarditis?
- Chest pain relieved by lying flat; ST depression in multiple leads
- Chest pain relieved by sitting forward; pericardial friction rub
- Chest pain radiating to jaw; ST elevation in contiguous leads II, III, aVF
- No chest pain; elevated troponin and CK-MB
Correct Answer: Chest pain relieved by sitting forward; pericardial friction rub
Q7. The nurse suspects cardiac tamponade in a post–cardiac surgery patient with hypotension, jugular venous distention, and muffled heart sounds. What is the priority action?
- Administer IV furosemide
- Prepare for emergent pericardiocentesis
- Start high-dose IV vasodilators
- Obtain an arterial blood gas
Correct Answer: Prepare for emergent pericardiocentesis
Q8. A patient with infective endocarditis reports sudden left arm weakness and facial droop. What is the nurse’s priority response?
- Reassure the patient that this is a transient symptom
- Administer PRN acetaminophen for fever
- Activate stroke protocol and notify the provider immediately
- Assess for new cardiac murmurs
Correct Answer: Activate stroke protocol and notify the provider immediately
Q9. Which patient statement indicates correct understanding of sublingual nitroglycerin use for angina?
- “I can take up to five tablets if the pain persists.”
- “I will store my tablets in a pill organizer for convenience.”
- “I will call emergency services if pain persists after one dose.”
- “I should swallow the tablet quickly with water.”
Correct Answer: I will call emergency services if pain persists after one dose.
Q10. In a hypertensive emergency, what is the recommended initial blood pressure goal within the first hour of treatment?
- Normalize systolic BP to below 120 mm Hg
- Reduce mean arterial pressure by no more than 25%
- Lower diastolic BP to below 80 mm Hg
- Reduce systolic BP to below 140 mm Hg immediately
Correct Answer: Reduce mean arterial pressure by no more than 25%
Q11. Which ECG finding indicates pacemaker failure to capture?
- Pacing spikes consistently followed by wide QRS complexes
- Regular intrinsic rhythm without pacer spikes
- Pacing spikes not followed by QRS complexes
- Irregular spikes with variable timing but normal QRS after each spike
Correct Answer: Pacing spikes not followed by QRS complexes
Q12. Before administering metoprolol for rate control, which assessment finding requires immediate provider notification?
- Respiratory rate 24/min
- Heart rate 48/min
- Blood pressure 138/86 mm Hg
- Blood glucose 110 mg/dL
Correct Answer: Heart rate 48/min
Q13. A post–CABG patient has mediastinal chest tube drainage of 250 mL in the last hour. What is the best nursing action?
- Document the output and recheck in 2 hours
- Elevate the chest tube collection device above the patient’s chest
- Notify the provider immediately due to risk of hemorrhage
- Clamp the chest tube to reduce blood loss
Correct Answer: Notify the provider immediately due to risk of hemorrhage
Q14. Which patient with suspected STEMI is the best candidate for fibrinolytic therapy (alteplase) within the window period?
- 72-year-old with chest pain for 2 hours, BP 182/112, history of intracranial hemorrhage
- 55-year-old with chest pain for 3 hours, BP 160/90, no bleeding history
- 60-year-old with chest pain for 5 hours, recent major surgery 1 week ago
- 50-year-old with chest pain for 1 hour, active GI bleeding
Correct Answer: 55-year-old with chest pain for 3 hours, BP 160/90, no bleeding history
Q15. Which finding is characteristic of aortic stenosis on assessment?
- Holosystolic murmur at the apex radiating to the axilla
- Crescendo-decrescendo systolic murmur at the right second intercostal space radiating to the carotids
- Early diastolic decrescendo murmur along the left sternal border
- Continuous machinery murmur at the left infraclavicular area
Correct Answer: Crescendo-decrescendo systolic murmur at the right second intercostal space radiating to the carotids
Q16. A patient with nonvalvular atrial fibrillation is on warfarin. Which INR indicates therapeutic anticoagulation?
- 1.2
- 1.8
- 2.5
- 3.8
Correct Answer: 2.5
Q17. Which laboratory result supports the diagnosis of acute decompensated heart failure?
- BNP 1200 pg/mL
- Troponin I 0.01 ng/mL
- CK-MB within normal limits
- D-dimer negative
Correct Answer: BNP 1200 pg/mL
Q18. A patient with Prinzmetal (variant) angina continues to have episodes at rest with transient ST elevation. Which medication is most appropriate for prevention?
- Propranolol
- Diltiazem
- Digoxin
- Hydrochlorothiazide
Correct Answer: Diltiazem
Q19. Which ECG change is most consistent with significant hyperkalemia?
- Prolonged PR interval with U waves
- Peaked T waves with widened QRS complexes
- ST-segment depression in V1-V3
- Sawtooth flutter waves
Correct Answer: Peaked T waves with widened QRS complexes
Q20. A patient recently started on lisinopril for heart failure calls the clinic with swelling of lips and tongue. What is the nurse’s best instruction?
- “This is a common side effect; continue the medication.”
- “Skip tonight’s dose and come in tomorrow.”
- “Call emergency services now due to possible angioedema.”
- “Drink fluids and monitor for dizziness.”
Correct Answer: Call emergency services now due to possible angioedema.
Q21. Which intervention is most important to include in the plan of care for a patient with chronic systolic heart failure (HFrEF)?
- Encourage fluid intake of at least 3 liters daily
- Teach sodium restriction to 2 grams per day
- Discontinue daily weights once stable
- Encourage use of NSAIDs for pain control
Correct Answer: Teach sodium restriction to 2 grams per day
Q22. Which clinical finding differentiates peripheral arterial disease (PAD) from chronic venous insufficiency?
- Warm, edematous skin with brown discoloration at the ankles
- Dependent rubor, diminished pulses, and pain with leg elevation
- Ulcers at the medial malleolus with heavy drainage
- Improved pain with leg elevation above heart level
Correct Answer: Dependent rubor, diminished pulses, and pain with leg elevation
Q23. After a femoral cardiac catheterization, which finding requires immediate action by the nurse?
- Small ecchymosis at the insertion site
- Mild tenderness at the puncture site
- New severe back pain with hypotension and tachycardia
- Warmth at the insertion site without drainage
Correct Answer: New severe back pain with hypotension and tachycardia
Q24. Which patient education is essential for a client with stable angina prescribed sublingual nitroglycerin?
- “Take it while standing and walk to relieve pain.”
- “Store tablets in a dark glass container and replace every 6–12 months.”
- “Use sildenafil with nitroglycerin to enhance vasodilation.”
- “Expect no headache if the medication is working.”
Correct Answer: Store tablets in a dark glass container and replace every 6–12 months.
Q25. Which assessment suggests an acute aortic dissection in a patient with severe chest pain?
- Pressure-like substernal pain relieved by rest
- Pleuritic chest pain worse with inspiration
- Tearing chest pain radiating to the back with a >20 mm Hg systolic BP difference between arms
- Positional chest pain relieved by leaning forward
Correct Answer: Tearing chest pain radiating to the back with a >20 mm Hg systolic BP difference between arms
Q26. Which hemodynamic profile is most consistent with cardiogenic shock?
- High cardiac output, low systemic vascular resistance, low pulmonary capillary wedge pressure
- Low cardiac output, high systemic vascular resistance, high pulmonary capillary wedge pressure
- Low cardiac output, low systemic vascular resistance, low pulmonary capillary wedge pressure
- High cardiac output, high systemic vascular resistance, high pulmonary capillary wedge pressure
Correct Answer: Low cardiac output, high systemic vascular resistance, high pulmonary capillary wedge pressure
Q27. A patient with hypertrophic obstructive cardiomyopathy (HOCM) asks about lifestyle changes. Which instruction is most appropriate?
- “Use nitrates for chest pain to reduce preload.”
- “Avoid dehydration and refrain from high-intensity competitive sports.”
- “Increase diuretic use to maintain a low preload state.”
- “Perform frequent Valsalva maneuvers to improve symptoms.”
Correct Answer: Avoid dehydration and refrain from high-intensity competitive sports.
Q28. A patient with suspected right ventricular infarction is admitted. Which order should the nurse question?
- Administer isotonic IV fluids as ordered
- Obtain right-sided ECG leads
- Administer sublingual nitroglycerin 0.4 mg
- Continuous cardiac monitoring
Correct Answer: Administer sublingual nitroglycerin 0.4 mg
Q29. A patient receiving sotalol develops polymorphic VT (torsades de pointes) on the monitor. What is the immediate medication of choice?
- IV adenosine
- IV magnesium sulfate
- IV calcium gluconate
- IV lidocaine only
Correct Answer: IV magnesium sulfate
Q30. Which finding in a patient with suspected acute coronary syndrome requires the most immediate intervention?
- New ST elevation of 2 mm in V2–V4
- Troponin I 0.04 ng/mL at presentation
- Chest pain rated 2/10 improving with rest
- Normal sinus rhythm at 78/min
Correct Answer: New ST elevation of 2 mm in V2–V4
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