Cardiovascular Nursing Practice Questions
20 NCLEX-RN Style MCQs with Rationales
Cardiac Nursing, Heart Failure, MI, Dysrhythmias & ECG
Review
Question 1
A 68-year-old client reports increasing shortness of breath when walking to the bathroom.
During assessment, the nurse notes bilateral ankle edema, jugular venous distention, and an
S3 heart sound. Which additional finding most strongly supports worsening heart failure?
A. Weight gain of 2.5 kg (5.5 lb) over 3 days
B. Heart rate of 76/min with regular rhythm
C. Capillary refill of 2 seconds
D. Warm, dry skin
Correct Answer: A. Weight gain of 2.5 kg (5.5 lb) over 3 days
Rationale: Rapid weight gain is an important indicator of fluid retention and worsening heart
failure. Daily weights are one of the most sensitive methods for detecting changes in fluid status
before severe symptoms develop.
Why the Other Options Are Incorrect:
• A: Correct. Rapid weight gain indicates fluid accumulation.
• B: A heart rate of 76/min may be normal and does not indicate worsening fluid overload.
• C: Normal capillary refill does not indicate acute deterioration.
• D: Warm, dry skin is not a characteristic indicator of worsening heart failure.
,Clinical Judgment Tested: Recognizing early evidence of fluid-volume excess.
Topic: Heart failure assessment
Difficulty: Easy
Bloom's Level: Application
Question 2
A client with hypertension is prescribed lisinopril. Which assessment finding should the nurse
report immediately before administering the medication?
A. Blood pressure of 148/88 mm Hg
B. Potassium level of 5.8 mEq/L
C. Heart rate of 78/min
D. Mild ankle edema
Correct Answer: B. Potassium level of 5.8 mEq/L
Rationale: ACE inhibitors can increase serum potassium. A potassium level of 5.8 mEq/L
represents clinically significant hyperkalemia and increases the risk of potentially dangerous
dysrhythmias. The nurse should notify the provider before administration.
Why the Other Options Are Incorrect:
• A: The blood pressure remains elevated but is not an immediate contraindication to the
medication.
• B: Correct. ACE inhibitors can worsen hyperkalemia.
• C: This heart rate is within a typical resting range.
• D: Mild edema is not the priority concern compared with significant hyperkalemia.
Clinical Judgment Tested: Identifying medication-related laboratory abnormalities requiring
intervention.
Topic: ACE inhibitor safety
, Difficulty: Moderate
Bloom's Level: Analysis
Question 3
A client arrives in the emergency department reporting crushing substernal chest pressure
radiating to the jaw and left arm. The client is pale and diaphoretic. Which action should the
nurse take first?
A. Obtain a 12-lead ECG
B. Administer a prescribed stool softener
C. Encourage the client to ambulate
D. Obtain a detailed dietary history
Correct Answer: A. Obtain a 12-lead ECG
Rationale: The symptoms are highly concerning for acute coronary syndrome. A 12-lead ECG
should be obtained promptly to identify myocardial ischemia or infarction and guide urgent
treatment.
Why the Other Options Are Incorrect:
• A: Correct. Rapid ECG assessment is a priority in suspected acute coronary syndrome.
• B: A stool softener is unrelated to the immediate threat.
• C: Activity increases myocardial oxygen demand and is inappropriate.
• D: A dietary history can be obtained later and does not address the immediate
emergency.
Clinical Judgment Tested: Prioritizing assessment of a potentially life-threatening cardiovascular
emergency.
Topic: Acute coronary syndrome
Difficulty: Moderate
20 NCLEX-RN Style MCQs with Rationales
Cardiac Nursing, Heart Failure, MI, Dysrhythmias & ECG
Review
Question 1
A 68-year-old client reports increasing shortness of breath when walking to the bathroom.
During assessment, the nurse notes bilateral ankle edema, jugular venous distention, and an
S3 heart sound. Which additional finding most strongly supports worsening heart failure?
A. Weight gain of 2.5 kg (5.5 lb) over 3 days
B. Heart rate of 76/min with regular rhythm
C. Capillary refill of 2 seconds
D. Warm, dry skin
Correct Answer: A. Weight gain of 2.5 kg (5.5 lb) over 3 days
Rationale: Rapid weight gain is an important indicator of fluid retention and worsening heart
failure. Daily weights are one of the most sensitive methods for detecting changes in fluid status
before severe symptoms develop.
Why the Other Options Are Incorrect:
• A: Correct. Rapid weight gain indicates fluid accumulation.
• B: A heart rate of 76/min may be normal and does not indicate worsening fluid overload.
• C: Normal capillary refill does not indicate acute deterioration.
• D: Warm, dry skin is not a characteristic indicator of worsening heart failure.
,Clinical Judgment Tested: Recognizing early evidence of fluid-volume excess.
Topic: Heart failure assessment
Difficulty: Easy
Bloom's Level: Application
Question 2
A client with hypertension is prescribed lisinopril. Which assessment finding should the nurse
report immediately before administering the medication?
A. Blood pressure of 148/88 mm Hg
B. Potassium level of 5.8 mEq/L
C. Heart rate of 78/min
D. Mild ankle edema
Correct Answer: B. Potassium level of 5.8 mEq/L
Rationale: ACE inhibitors can increase serum potassium. A potassium level of 5.8 mEq/L
represents clinically significant hyperkalemia and increases the risk of potentially dangerous
dysrhythmias. The nurse should notify the provider before administration.
Why the Other Options Are Incorrect:
• A: The blood pressure remains elevated but is not an immediate contraindication to the
medication.
• B: Correct. ACE inhibitors can worsen hyperkalemia.
• C: This heart rate is within a typical resting range.
• D: Mild edema is not the priority concern compared with significant hyperkalemia.
Clinical Judgment Tested: Identifying medication-related laboratory abnormalities requiring
intervention.
Topic: ACE inhibitor safety
, Difficulty: Moderate
Bloom's Level: Analysis
Question 3
A client arrives in the emergency department reporting crushing substernal chest pressure
radiating to the jaw and left arm. The client is pale and diaphoretic. Which action should the
nurse take first?
A. Obtain a 12-lead ECG
B. Administer a prescribed stool softener
C. Encourage the client to ambulate
D. Obtain a detailed dietary history
Correct Answer: A. Obtain a 12-lead ECG
Rationale: The symptoms are highly concerning for acute coronary syndrome. A 12-lead ECG
should be obtained promptly to identify myocardial ischemia or infarction and guide urgent
treatment.
Why the Other Options Are Incorrect:
• A: Correct. Rapid ECG assessment is a priority in suspected acute coronary syndrome.
• B: A stool softener is unrelated to the immediate threat.
• C: Activity increases myocardial oxygen demand and is inappropriate.
• D: A dietary history can be obtained later and does not address the immediate
emergency.
Clinical Judgment Tested: Prioritizing assessment of a potentially life-threatening cardiovascular
emergency.
Topic: Acute coronary syndrome
Difficulty: Moderate
