Neurological, cardiac, respiratory monitoring NCLEX-RN Practice Questions

Neurological, cardiac, respiratory monitoring NCLEX-RN Practice Questions help you sharpen clinical judgment on what to monitor, how to interpret trends, and which actions reduce complications. This topic is central to the Reduction of Risk Potential domain, where recognizing subtle changes early prevents deterioration. In these NCLEX-level items, you will analyze Glasgow Coma Scale trends, identify ST-segment deviations, prioritize responses to ventilator alarms, interpret ABGs and capnography, and act on hemodynamic and chest tube data. Expect clinically realistic scenarios focused on first actions, best next steps, safety, and escalation thresholds. Use these questions to practice rapid interpretation, triage, and monitoring precision that protects patients with neurological, cardiac, and respiratory vulnerabilities.

Q1. Which neurological assessment finding is the most sensitive early indicator of increased intracranial pressure (ICP) in a patient with a head injury?

• Unequal pupil size
• Widened pulse pressure
• New-onset vomiting
• Change in level of consciousness

Correct Answer: Change in level of consciousness

Q2. A patient with an external ventricular drain has ICP 22 mmHg and MAP 70 mmHg. CPP is calculated as 48 mmHg. Which nursing action is the best immediate intervention to optimize cerebral perfusion?

• Elevate the head of bed to 30 degrees and keep the neck midline
• Decrease sedation to allow neurological assessment
• Increase PEEP to improve oxygenation
• Restrict fluids to reduce cerebral edema

Correct Answer: Elevate the head of bed to 30 degrees and keep the neck midline

Q3. A patient received IV thrombolysis for acute ischemic stroke 45 minutes ago. Which finding requires immediate provider notification?

• Blood pressure 160/90 mmHg
• Sudden severe headache
• Mild improvement in aphasia
• Blood glucose 140 mg/dL

Correct Answer: Sudden severe headache

Q4. A client with a T4 spinal cord injury reports a pounding headache and has facial flushing. BP 220/110 mmHg, HR 48 bpm. Which interpretation is correct?

• Neurogenic shock; prepare to give vasopressors
• Autonomic dysreflexia; elevate HOB and assess for bladder distention
• Increased ICP; place client supine and hyperextend neck
• Orthostatic hypotension; assist to lying position

Correct Answer: Autonomic dysreflexia; elevate HOB and assess for bladder distention

Q5. During a generalized seizure, the client is on capnography with EtCO2 rising to 60 mmHg and SpO2 94%. Which parameter most indicates hypoventilation needing immediate intervention?

• EtCO2 60 mmHg
• SpO2 94%
• HR 110 bpm
• BP 146/88 mmHg

Correct Answer: EtCO2 60 mmHg

Q6. Telemetry shows a wide-complex tachycardia at 180 bpm; the patient is pulseless. What is the priority action?

• Synchronized cardioversion
• Administer atropine IV
• Immediate defibrillation and high-quality CPR
• Perform vagal maneuvers

Correct Answer: Immediate defibrillation and high-quality CPR

Q7. A patient develops new atrial fibrillation with RVR (HR 140) and hypotension (BP 82/50), dizziness, and chest discomfort. Which intervention is indicated first?

• Initiate diltiazem infusion
• Administer amiodarone IV push
• Synchronized cardioversion
• Start therapeutic heparin

Correct Answer: Synchronized cardioversion

Q8. A client on telemetry reports chest pain. The monitor shows 2 mm ST elevation in II, III, and aVF. What is the nurse’s priority action?

• Reposition ECG leads and reassess in 30 minutes
• Notify the provider immediately of possible inferior STEMI
• Administer PRN acetaminophen for pain
• Encourage ambulation to reduce anxiety

Correct Answer: Notify the provider immediately of possible inferior STEMI

Q9. Which lab result most strongly supports the diagnosis of acute myocardial injury?

• CK-MB 1.8 ng/mL (ref: 0–3 ng/mL)
• Troponin I 0.20 ng/mL (ref: ≤0.03 ng/mL)
• BNP 120 pg/mL (ref: <100 pg/mL)
• Myoglobin 45 ng/mL (ref: 25–72 ng/mL)

Correct Answer: Troponin I 0.20 ng/mL (ref: ≤0.03 ng/mL)

Q10. A paced patient’s ECG shows frequent pacer spikes not followed by QRS complexes. What is the nurse’s priority action?

• Increase the oxygen flow rate
• Administer atropine
• Assess the patient and check for pulse and symptoms while preparing to troubleshoot the pacing system
• Turn the pacer off and observe intrinsic rhythm

Correct Answer: Assess the patient and check for pulse and symptoms while preparing to troubleshoot the pacing system

Q11. Postoperative client on opioid PCA is somnolent with RR 6/min. ABG: pH 7.25, PaCO2 60 mmHg, HCO3– 24 mEq/L. What is the priority nursing action?

• Administer a fluid bolus for hypotension
• Begin bag-valve-mask ventilation and call for help
• Place in Trendelenburg position
• Encourage the client to ambulate

Correct Answer: Begin bag-valve-mask ventilation and call for help

Q12. A ventilated patient’s high-pressure alarm sounds. The patient is agitated and biting the ET tube; SpO2 is dropping. What is the priority nursing action?

• Turn off the ventilator alarms and observe
• Increase tidal volume
• Insert an oropharyngeal airway and increase sedation per protocol
• Decrease PEEP

Correct Answer: Insert an oropharyngeal airway and increase sedation per protocol

Q13. A ventilated patient triggers a low-pressure alarm; the ET tube has disconnected from the ventilator. What should the nurse do first?

• Silence the alarm until respiratory therapy arrives
• Reconnect the ventilator tubing to the endotracheal tube; if not possible, manually ventilate with a bag-valve mask
• Decrease the respiratory rate setting
• Notify the provider to replace the ET tube

Correct Answer: Reconnect the ventilator tubing to the endotracheal tube; if not possible, manually ventilate with a bag-valve mask

Q14. Which monitoring method best detects oxygenation problems in suspected carbon monoxide poisoning when pulse oximetry reads 100%?

• Standard arterial blood gas without co-oximetry
• Capnography
• Co-oximetry to measure carboxyhemoglobin
• End-tidal oxygen monitoring

Correct Answer: Co-oximetry to measure carboxyhemoglobin

Q15. For a client with COPD exacerbation, which parameter best reflects adequacy of ventilation?

• Pulse oximetry (SpO2)
• Respiratory rate
• PaCO2 on arterial blood gas
• Breath sound symmetry

Correct Answer: PaCO2 on arterial blood gas

Q16. A patient with a chest tube after lobectomy suddenly drains 200 mL of bright red blood in 15 minutes. What is the priority action?

• Milk the chest tube to clear clots
• Increase suction to –40 cm H2O
• Notify the provider immediately of possible hemorrhage
• Clamp the chest tube

Correct Answer: Notify the provider immediately of possible hemorrhage

Q17. Continuous bubbling is noted in the chest tube water-seal chamber. What is the best nursing action?

• Add more sterile water to the water-seal chamber
• Clamp the chest tube near the drainage system
• Systematically assess for an air leak starting at the patient and moving toward the drainage system
• Increase the patient’s oxygen to 100%

Correct Answer: Systematically assess for an air leak starting at the patient and moving toward the drainage system

Q18. A client with myasthenia gravis shows declining respiratory metrics: vital capacity 12 mL/kg and NIF –18 cm H2O. What is the priority action?

• Encourage incentive spirometry every hour
• Administer PRN antitussives
• Prepare for elective intubation and notify the provider
• Increase oral fluids to thin secretions

Correct Answer: Prepare for elective intubation and notify the provider

Q19. Which is an early clinical sign of hypoxemia that the nurse should monitor for?

• Cyanosis
• Restlessness and anxiety
• Bradycardia
• Clubbing of fingers

Correct Answer: Restlessness and anxiety

Q20. To reduce ICP spikes during suctioning in a brain-injured patient, which nursing approach is best?

• Perform repeated suction passes until secretions are cleared
• Preoxygenate, use in-line suction, and limit each pass to under 10 seconds
• Lower the head of bed before suctioning
• Increase suction pressure to shorten time

Correct Answer: Preoxygenate, use in-line suction, and limit each pass to under 10 seconds

Q21. Which set of findings most strongly suggests Cushing triad from increased intracranial pressure?

• Tachycardia, hypotension, tachypnea
• Bradycardia, widened pulse pressure, irregular respirations
• Hypertension, tachycardia, Kussmaul respirations
• Hypotension, bradypnea, pinpoint pupils

Correct Answer: Bradycardia, widened pulse pressure, irregular respirations

Q22. ABG results: pH 7.28, PaCO2 30 mmHg, HCO3– 14 mEq/L. The client has deep, rapid respirations. What is the correct interpretation?

• Respiratory acidosis with metabolic compensation
• Metabolic acidosis with respiratory compensation
• Metabolic alkalosis with respiratory compensation
• Respiratory alkalosis with metabolic compensation

Correct Answer: Metabolic acidosis with respiratory compensation

Q23. A client’s serum potassium is 6.8 mEq/L. Which ECG change is most consistent with this finding?

• U waves
• Peaked, tall T waves
• ST-segment depression
• Prolonged PR interval with flattened T waves

Correct Answer: Peaked, tall T waves

Q24. What ECG finding indicates pacemaker failure to sense?

• Pacing spikes without subsequent QRS complexes
• Pacing spikes occurring at random times not synchronous with intrinsic QRS complexes
• Bradycardia with widened QRS complexes
• Sinus rhythm with normal PR intervals

Correct Answer: Pacing spikes occurring at random times not synchronous with intrinsic QRS complexes

Q25. Which is the correct technique to assess for orthostatic hypotension?

• Measure BP only once in the lying position
• Measure BP and HR supine for 5 minutes, then within 1–3 minutes of standing
• Measure BP seated and then immediately after standing
• Measure BP before and after a 6-minute walk test

Correct Answer: Measure BP and HR supine for 5 minutes, then within 1–3 minutes of standing

Q26. To ensure accurate arterial line blood pressure readings, which nursing action is essential?

• Level the transducer at the phlebostatic axis and zero to air
• Keep the transducer above heart level
• Set continuous flush to 10 mL/hr
• Place the arm below heart level during measurement

Correct Answer: Level the transducer at the phlebostatic axis and zero to air

Q27. Which monitoring strategy best detects early opioid-induced hypoventilation in a client with obstructive sleep apnea?

• Intermittent pulse oximetry
• Bedside respiratory rate checks every 2 hours
• Continuous capnography
• Daily arterial blood gases

Correct Answer: Continuous capnography

Q28. After emergent needle decompression for tension pneumothorax, which findings indicate clinical improvement?

• Increased tracheal deviation and lower SpO2
• Improved oxygen saturation and decreased respiratory distress
• Absent breath sounds on the affected side
• New onset hypotension and JVD

Correct Answer: Improved oxygen saturation and decreased respiratory distress

Q29. Post–cardiac catheterization (femoral approach), which finding requires immediate intervention?

• Small ecchymosis at the insertion site
• Blood pressure 138/84 mmHg
• Growing, firm hematoma at the site with dropping BP
• Mild discomfort at the site rated 3/10

Correct Answer: Growing, firm hematoma at the site with dropping BP

Q30. A patient receiving IV mannitol for increased ICP is being monitored. Which finding best indicates therapeutic effectiveness?

• Serum sodium decreases and urine output declines
• Increased urine output with improved Glasgow Coma Scale score
• Elevated ICP with bradycardia
• Pupils become fixed and dilated

Correct Answer: Increased urine output with improved Glasgow Coma Scale score

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

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