NCLEX-RN Cardiovascular Nursing: Practice Questions with Answers
and Rationales 100%correct.
A single-unit review covering myocardial infarction, angina, heart failure, dysrhythmias, cardiac
procedures, vascular disorders, and pericardial and valvular conditions. Every question has the correct
answer and a rationale. Verify values and protocols against a current reference before relying on them
clinically.
How to Use This Guide
Answer each question before reading the rationale. For cardiovascular questions, think about perfusion
first: is blood getting to the heart, the brain, and the extremities? Ask which finding is life-threatening
and act on that first. Re-attempt missed questions after 48 hours.
Part 1: Myocardial Infarction and Angina
1. Which laboratory test is the most specific indicator of myocardial damage?
A. Myoglobin B. Troponin C. Lactate dehydrogenase (LDH) D. Total cholesterol
Answer: B. Troponin is the most specific and sensitive marker for myocardial injury. It rises within about
3 to 4 hours, peaks around 24 hours, and can stay elevated for 7 to 14 days. Myoglobin rises earliest but
is not specific to the heart. Serial troponin levels are drawn to detect a rise and fall.
2. A client in the emergency department reports crushing chest pain radiating to the left arm. What is
the nurse's priority action?
A. Obtain a detailed family history B. Stay with the client, check vital signs, and obtain a 12-lead ECG
right away C. Send the client to the waiting room D. Give a large meal to settle the stomach
Answer: B. Time is muscle. A 12-lead ECG should be obtained within about 10 minutes of arrival. Stay
with the client, apply oxygen if the saturation is low, establish IV access, and notify the provider. Aspirin
is typically given (chewed, non-enteric-coated) unless the client is allergic, per protocol.
3. Which presentation of a myocardial infarction is more common in women than in men?
A. Crushing substernal chest pain only B. Fatigue, shortness of breath, nausea, and jaw or back pain
without classic chest pain C. Pain only with exertion that resolves in 1 minute D. No symptoms at all
Answer: B. Women often present with atypical symptoms such as unusual fatigue, shortness of breath,
indigestion or nausea, and pain in the jaw, neck, or back. Because these signs are easily dismissed, they
should be taken seriously. Older adults and clients with diabetes may also have atypical presentations.
4. How does the nurse distinguish unstable angina from stable angina?
A. Stable angina occurs at rest and is not relieved by nitroglycerin B. Unstable angina occurs at rest or
with increasing frequency and is not relieved by rest or nitroglycerin C. Both are always relieved within 1
minute D. They cannot be distinguished
, Answer: B. Stable angina is predictable, occurs with exertion or stress, and is relieved by rest or
nitroglycerin within about 5 minutes. Unstable angina occurs at rest, is new or worsening, and is not
relieved as expected. It is an emergency because it can progress to myocardial infarction.
Part 2: Heart Failure
5. (Select all that apply) Which findings are expected in a client with left-sided heart failure?
A. Crackles in the lungs B. Orthopnea C. Jugular vein distention D. Peripheral edema E. Cough with pink,
frothy sputum
Answer: A, B, E. Left-sided failure causes blood to back up into the lungs, producing crackles, dyspnea,
orthopnea, a cough, and in severe cases pink frothy sputum from pulmonary edema. Jugular vein
distention and peripheral edema are signs of right-sided failure.
6. (Select all that apply) Which findings are expected in a client with right-sided heart failure?
A. Jugular vein distention B. Peripheral edema C. Hepatomegaly D. Clear lung sounds E. Weight gain
from fluid retention
Answer: A, B, C, D, E. Right-sided failure causes systemic venous congestion, leading to distended neck
veins, dependent edema, an enlarged liver, abdominal swelling, and weight gain. Lung sounds are often
clear unless left-sided failure is also present.
7. A client with heart failure is being discharged. Which instruction about weight monitoring is correct?
A. Weigh once a month B. Weigh daily at the same time, and report a gain of more than 2 to 3 pounds in
24 hours or 5 pounds in a week C. Weigh only when feeling swollen D. Ignore small changes
Answer: B. Daily weights are the best early warning of fluid retention. Weigh each morning after
urinating and before eating, on the same scale, in similar clothing. Teach a low-sodium diet, fluid
guidance as ordered, medication adherence, and symptom reporting.
8. A client with acute pulmonary edema is sitting up, gasping, and coughing pink frothy sputum. Which
action is the priority?
A. Lay the client flat B. Keep the client upright, give oxygen, and prepare for IV furosemide as ordered C.
Offer a high-sodium snack D. Give oral fluids
Answer: B. This is a medical emergency. Keep the client in a high Fowler's position to ease breathing,
give oxygen, and expect IV diuretics, possibly morphine, and other medications as ordered. Monitor
oxygen saturation, vital signs, and urine output.
9. Which laboratory finding supports a diagnosis of heart failure?
A. Low troponin B. Elevated B-type natriuretic peptide (BNP) C. Low white blood cell count D. High
hemoglobin A1c
Answer: B. BNP is released when the ventricles are stretched by fluid overload, so it rises in heart
failure. A typical normal value is below about 100 pg/mL. Higher values suggest a greater degree of
failure, and trends are used to follow treatment.
and Rationales 100%correct.
A single-unit review covering myocardial infarction, angina, heart failure, dysrhythmias, cardiac
procedures, vascular disorders, and pericardial and valvular conditions. Every question has the correct
answer and a rationale. Verify values and protocols against a current reference before relying on them
clinically.
How to Use This Guide
Answer each question before reading the rationale. For cardiovascular questions, think about perfusion
first: is blood getting to the heart, the brain, and the extremities? Ask which finding is life-threatening
and act on that first. Re-attempt missed questions after 48 hours.
Part 1: Myocardial Infarction and Angina
1. Which laboratory test is the most specific indicator of myocardial damage?
A. Myoglobin B. Troponin C. Lactate dehydrogenase (LDH) D. Total cholesterol
Answer: B. Troponin is the most specific and sensitive marker for myocardial injury. It rises within about
3 to 4 hours, peaks around 24 hours, and can stay elevated for 7 to 14 days. Myoglobin rises earliest but
is not specific to the heart. Serial troponin levels are drawn to detect a rise and fall.
2. A client in the emergency department reports crushing chest pain radiating to the left arm. What is
the nurse's priority action?
A. Obtain a detailed family history B. Stay with the client, check vital signs, and obtain a 12-lead ECG
right away C. Send the client to the waiting room D. Give a large meal to settle the stomach
Answer: B. Time is muscle. A 12-lead ECG should be obtained within about 10 minutes of arrival. Stay
with the client, apply oxygen if the saturation is low, establish IV access, and notify the provider. Aspirin
is typically given (chewed, non-enteric-coated) unless the client is allergic, per protocol.
3. Which presentation of a myocardial infarction is more common in women than in men?
A. Crushing substernal chest pain only B. Fatigue, shortness of breath, nausea, and jaw or back pain
without classic chest pain C. Pain only with exertion that resolves in 1 minute D. No symptoms at all
Answer: B. Women often present with atypical symptoms such as unusual fatigue, shortness of breath,
indigestion or nausea, and pain in the jaw, neck, or back. Because these signs are easily dismissed, they
should be taken seriously. Older adults and clients with diabetes may also have atypical presentations.
4. How does the nurse distinguish unstable angina from stable angina?
A. Stable angina occurs at rest and is not relieved by nitroglycerin B. Unstable angina occurs at rest or
with increasing frequency and is not relieved by rest or nitroglycerin C. Both are always relieved within 1
minute D. They cannot be distinguished
, Answer: B. Stable angina is predictable, occurs with exertion or stress, and is relieved by rest or
nitroglycerin within about 5 minutes. Unstable angina occurs at rest, is new or worsening, and is not
relieved as expected. It is an emergency because it can progress to myocardial infarction.
Part 2: Heart Failure
5. (Select all that apply) Which findings are expected in a client with left-sided heart failure?
A. Crackles in the lungs B. Orthopnea C. Jugular vein distention D. Peripheral edema E. Cough with pink,
frothy sputum
Answer: A, B, E. Left-sided failure causes blood to back up into the lungs, producing crackles, dyspnea,
orthopnea, a cough, and in severe cases pink frothy sputum from pulmonary edema. Jugular vein
distention and peripheral edema are signs of right-sided failure.
6. (Select all that apply) Which findings are expected in a client with right-sided heart failure?
A. Jugular vein distention B. Peripheral edema C. Hepatomegaly D. Clear lung sounds E. Weight gain
from fluid retention
Answer: A, B, C, D, E. Right-sided failure causes systemic venous congestion, leading to distended neck
veins, dependent edema, an enlarged liver, abdominal swelling, and weight gain. Lung sounds are often
clear unless left-sided failure is also present.
7. A client with heart failure is being discharged. Which instruction about weight monitoring is correct?
A. Weigh once a month B. Weigh daily at the same time, and report a gain of more than 2 to 3 pounds in
24 hours or 5 pounds in a week C. Weigh only when feeling swollen D. Ignore small changes
Answer: B. Daily weights are the best early warning of fluid retention. Weigh each morning after
urinating and before eating, on the same scale, in similar clothing. Teach a low-sodium diet, fluid
guidance as ordered, medication adherence, and symptom reporting.
8. A client with acute pulmonary edema is sitting up, gasping, and coughing pink frothy sputum. Which
action is the priority?
A. Lay the client flat B. Keep the client upright, give oxygen, and prepare for IV furosemide as ordered C.
Offer a high-sodium snack D. Give oral fluids
Answer: B. This is a medical emergency. Keep the client in a high Fowler's position to ease breathing,
give oxygen, and expect IV diuretics, possibly morphine, and other medications as ordered. Monitor
oxygen saturation, vital signs, and urine output.
9. Which laboratory finding supports a diagnosis of heart failure?
A. Low troponin B. Elevated B-type natriuretic peptide (BNP) C. Low white blood cell count D. High
hemoglobin A1c
Answer: B. BNP is released when the ventricles are stretched by fluid overload, so it rises in heart
failure. A typical normal value is below about 100 pg/mL. Higher values suggest a greater degree of
failure, and trends are used to follow treatment.
