2026 CV-BC Exam Prep: Cardiac Vascular
Nursing Practice Questions, Answer
Rationales, Cardiac Assessment, Vascular
Disorders, Clinical Management Study
Guide & Test Success
DOMAIN 1: Assessment and Diagnosis (Questions 1–22)
Q1. A nurse is performing a cardiovascular assessment on a patient with
suspected heart failure. Which heart sound is most closely associated with heart
failure in adults?
A) S1 split
B) S2 split
C) S3 gallop
D) S4 gallop
Correct Answer: C
Rationale: An S3 gallop (ventricular gallop) is heard early in diastole and is
associated with volume overload and decreased ventricular compliance,
commonly seen in heart failure. An S4 gallop is associated with ventricular
hypertrophy and decreased compliance, often seen in hypertension or aortic
stenosis.
Q2. The cardiac monitor shows ST-segment elevation in leads V1–V4. Which
coronary artery is most likely occluded?
A) Right coronary artery
B) Left anterior descending (LAD) artery
C) Left circumflex artery
D) Posterior descending artery
Correct Answer: B
Rationale: ST-segment elevation in leads V1–V4 indicates an anterior wall
,myocardial infarction, most commonly caused by occlusion of the LAD artery. The
LAD supplies the anterior wall of the left ventricle and the interventricular
septum.
Q3. During a cardiac assessment, the nurse notes a continuous "machinery-like"
murmur. This finding is most consistent with:
A) Mitral stenosis
B) Aortic regurgitation
C) Patent ductus arteriosus (PDA)
D) Ventricular septal defect
Correct Answer: C
Rationale: A continuous "machinery-like" murmur is the classic auscultatory
finding in patent ductus arteriosus. The murmur is heard throughout systole and
diastole due to continuous flow from the aorta to the pulmonary artery.
Q4. Examination of a patient in a supine position reveals distended jugular veins
from the base of the neck to the angle of the jaw. This finding indicates:
A) Decreased venous return
B) Increased central venous pressure
C) Increased pulmonary artery capillary pressure
D) Left-sided heart failure
Correct Answer: B
Rationale: Jugular venous distention (JVD) to the angle of the jaw in a supine
patient indicates increased central venous pressure, reflecting right-sided heart
failure or fluid overload.
Q5. Which leads on a 12-lead ECG provide a view of the inferior wall of the left
ventricle?
A) V1, V2, V3
B) I, aVL, V5, V6
C) II, III, aVF
D) V3R, V4R
,Correct Answer: C
Rationale: Leads II, III, and aVF view the inferior surface of the heart, typically
supplied by the right coronary artery (RCA).
Q6. Which group of 12-lead ECG leads views the lateral wall of the left ventricle?
A) Leads II, III, and aVF
B) Leads V1, V2, V3, and V4
C) Leads I, aVL, V5, and V6
D) Leads V3R, V4R, and V5R
Correct Answer: C
Rationale: Leads I, aVL, V5, and V6 record electrical activity from the lateral wall
of the left ventricle, typically perfused by the left circumflex artery.
Q7. The S4 heart sound (atrial gallop) is best heard in which condition?
A) Acute myocardial infarction or hypertension
B) Aortic stenosis
C) Fluid overload
D) Both A and B
Correct Answer: D
Rationale: The S4 gallop occurs during late diastole when the atria contract into a
stiff, non-compliant ventricle. It is heard in conditions with decreased ventricular
compliance such as acute MI, hypertension, and aortic stenosis.
Q8. Which cardiac biomarker is considered the gold standard for diagnosing
myocardial necrosis due to its high cardiac tissue specificity?
A) Myoglobin
B) Creatine Kinase-MB (CK-MB)
C) Cardiac Troponin I or T
D) Lactate Dehydrogenase (LDH)
Correct Answer: C
Rationale: Cardiac troponins are structural proteins specific to myocardial tissue.
They rise within 3–6 hours after injury and remain elevated for up to 10–14 days,
offering high sensitivity and specificity.
, Q9. In the timeline of an acute myocardial infarction, when do CK-MB levels
typically peak after the onset of chest pain?
A) 1 to 2 hours
B) 12 to 24 hours
C) 4 to 7 days
D) 14 to 21 days
Correct Answer: B
Rationale: CK-MB begins to rise within 3–6 hours, peaks around 12 to 24 hours,
and returns to baseline within 48 to 72 hours.
Q10. What is the primary clinical utility of measuring B-type Natriuretic Peptide
(BNP)?
A) Diagnosing acute bacterial endocarditis
B) Assessing myocardial wall stretch and volume overload to aid in heart failure
diagnosis
C) Evaluating coronary artery plaque calcification
D) Monitoring heparin-induced anticoagulation
Correct Answer: B
Rationale: BNP is released by ventricular myocytes in response to increased wall
tension and volume overload, making it a valuable diagnostic and prognostic
biomarker for heart failure.
Q11. A patient with a permanent pacemaker (set at 70 bpm) has a heart rate of
52 bpm on the monitor. The ECG shows pacer spikes followed by no QRS
complex. What is the correct interpretation?
A) Failure to capture
B) Failure to sense
C) Normal pacemaker function
D) Oversensing
Correct Answer: A
Rationale: Pacer spikes without subsequent QRS complexes indicate failure to
capture—the pacemaker is firing but the myocardium is not depolarizing in
response.
Nursing Practice Questions, Answer
Rationales, Cardiac Assessment, Vascular
Disorders, Clinical Management Study
Guide & Test Success
DOMAIN 1: Assessment and Diagnosis (Questions 1–22)
Q1. A nurse is performing a cardiovascular assessment on a patient with
suspected heart failure. Which heart sound is most closely associated with heart
failure in adults?
A) S1 split
B) S2 split
C) S3 gallop
D) S4 gallop
Correct Answer: C
Rationale: An S3 gallop (ventricular gallop) is heard early in diastole and is
associated with volume overload and decreased ventricular compliance,
commonly seen in heart failure. An S4 gallop is associated with ventricular
hypertrophy and decreased compliance, often seen in hypertension or aortic
stenosis.
Q2. The cardiac monitor shows ST-segment elevation in leads V1–V4. Which
coronary artery is most likely occluded?
A) Right coronary artery
B) Left anterior descending (LAD) artery
C) Left circumflex artery
D) Posterior descending artery
Correct Answer: B
Rationale: ST-segment elevation in leads V1–V4 indicates an anterior wall
,myocardial infarction, most commonly caused by occlusion of the LAD artery. The
LAD supplies the anterior wall of the left ventricle and the interventricular
septum.
Q3. During a cardiac assessment, the nurse notes a continuous "machinery-like"
murmur. This finding is most consistent with:
A) Mitral stenosis
B) Aortic regurgitation
C) Patent ductus arteriosus (PDA)
D) Ventricular septal defect
Correct Answer: C
Rationale: A continuous "machinery-like" murmur is the classic auscultatory
finding in patent ductus arteriosus. The murmur is heard throughout systole and
diastole due to continuous flow from the aorta to the pulmonary artery.
Q4. Examination of a patient in a supine position reveals distended jugular veins
from the base of the neck to the angle of the jaw. This finding indicates:
A) Decreased venous return
B) Increased central venous pressure
C) Increased pulmonary artery capillary pressure
D) Left-sided heart failure
Correct Answer: B
Rationale: Jugular venous distention (JVD) to the angle of the jaw in a supine
patient indicates increased central venous pressure, reflecting right-sided heart
failure or fluid overload.
Q5. Which leads on a 12-lead ECG provide a view of the inferior wall of the left
ventricle?
A) V1, V2, V3
B) I, aVL, V5, V6
C) II, III, aVF
D) V3R, V4R
,Correct Answer: C
Rationale: Leads II, III, and aVF view the inferior surface of the heart, typically
supplied by the right coronary artery (RCA).
Q6. Which group of 12-lead ECG leads views the lateral wall of the left ventricle?
A) Leads II, III, and aVF
B) Leads V1, V2, V3, and V4
C) Leads I, aVL, V5, and V6
D) Leads V3R, V4R, and V5R
Correct Answer: C
Rationale: Leads I, aVL, V5, and V6 record electrical activity from the lateral wall
of the left ventricle, typically perfused by the left circumflex artery.
Q7. The S4 heart sound (atrial gallop) is best heard in which condition?
A) Acute myocardial infarction or hypertension
B) Aortic stenosis
C) Fluid overload
D) Both A and B
Correct Answer: D
Rationale: The S4 gallop occurs during late diastole when the atria contract into a
stiff, non-compliant ventricle. It is heard in conditions with decreased ventricular
compliance such as acute MI, hypertension, and aortic stenosis.
Q8. Which cardiac biomarker is considered the gold standard for diagnosing
myocardial necrosis due to its high cardiac tissue specificity?
A) Myoglobin
B) Creatine Kinase-MB (CK-MB)
C) Cardiac Troponin I or T
D) Lactate Dehydrogenase (LDH)
Correct Answer: C
Rationale: Cardiac troponins are structural proteins specific to myocardial tissue.
They rise within 3–6 hours after injury and remain elevated for up to 10–14 days,
offering high sensitivity and specificity.
, Q9. In the timeline of an acute myocardial infarction, when do CK-MB levels
typically peak after the onset of chest pain?
A) 1 to 2 hours
B) 12 to 24 hours
C) 4 to 7 days
D) 14 to 21 days
Correct Answer: B
Rationale: CK-MB begins to rise within 3–6 hours, peaks around 12 to 24 hours,
and returns to baseline within 48 to 72 hours.
Q10. What is the primary clinical utility of measuring B-type Natriuretic Peptide
(BNP)?
A) Diagnosing acute bacterial endocarditis
B) Assessing myocardial wall stretch and volume overload to aid in heart failure
diagnosis
C) Evaluating coronary artery plaque calcification
D) Monitoring heparin-induced anticoagulation
Correct Answer: B
Rationale: BNP is released by ventricular myocytes in response to increased wall
tension and volume overload, making it a valuable diagnostic and prognostic
biomarker for heart failure.
Q11. A patient with a permanent pacemaker (set at 70 bpm) has a heart rate of
52 bpm on the monitor. The ECG shows pacer spikes followed by no QRS
complex. What is the correct interpretation?
A) Failure to capture
B) Failure to sense
C) Normal pacemaker function
D) Oversensing
Correct Answer: A
Rationale: Pacer spikes without subsequent QRS complexes indicate failure to
capture—the pacemaker is firing but the myocardium is not depolarizing in
response.
