ATI Medical-Surgical Nursing - CARDIAC: 200 NCLEX-Style Questions with Rationales | Based on Lewis's Med-Surg Nursing 11th Edition

Question 1 A nurse is assessing a patient with a history of coronary artery disease. Which finding during a cardiac assessment requires immediate intervention? A. Heart rate of 58 bpm B. Presence of an S3 heart sound C. Capillary refill time of 2 seconds D. Mild ankle edema at the end of the day Answer: B. Presence of an S3 heart sound Rationale: An S3 heart sound in an adult may indicate early heart failure and requires further evaluation. While bradycardia (HR 58) can be normal in some patients, especially athletes, an S3 is an abnormal finding suggestive of volume overload or decreased ventricular compliance. ________________________________________ Question 2 The nurse auscultates a blowing systolic murmur at the apex. Which condition does this finding most likely indicate? A. Aortic stenosis B. Mitral regurgitation C. Pericardial friction rub D. Tricuspid stenosis Answer: B. Mitral regurgitation Rationale: A blowing systolic murmur heard at the apex is classic for mitral regurgitation, where blood flows backward into the left atrium during systole. ________________________________________ Question 3 Which of the following subjective symptoms would most likely prompt the nurse to suspect angina in a patient during assessment? A. Sharp chest pain that increases with deep inspiration B. Dull ache localized to the right side of the chest C. Substernal chest pressure relieved by rest D. Epigastric pain relieved with antacids Answer: C. Substernal chest pressure relieved by rest Rationale: This is classic anginal pain, typically described as pressure or heaviness behind the sternum and often relieved by rest or nitroglycerin. ________________________________________ Question 4 The nurse is palpating the point of maximal impulse (PMI) on a patient. Which location is correct? A. Midsternal line, third intercostal space B. Left midclavicular line, fifth intercostal space C. Right sternal border, fourth intercostal space D. Left sternal border, second intercostal space Answer: B. Left midclavicular line, fifth intercostal space Rationale: The PMI is typically located at the fifth intercostal space, midclavicular line. Displacement may indicate ventricular enlargement. ________________________________________ Question 5 When assessing for jugular venous distension (JVD), the nurse should place the patient in which position? A. Supine at 90 degrees B. Lying flat C. Semi-Fowler’s at 30–45 degrees D. Sitting upright Answer: C. Semi-Fowler’s at 30–45 degrees Rationale: JVD is best assessed with the patient at a 30–45° angle. This position allows for accurate visualization of the jugular veins. ________________________________________ Question 6 A nurse notes bilateral 2+ pitting edema in a patient's lower extremities. What is the most appropriate action? A. Document the finding as normal B. Notify the provider immediately C. Elevate the patient’s legs and continue to monitor D. Restrict fluid intake to 500 mL/day Answer: C. Elevate the patient’s legs and continue to monitor Rationale: 2+ edema can be associated with venous insufficiency or early heart failure. Elevation helps reduce swelling; further action depends on other findings. ________________________________________ Question 7 Which laboratory value should the nurse monitor as the most specific indicator of myocardial injury? A. Creatine kinase-MB (CK-MB) B. Myoglobin C. Troponin I D. B-type natriuretic peptide (BNP) Answer: C. Troponin I Rationale: Troponin I is the most specific and sensitive marker for myocardial injury. It remains elevated longer than CK-MB and is more specific than myoglobin. ________________________________________ Question 8 A nurse palpates a pulse deficit in a patient with atrial fibrillation. What is the correct interpretation? A. The radial and apical pulses are equal B. The apical pulse rate is lower than radial C. The radial pulse is irregular but equal to apical D. The apical pulse is greater than the radial Answer: D. The apical pulse is greater than the radial Rationale: A pulse deficit means that not all heartbeats are perfusing peripherally. In atrial fibrillation, apical beats may not be strong enough to create a palpable radial pulse. ________________________________________ Question 9 Which position best helps a nurse auscultate for a pericardial friction rub? A. Supine B. Lying on the right side C. Sitting and leaning forward D. Left lateral recumbent Answer: C. Sitting and leaning forward Rationale: Pericardial friction rubs are best heard when the patient is sitting up and leaning forward. It increases contact between the pericardium and chest wall. ________________________________________ Question 10 During a cardiovascular assessment, which finding should be reported immediately? A. Systolic BP of 138 mm Hg B. Irregular apical pulse of 130 bpm C. Bounding pedal pulses D. Cool extremities with delayed capillary refill Answer: D. Cool extremities with delayed capillary refill Rationale: These signs may indicate poor peripheral perfusion or shock and should be addressed immediately. A patient reports dizziness and lightheadedness when standing up quickly. Which assessment finding supports a diagnosis of orthostatic hypotension? A. Heart rate decreases by 10 bpm when standing B. Blood pressure decreases by 20 mm Hg systolic when standing C. Respiratory rate increases when standing D. Oxygen saturation drops below 95% when standing Answer: B. Blood pressure decreases by 20 mm Hg systolic when standing Rationale: Orthostatic hypotension is defined as a drop in systolic blood pressure of at least 20 mm Hg or diastolic pressure of 10 mm Hg within three minutes of standing. ________________________________________ Question 12 Which pulse grading indicates a normal, strong pulse during peripheral vascular assessment? A. 0 B. 1+ C. 2+ D. 3+ Answer: C. 2+ Rationale: A 2+ pulse is considered normal and easily palpable without difficulty. ________________________________________ Question 13 The nurse hears a split S2 heart sound during auscultation. Which statement best describes this finding? A. It indicates heart failure B. It is a normal variation during inspiration C. It signals mitral valve stenosis D. It reflects pericardial effusion Answer: B. It is a normal variation during inspiration Rationale: A split S2 occurs when the aortic and pulmonic valves close at slightly different times during inspiration, which is normal. ________________________________________ Question 14 Which assessment technique should the nurse use to evaluate for peripheral arterial disease (PAD)? A. Palpate for pedal pulses and assess skin temperature B. Measure jugular venous pressure C. Auscultate lung fields for crackles D. Check capillary refill in the fingernails only Answer: A. Palpate for pedal pulses and assess skin temperature Rationale: PAD often causes diminished or absent pedal pulses and cool extremities due to decreased arterial blood flow. ________________________________________ Question 15 A patient with chronic venous insufficiency is likely to have which skin changes on assessment? A. Thickened, shiny skin with hair loss B. Brownish discoloration and edema around the ankles C. Cool, pale skin with ulcers on toes D. Cyanosis with clubbing of fingers Answer: B. Brownish discoloration and edema around the ankles Rationale: Venous insufficiency causes blood pooling, leading to edema and hemosiderin deposits, resulting in brownish skin discoloration.