Cardiovascular Nursing Practice Questions Test Bank
NCLEX-RN & NGN-Style MCQs with Answers & Rationales
Medical-Surgical Nursing Exam Prep
1. Acute Coronary Syndrome — Priority Assessment
A patient arrives in the emergency department reporting crushing substernal chest pressure
radiating to the left arm and jaw. The patient is diaphoretic and nauseated. Which action should
the nurse take first?
A. Obtain a 12-lead ECG
B. Administer prescribed morphine
C. Prepare the patient for cardiac catheterization
D. Draw blood for a lipid profile
Answer: A. Obtain a 12-lead ECG
Rationale: A 12-lead ECG should be obtained rapidly in a patient with suspected acute coronary
syndrome to identify myocardial ischemia or STEMI and guide immediate treatment. Pain
medication and diagnostic blood work are important but should not delay rapid ECG
assessment.
2. Heart Failure — Recognizing Deterioration
A patient with heart failure has gained 2.5 kg (5.5 lb) over the past 4 days. The patient reports
increasing shortness of breath and difficulty sleeping while lying flat. Which finding is most
concerning?
, A. Heart rate of 88/min
B. Bilateral crackles extending to the mid-lung fields
C. Mild dependent ankle edema
D. Blood pressure of 138/84 mm Hg
Answer: B. Bilateral crackles extending to the mid-lung fields
Rationale: Crackles extending beyond the bases indicate significant pulmonary congestion and
possible worsening left-sided heart failure. Orthopnea and rapid weight gain further support
fluid retention. This patient requires prompt assessment and intervention to prevent acute
pulmonary edema.
3. Digoxin Therapy — Toxicity
A patient with heart failure takes digoxin daily. Which assessment finding should cause the
nurse to hold the medication and notify the provider?
A. Apical pulse of 54/min
B. Blood pressure of 128/76 mm Hg
C. Respiratory rate of 18/min
D. Potassium level of 4.2 mEq/L
Answer: A. Apical pulse of 54/min
Rationale: Digoxin can cause bradycardia because of its effects on cardiac conduction. An apical
pulse below the prescribed safety threshold, commonly less than 60/min in adults, warrants
withholding the dose and notifying the provider. Hypokalemia increases digoxin toxicity risk, but
this patient's potassium is normal.
4. Hypertension — Clinical Judgment
NCLEX-RN & NGN-Style MCQs with Answers & Rationales
Medical-Surgical Nursing Exam Prep
1. Acute Coronary Syndrome — Priority Assessment
A patient arrives in the emergency department reporting crushing substernal chest pressure
radiating to the left arm and jaw. The patient is diaphoretic and nauseated. Which action should
the nurse take first?
A. Obtain a 12-lead ECG
B. Administer prescribed morphine
C. Prepare the patient for cardiac catheterization
D. Draw blood for a lipid profile
Answer: A. Obtain a 12-lead ECG
Rationale: A 12-lead ECG should be obtained rapidly in a patient with suspected acute coronary
syndrome to identify myocardial ischemia or STEMI and guide immediate treatment. Pain
medication and diagnostic blood work are important but should not delay rapid ECG
assessment.
2. Heart Failure — Recognizing Deterioration
A patient with heart failure has gained 2.5 kg (5.5 lb) over the past 4 days. The patient reports
increasing shortness of breath and difficulty sleeping while lying flat. Which finding is most
concerning?
, A. Heart rate of 88/min
B. Bilateral crackles extending to the mid-lung fields
C. Mild dependent ankle edema
D. Blood pressure of 138/84 mm Hg
Answer: B. Bilateral crackles extending to the mid-lung fields
Rationale: Crackles extending beyond the bases indicate significant pulmonary congestion and
possible worsening left-sided heart failure. Orthopnea and rapid weight gain further support
fluid retention. This patient requires prompt assessment and intervention to prevent acute
pulmonary edema.
3. Digoxin Therapy — Toxicity
A patient with heart failure takes digoxin daily. Which assessment finding should cause the
nurse to hold the medication and notify the provider?
A. Apical pulse of 54/min
B. Blood pressure of 128/76 mm Hg
C. Respiratory rate of 18/min
D. Potassium level of 4.2 mEq/L
Answer: A. Apical pulse of 54/min
Rationale: Digoxin can cause bradycardia because of its effects on cardiac conduction. An apical
pulse below the prescribed safety threshold, commonly less than 60/min in adults, warrants
withholding the dose and notifying the provider. Hypokalemia increases digoxin toxicity risk, but
this patient's potassium is normal.
4. Hypertension — Clinical Judgment
