Cardiovascular Nursing Practice Questions
NCLEX-RN MCQs with Rationales
Med-Surg Exam Prep
Question 1
A 68-year-old patient reports increasing fatigue, exertional dyspnea, and swelling of both ankles
over the past month. During assessment, the nurse notes jugular venous distention at 45
degrees, bilateral 2+ ankle edema, cool lower extremities, and an S3 heart sound. Which
additional assessment finding would most strongly support worsening heart failure?
A. Increased appetite and a 1-kg weight loss
B. New orthopnea requiring three pillows at night
C. Capillary refill of less than 2 seconds
D. Blood pressure of 118/72 mm Hg without symptoms
Correct Answer: B. New orthopnea requiring three pillows at night
Rationale: Orthopnea occurs when pulmonary congestion worsens in the supine position and is
a classic manifestation of left-sided heart failure. In a patient already demonstrating JVD,
edema, and an S3, new or worsening orthopnea suggests increasing pulmonary fluid
congestion.
Why the Other Options Are Incorrect:
A: Weight loss and increased appetite do not indicate fluid retention or worsening heart failure.
B: Correct. Increasing orthopnea suggests worsening pulmonary congestion.
,C: Normal capillary refill indicates preserved peripheral perfusion and does not specifically
indicate deterioration.
D: A normal blood pressure in an asymptomatic patient does not provide evidence of worsening
heart failure.
Clinical Judgment Tested: Recognizing a pattern of findings indicating worsening heart failure.
Topic: Cardiovascular Assessment / Heart Failure
Difficulty: Moderate
Bloom's Level: Analysis
Question 2
A patient presents to the emergency department with crushing substernal chest pressure
radiating to the left arm. The patient is pale and diaphoretic and reports nausea. Vital signs are
BP 146/88 mm Hg, HR 104/min, RR 22/min, and SpO₂ 95% on room air. Which action should the
nurse prioritize?
A. Obtain a 12-lead ECG
B. Administer a prescribed stool softener
C. Encourage the patient to ambulate to assess exercise tolerance
D. Obtain a fasting lipid profile before initiating treatment
Correct Answer: A. Obtain a 12-lead ECG
Rationale: The patient's symptoms are highly concerning for acute coronary syndrome. A 12-
lead ECG should be obtained promptly to identify evidence of myocardial ischemia or infarction
and guide immediate treatment decisions.
Why the Other Options Are Incorrect:
A: Correct. Rapid ECG acquisition is a priority in suspected acute coronary syndrome.
, B: A stool softener is unrelated to the immediate life-threatening problem.
C: Ambulation could increase myocardial oxygen demand and worsen ischemia.
D: A lipid profile may be appropriate later but should not delay evaluation of acute chest pain.
Clinical Judgment Tested: Prioritizing rapid assessment of a potentially life-threatening
cardiovascular emergency.
Topic: Acute Coronary Syndrome / Diagnostic Testing
Difficulty: Easy
Bloom's Level: Clinical Judgment
Question 3
A patient with hypertension has been prescribed lisinopril. At a follow-up visit, the patient
reports occasional dizziness when standing. The blood pressure is 104/66 mm Hg sitting and
88/58 mm Hg after standing. Which nursing intervention is most appropriate?
A. Instruct the patient to stop taking lisinopril immediately
B. Teach the patient to change positions slowly
C. Encourage the patient to double the next dose
D. Recommend restricting all fluid intake
Correct Answer: B. Teach the patient to change positions slowly
Rationale: The patient's blood pressure drops significantly with standing, consistent with
orthostatic hypotension. Teaching slow position changes can reduce dizziness and fall risk. The
medication should not be discontinued independently without further evaluation by the
prescribing clinician.
Why the Other Options Are Incorrect:
NCLEX-RN MCQs with Rationales
Med-Surg Exam Prep
Question 1
A 68-year-old patient reports increasing fatigue, exertional dyspnea, and swelling of both ankles
over the past month. During assessment, the nurse notes jugular venous distention at 45
degrees, bilateral 2+ ankle edema, cool lower extremities, and an S3 heart sound. Which
additional assessment finding would most strongly support worsening heart failure?
A. Increased appetite and a 1-kg weight loss
B. New orthopnea requiring three pillows at night
C. Capillary refill of less than 2 seconds
D. Blood pressure of 118/72 mm Hg without symptoms
Correct Answer: B. New orthopnea requiring three pillows at night
Rationale: Orthopnea occurs when pulmonary congestion worsens in the supine position and is
a classic manifestation of left-sided heart failure. In a patient already demonstrating JVD,
edema, and an S3, new or worsening orthopnea suggests increasing pulmonary fluid
congestion.
Why the Other Options Are Incorrect:
A: Weight loss and increased appetite do not indicate fluid retention or worsening heart failure.
B: Correct. Increasing orthopnea suggests worsening pulmonary congestion.
,C: Normal capillary refill indicates preserved peripheral perfusion and does not specifically
indicate deterioration.
D: A normal blood pressure in an asymptomatic patient does not provide evidence of worsening
heart failure.
Clinical Judgment Tested: Recognizing a pattern of findings indicating worsening heart failure.
Topic: Cardiovascular Assessment / Heart Failure
Difficulty: Moderate
Bloom's Level: Analysis
Question 2
A patient presents to the emergency department with crushing substernal chest pressure
radiating to the left arm. The patient is pale and diaphoretic and reports nausea. Vital signs are
BP 146/88 mm Hg, HR 104/min, RR 22/min, and SpO₂ 95% on room air. Which action should the
nurse prioritize?
A. Obtain a 12-lead ECG
B. Administer a prescribed stool softener
C. Encourage the patient to ambulate to assess exercise tolerance
D. Obtain a fasting lipid profile before initiating treatment
Correct Answer: A. Obtain a 12-lead ECG
Rationale: The patient's symptoms are highly concerning for acute coronary syndrome. A 12-
lead ECG should be obtained promptly to identify evidence of myocardial ischemia or infarction
and guide immediate treatment decisions.
Why the Other Options Are Incorrect:
A: Correct. Rapid ECG acquisition is a priority in suspected acute coronary syndrome.
, B: A stool softener is unrelated to the immediate life-threatening problem.
C: Ambulation could increase myocardial oxygen demand and worsen ischemia.
D: A lipid profile may be appropriate later but should not delay evaluation of acute chest pain.
Clinical Judgment Tested: Prioritizing rapid assessment of a potentially life-threatening
cardiovascular emergency.
Topic: Acute Coronary Syndrome / Diagnostic Testing
Difficulty: Easy
Bloom's Level: Clinical Judgment
Question 3
A patient with hypertension has been prescribed lisinopril. At a follow-up visit, the patient
reports occasional dizziness when standing. The blood pressure is 104/66 mm Hg sitting and
88/58 mm Hg after standing. Which nursing intervention is most appropriate?
A. Instruct the patient to stop taking lisinopril immediately
B. Teach the patient to change positions slowly
C. Encourage the patient to double the next dose
D. Recommend restricting all fluid intake
Correct Answer: B. Teach the patient to change positions slowly
Rationale: The patient's blood pressure drops significantly with standing, consistent with
orthostatic hypotension. Teaching slow position changes can reduce dizziness and fall risk. The
medication should not be discontinued independently without further evaluation by the
prescribing clinician.
Why the Other Options Are Incorrect:
