RN CARDIOVASCULAR NURSING 2026 100
HIGH YIELD EXAM MCQS AND
RATIONALES MED SURG MASTERCLASS
Cardiovascular Practice Exam Questions 1–100
1. A patient with acute decompensated heart failure
(ADHF) is receiving a continuous intravenous infusion
of nitroprusside. The nurse notes the patient is
becoming increasingly confused, agitated, and reports
severe abdominal pain. The patient’s oxygen saturation
is 94% on a non-rebreather mask, but the arterial blood
gas (ABG) reveals a severe metabolic acidosis. Which
action should the nurse take first?
A. Increase the oxygen flow rate on the non-rebreather mask.
B. Stop the nitroprusside infusion immediately.
C. Administer an intravenous bolus of sodium bicarbonate.
D. Obtain a stat serum digoxin level.
CORRECT ANSWER: B
RATiONAlE: Nitroprusside is metabolized into thiocyanate
and cyanide. Prolonged infusions, high doses, or renal/hepatic
impairment can lead to cyanide toxicity. Signs include altered
mental status, abdominal pain, and severe metabolic acidosis
due to cellular hypoxia. The immediate priority is to stop the
offending medication.
2. A nurse is caring for a patient who is 4 hours
postoperative following a percutaneous coronary
,intervention (PCI) via the right femoral artery. The
patient complains of sudden, severe lower back pain.
Assessment reveals a blood pressure of 88/52 mmHg,
pulse 118 bpm, and the right groin dressing is dry and
intact with no palpable hematoma. What complication
should the nurse immediately suspect?
A. Acute retroperitoneal hemorrhage
B. Dissecting aortic aneurysm
C. Acute stent thrombosis
D. Vasovagal reaction from sheath removal
CORRECT ANSWER: A
RATiONAlE: Retroperitoneal bleeding is a serious
complication of femoral artery access. Because the bleeding
occurs behind the peritoneum, the groin site dressing may
remain dry and free of hematomas. Typical presentations
include sudden back, flank, or abdominal pain alongside signs of
hypovolemic shock (hypotension, tachycardia).
3. A patient admitted with an acute anterior wall
myocardial infarction develops a new, loud holosystolic
murmur heard best at the left sternal border,
accompanied by a palpable thrill. The patient is rapidly
becoming dyspneic and hypotensive. The nurse
recognizes these findings as indicative of which
complication?
A. Mitral valve prolapse
B. Cardiac tamponade
C. Acute ventricular septal rupture
D. Dressler's syndrome
,CORRECT ANSWER: C
RATiONAlE: Ventricular septal rupture (VSR) is a rare but
catastrophic mechanical complication of an anterior wall MI,
typically occurring within the first week. It presents as a sudden
holosystolic murmur at the left sternal border with a thrill,
accompanied by rapid hemodynamic deterioration.
4. The nurse is managing a patient in the cardiac
intensive care unit who is receiving a continuous
epinephrine infusion for cardiogenic shock. The current
infusion rate is 0.1 mcg/kg/min. Which physiological
response indicates the medication is achieving its
therapeutic target?
A. Marked peripheral vasodilation and decreased systemic
vascular resistance (SVR)
B. Increased myocardial contractility and improved cardiac
output
C. Decreased myocardial oxygen consumption and heart rate
D. Selective dilation of the renal and mesenteric blood vessels
CORRECT ANSWER: B
RATiONAlE: At standard doses, epinephrine acts as a potent
beta-1 and alpha-1 agonist, which increases myocardial
contractility (positive inotropy), heart rate (positive
chronotropy), and cardiac output to combat cardiogenic shock.
5. A patient with a history of severe chronic heart failure
presents to the emergency department with profound
weakness and syncope. The cardiac monitor shows a
, regular, wide-complex rhythm at a rate of 38 bpm. There
are no discernible P waves. The emergency physician
diagnoses an idioventricular escape rhythm. Which
intervention is the definitive treatment for this patient?
A. Intravenous bolus of amiodarone 150 mg
B. Immediate synchronized cardioversion at 100 Joules
C. Initiation of transcutaneous or transvenous pacing
D. Carotid sinus massage to slow the ventricular response
CORRECT ANSWER: C
RATiONAlE: An idioventricular escape rhythm at a rate of 38
bpm produces profoundly inadequate cardiac output. Because
this is a ventricular escape rhythm acting as a safety net,
antiarrhythmics like amiodarone are contraindicated as they
can suppress the rhythm entirely. Emergency pacing is required
to restore an adequate heart rate.
6. A patient who underwent a mechanical mitral valve
replacement 2 days ago is being prepared for discharge
education. The nurse is reviewing the patient's
medication list, which includes warfarin. What target
International Normalized Ratio (INR) range should the
nurse instruct the patient to maintain?
A. 1.5 – 2.0
B. 2.0 – 3.0
C. 2.5 – 3.5
D. 3.5 – 4.5
CORRECT ANSWER: C
HIGH YIELD EXAM MCQS AND
RATIONALES MED SURG MASTERCLASS
Cardiovascular Practice Exam Questions 1–100
1. A patient with acute decompensated heart failure
(ADHF) is receiving a continuous intravenous infusion
of nitroprusside. The nurse notes the patient is
becoming increasingly confused, agitated, and reports
severe abdominal pain. The patient’s oxygen saturation
is 94% on a non-rebreather mask, but the arterial blood
gas (ABG) reveals a severe metabolic acidosis. Which
action should the nurse take first?
A. Increase the oxygen flow rate on the non-rebreather mask.
B. Stop the nitroprusside infusion immediately.
C. Administer an intravenous bolus of sodium bicarbonate.
D. Obtain a stat serum digoxin level.
CORRECT ANSWER: B
RATiONAlE: Nitroprusside is metabolized into thiocyanate
and cyanide. Prolonged infusions, high doses, or renal/hepatic
impairment can lead to cyanide toxicity. Signs include altered
mental status, abdominal pain, and severe metabolic acidosis
due to cellular hypoxia. The immediate priority is to stop the
offending medication.
2. A nurse is caring for a patient who is 4 hours
postoperative following a percutaneous coronary
,intervention (PCI) via the right femoral artery. The
patient complains of sudden, severe lower back pain.
Assessment reveals a blood pressure of 88/52 mmHg,
pulse 118 bpm, and the right groin dressing is dry and
intact with no palpable hematoma. What complication
should the nurse immediately suspect?
A. Acute retroperitoneal hemorrhage
B. Dissecting aortic aneurysm
C. Acute stent thrombosis
D. Vasovagal reaction from sheath removal
CORRECT ANSWER: A
RATiONAlE: Retroperitoneal bleeding is a serious
complication of femoral artery access. Because the bleeding
occurs behind the peritoneum, the groin site dressing may
remain dry and free of hematomas. Typical presentations
include sudden back, flank, or abdominal pain alongside signs of
hypovolemic shock (hypotension, tachycardia).
3. A patient admitted with an acute anterior wall
myocardial infarction develops a new, loud holosystolic
murmur heard best at the left sternal border,
accompanied by a palpable thrill. The patient is rapidly
becoming dyspneic and hypotensive. The nurse
recognizes these findings as indicative of which
complication?
A. Mitral valve prolapse
B. Cardiac tamponade
C. Acute ventricular septal rupture
D. Dressler's syndrome
,CORRECT ANSWER: C
RATiONAlE: Ventricular septal rupture (VSR) is a rare but
catastrophic mechanical complication of an anterior wall MI,
typically occurring within the first week. It presents as a sudden
holosystolic murmur at the left sternal border with a thrill,
accompanied by rapid hemodynamic deterioration.
4. The nurse is managing a patient in the cardiac
intensive care unit who is receiving a continuous
epinephrine infusion for cardiogenic shock. The current
infusion rate is 0.1 mcg/kg/min. Which physiological
response indicates the medication is achieving its
therapeutic target?
A. Marked peripheral vasodilation and decreased systemic
vascular resistance (SVR)
B. Increased myocardial contractility and improved cardiac
output
C. Decreased myocardial oxygen consumption and heart rate
D. Selective dilation of the renal and mesenteric blood vessels
CORRECT ANSWER: B
RATiONAlE: At standard doses, epinephrine acts as a potent
beta-1 and alpha-1 agonist, which increases myocardial
contractility (positive inotropy), heart rate (positive
chronotropy), and cardiac output to combat cardiogenic shock.
5. A patient with a history of severe chronic heart failure
presents to the emergency department with profound
weakness and syncope. The cardiac monitor shows a
, regular, wide-complex rhythm at a rate of 38 bpm. There
are no discernible P waves. The emergency physician
diagnoses an idioventricular escape rhythm. Which
intervention is the definitive treatment for this patient?
A. Intravenous bolus of amiodarone 150 mg
B. Immediate synchronized cardioversion at 100 Joules
C. Initiation of transcutaneous or transvenous pacing
D. Carotid sinus massage to slow the ventricular response
CORRECT ANSWER: C
RATiONAlE: An idioventricular escape rhythm at a rate of 38
bpm produces profoundly inadequate cardiac output. Because
this is a ventricular escape rhythm acting as a safety net,
antiarrhythmics like amiodarone are contraindicated as they
can suppress the rhythm entirely. Emergency pacing is required
to restore an adequate heart rate.
6. A patient who underwent a mechanical mitral valve
replacement 2 days ago is being prepared for discharge
education. The nurse is reviewing the patient's
medication list, which includes warfarin. What target
International Normalized Ratio (INR) range should the
nurse instruct the patient to maintain?
A. 1.5 – 2.0
B. 2.0 – 3.0
C. 2.5 – 3.5
D. 3.5 – 4.5
CORRECT ANSWER: C
