Medical-Surgical Nursing Cardiovascular Disorders Practice
Exam Study Guide Updated 2026 🫀 | 200+ Verified
Questions and Answers with Detailed Rationales | Coronary
Artery Disease, Myocardial Infarction, Heart Failure,
Hypertension, Dysrhythmias and ECG Interpretation,
Valvular Heart Diseases, Peripheral Vascular Disorders,
Shock (Cardiogenic, Hypovolemic), Hemodynamic
Monitoring, Pharmacology (Beta Blockers, ACE Inhibitors,
Anticoagulants), NCLEX-Style Clinical Judgment Questions |
Complete Exam Prep Resource for Nursing Students
Success
Question 1: A 68-year-old male patient presents to the emergency department with
crushing substernal chest pain radiating to his left arm, diaphoresis, and nausea.
His ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery
is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
CORRECT ANSWER: C. Right coronary artery
RATIONALE: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is most commonly caused by occlusion of the right
coronary artery. The right coronary artery supplies blood to the inferior portion of the
heart, and its occlusion produces characteristic ECG changes in these inferior leads.
Question 2: A nurse is caring for a patient with newly diagnosed heart failure with
reduced ejection fraction (HFrEF). Which medication class is considered first-line
therapy to reduce mortality in this population?
A. Loop diuretics
B. Angiotensin-converting enzyme (ACE) inhibitors
C. Calcium channel blockers
D. Nitrates
CORRECT ANSWER: B. Angiotensin-converting enzyme (ACE) inhibitors
RATIONALE: ACE inhibitors are first-line therapy for HFrEF because they reduce
afterload, decrease ventricular remodeling, and have been proven in multiple clinical
trials to significantly reduce mortality and hospitalizations. Loop diuretics manage
symptoms but do not improve survival, while calcium channel blockers and nitrates are
not first-line for mortality reduction in HFrEF.
Question 3: During assessment of a patient with suspected deep vein thrombosis
(DVT), the nurse notes unilateral leg swelling, warmth, and tenderness along the
calf. Which diagnostic test is considered the gold standard for confirming DVT?
,A. D-dimer assay
B. Venous duplex ultrasonography
C. Impedance plethysmography
D. Contrast venography
CORRECT ANSWER: B. Venous duplex ultrasonography
RATIONALE: Venous duplex ultrasonography is the gold standard for diagnosing DVT
because it is non-invasive, highly sensitive and specific for detecting thrombus in
proximal veins, readily available, and does not involve radiation or contrast. D-dimer is
useful for ruling out DVT in low-risk patients but lacks specificity, while contrast
venography is invasive and rarely used first-line.
Question 4: A patient with atrial fibrillation is prescribed warfarin for stroke
prophylaxis. The nurse understands that the therapeutic international normalized
ratio (INR) range for this indication is:
A. 1.0 to 1.5
B. 1.5 to 2.0
C. 2.0 to 3.0
D. 3.0 to 4.5
CORRECT ANSWER: C. 2.0 to 3.0
RATIONALE: For stroke prophylaxis in non-valvular atrial fibrillation, the target INR range
is 2.0 to 3.0. This range provides optimal anticoagulation to prevent thromboembolic
events while minimizing bleeding risk. Higher ranges increase bleeding complications
without additional benefit, while lower ranges may be insufficient for stroke prevention.
Question 5: A nurse is preparing to administer metoprolol to a patient with acute
coronary syndrome. Which assessment finding would require the nurse to hold the
medication and notify the provider?
A. Blood pressure 110/70 mmHg
B. Heart rate 52 beats per minute
C. Respiratory rate 18 breaths per minute
D. Oxygen saturation 96% on room air
CORRECT ANSWER: B. Heart rate 52 beats per minute
RATIONALE: Beta-blockers like metoprolol decrease heart rate and contractility. A heart
rate below 60 beats per minute is a common parameter for holding beta-blockers in
acute cardiac conditions, as excessive bradycardia can compromise cardiac output and
perfusion. The other vital signs are within acceptable ranges for administration.
Question 6: Which clinical manifestation is most characteristic of right-sided heart
failure?
A. Pulmonary crackles
B. Orthopnea
,C. Peripheral edema
D. Paroxysmal nocturnal dyspnea
CORRECT ANSWER: C. Peripheral edema
RATIONALE: Right-sided heart failure results in systemic venous congestion, leading to
peripheral edema, jugular venous distension, hepatomegaly, and ascites. Pulmonary
crackles, orthopnea, and paroxysmal nocturnal dyspnea are manifestations of left-
sided heart failure, which causes pulmonary congestion.
Question 7: A patient is scheduled for cardiac catheterization via the femoral artery
approach. Which post-procedure nursing intervention is highest priority to prevent
complications?
A. Encouraging oral fluid intake
B. Maintaining bed rest with the affected leg straight
C. Applying a warm compress to the insertion site
D. Administering prophylactic antibiotics
CORRECT ANSWER: B. Maintaining bed rest with the affected leg straight
RATIONALE: After femoral artery catheterization, maintaining bed rest with the affected
leg straight for 4-6 hours (or per protocol) is critical to prevent bleeding, hematoma
formation, or pseudoaneurysm at the arterial puncture site. While hydration is
important to flush contrast dye, immobilization takes priority to ensure hemostasis.
Question 8: A nurse is educating a patient with hypertension about lifestyle
modifications. Which recommendation has the greatest impact on lowering blood
pressure?
A. Reducing dietary sodium to less than 2,300 mg/day
B. Engaging in moderate aerobic exercise 30 minutes most days
C. Achieving and maintaining a healthy body weight
D. Limiting alcohol consumption to moderate levels
CORRECT ANSWER: C. Achieving and maintaining a healthy body weight
RATIONALE: Weight reduction has the most significant impact on blood pressure
control, with approximately 1 mmHg reduction in systolic BP per kilogram of weight
loss. While all listed modifications are beneficial, weight management addresses
multiple pathophysiological mechanisms of hypertension and often yields the greatest
BP reduction.
Question 9: A patient with a mechanical mitral valve replacement requires lifelong
anticoagulation. Which statement by the patient indicates understanding of
discharge teaching?
A. "I will take my warfarin at the same time each day and have my INR checked
regularly."
B. "I can stop taking my anticoagulant if I feel well and have no symptoms."
, C. "I should avoid all green leafy vegetables to prevent interference with my medication."
D. "I will use an electric razor and soft toothbrush only when my INR is above 3.5."
CORRECT ANSWER: A. "I will take my warfarin at the same time each day and have
my INR checked regularly."
RATIONALE: Consistent timing of warfarin administration and regular INR monitoring
are essential for maintaining therapeutic anticoagulation and preventing
thromboembolic or bleeding complications. Patients should not discontinue
anticoagulants without provider approval, do not need to eliminate vitamin K foods
entirely (but should maintain consistent intake), and should use bleeding-precaution
tools regardless of INR value.
Question 10: Which ECG finding is diagnostic of a third-degree (complete) heart
block?
A. PR interval progressively lengthens until a QRS complex is dropped
B. PR interval is fixed and prolonged greater than 0.20 seconds
C. Atrial and ventricular rhythms are independent with no relationship between P waves
and QRS complexes
D. Irregularly irregular rhythm with no discernible P waves
CORRECT ANSWER: C. Atrial and ventricular rhythms are independent with no
relationship between P waves and QRS complexes
RATIONALE: In third-degree heart block, there is complete dissociation between atrial
and ventricular electrical activity due to failure of conduction through the AV node. P
waves occur at a regular atrial rate, QRS complexes occur at a slower ventricular
escape rate, and there is no consistent PR interval. Option A describes Mobitz type I, B
describes first-degree block, and D describes atrial fibrillation.
Question 11: A patient with acute decompensated heart failure is receiving
intravenous furosemide. Which assessment finding indicates the medication is
having the desired therapeutic effect?
A. Decreased serum potassium level
B. Increased urine output and decreased crackles in lung fields
C. Elevated blood urea nitrogen and creatinine
D. Heart rate increased by 20 beats per minute
CORRECT ANSWER: B. Increased urine output and decreased crackles in lung
fields
RATIONALE: Furosemide, a loop diuretic, promotes excretion of sodium and water,
reducing preload and pulmonary congestion in heart failure. Increased urine output and
resolution of pulmonary crackles indicate effective fluid removal. Hypokalemia is a side
effect requiring monitoring, elevated renal markers may indicate over-diuresis, and
tachycardia is not a therapeutic goal.
Exam Study Guide Updated 2026 🫀 | 200+ Verified
Questions and Answers with Detailed Rationales | Coronary
Artery Disease, Myocardial Infarction, Heart Failure,
Hypertension, Dysrhythmias and ECG Interpretation,
Valvular Heart Diseases, Peripheral Vascular Disorders,
Shock (Cardiogenic, Hypovolemic), Hemodynamic
Monitoring, Pharmacology (Beta Blockers, ACE Inhibitors,
Anticoagulants), NCLEX-Style Clinical Judgment Questions |
Complete Exam Prep Resource for Nursing Students
Success
Question 1: A 68-year-old male patient presents to the emergency department with
crushing substernal chest pain radiating to his left arm, diaphoresis, and nausea.
His ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery
is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
CORRECT ANSWER: C. Right coronary artery
RATIONALE: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is most commonly caused by occlusion of the right
coronary artery. The right coronary artery supplies blood to the inferior portion of the
heart, and its occlusion produces characteristic ECG changes in these inferior leads.
Question 2: A nurse is caring for a patient with newly diagnosed heart failure with
reduced ejection fraction (HFrEF). Which medication class is considered first-line
therapy to reduce mortality in this population?
A. Loop diuretics
B. Angiotensin-converting enzyme (ACE) inhibitors
C. Calcium channel blockers
D. Nitrates
CORRECT ANSWER: B. Angiotensin-converting enzyme (ACE) inhibitors
RATIONALE: ACE inhibitors are first-line therapy for HFrEF because they reduce
afterload, decrease ventricular remodeling, and have been proven in multiple clinical
trials to significantly reduce mortality and hospitalizations. Loop diuretics manage
symptoms but do not improve survival, while calcium channel blockers and nitrates are
not first-line for mortality reduction in HFrEF.
Question 3: During assessment of a patient with suspected deep vein thrombosis
(DVT), the nurse notes unilateral leg swelling, warmth, and tenderness along the
calf. Which diagnostic test is considered the gold standard for confirming DVT?
,A. D-dimer assay
B. Venous duplex ultrasonography
C. Impedance plethysmography
D. Contrast venography
CORRECT ANSWER: B. Venous duplex ultrasonography
RATIONALE: Venous duplex ultrasonography is the gold standard for diagnosing DVT
because it is non-invasive, highly sensitive and specific for detecting thrombus in
proximal veins, readily available, and does not involve radiation or contrast. D-dimer is
useful for ruling out DVT in low-risk patients but lacks specificity, while contrast
venography is invasive and rarely used first-line.
Question 4: A patient with atrial fibrillation is prescribed warfarin for stroke
prophylaxis. The nurse understands that the therapeutic international normalized
ratio (INR) range for this indication is:
A. 1.0 to 1.5
B. 1.5 to 2.0
C. 2.0 to 3.0
D. 3.0 to 4.5
CORRECT ANSWER: C. 2.0 to 3.0
RATIONALE: For stroke prophylaxis in non-valvular atrial fibrillation, the target INR range
is 2.0 to 3.0. This range provides optimal anticoagulation to prevent thromboembolic
events while minimizing bleeding risk. Higher ranges increase bleeding complications
without additional benefit, while lower ranges may be insufficient for stroke prevention.
Question 5: A nurse is preparing to administer metoprolol to a patient with acute
coronary syndrome. Which assessment finding would require the nurse to hold the
medication and notify the provider?
A. Blood pressure 110/70 mmHg
B. Heart rate 52 beats per minute
C. Respiratory rate 18 breaths per minute
D. Oxygen saturation 96% on room air
CORRECT ANSWER: B. Heart rate 52 beats per minute
RATIONALE: Beta-blockers like metoprolol decrease heart rate and contractility. A heart
rate below 60 beats per minute is a common parameter for holding beta-blockers in
acute cardiac conditions, as excessive bradycardia can compromise cardiac output and
perfusion. The other vital signs are within acceptable ranges for administration.
Question 6: Which clinical manifestation is most characteristic of right-sided heart
failure?
A. Pulmonary crackles
B. Orthopnea
,C. Peripheral edema
D. Paroxysmal nocturnal dyspnea
CORRECT ANSWER: C. Peripheral edema
RATIONALE: Right-sided heart failure results in systemic venous congestion, leading to
peripheral edema, jugular venous distension, hepatomegaly, and ascites. Pulmonary
crackles, orthopnea, and paroxysmal nocturnal dyspnea are manifestations of left-
sided heart failure, which causes pulmonary congestion.
Question 7: A patient is scheduled for cardiac catheterization via the femoral artery
approach. Which post-procedure nursing intervention is highest priority to prevent
complications?
A. Encouraging oral fluid intake
B. Maintaining bed rest with the affected leg straight
C. Applying a warm compress to the insertion site
D. Administering prophylactic antibiotics
CORRECT ANSWER: B. Maintaining bed rest with the affected leg straight
RATIONALE: After femoral artery catheterization, maintaining bed rest with the affected
leg straight for 4-6 hours (or per protocol) is critical to prevent bleeding, hematoma
formation, or pseudoaneurysm at the arterial puncture site. While hydration is
important to flush contrast dye, immobilization takes priority to ensure hemostasis.
Question 8: A nurse is educating a patient with hypertension about lifestyle
modifications. Which recommendation has the greatest impact on lowering blood
pressure?
A. Reducing dietary sodium to less than 2,300 mg/day
B. Engaging in moderate aerobic exercise 30 minutes most days
C. Achieving and maintaining a healthy body weight
D. Limiting alcohol consumption to moderate levels
CORRECT ANSWER: C. Achieving and maintaining a healthy body weight
RATIONALE: Weight reduction has the most significant impact on blood pressure
control, with approximately 1 mmHg reduction in systolic BP per kilogram of weight
loss. While all listed modifications are beneficial, weight management addresses
multiple pathophysiological mechanisms of hypertension and often yields the greatest
BP reduction.
Question 9: A patient with a mechanical mitral valve replacement requires lifelong
anticoagulation. Which statement by the patient indicates understanding of
discharge teaching?
A. "I will take my warfarin at the same time each day and have my INR checked
regularly."
B. "I can stop taking my anticoagulant if I feel well and have no symptoms."
, C. "I should avoid all green leafy vegetables to prevent interference with my medication."
D. "I will use an electric razor and soft toothbrush only when my INR is above 3.5."
CORRECT ANSWER: A. "I will take my warfarin at the same time each day and have
my INR checked regularly."
RATIONALE: Consistent timing of warfarin administration and regular INR monitoring
are essential for maintaining therapeutic anticoagulation and preventing
thromboembolic or bleeding complications. Patients should not discontinue
anticoagulants without provider approval, do not need to eliminate vitamin K foods
entirely (but should maintain consistent intake), and should use bleeding-precaution
tools regardless of INR value.
Question 10: Which ECG finding is diagnostic of a third-degree (complete) heart
block?
A. PR interval progressively lengthens until a QRS complex is dropped
B. PR interval is fixed and prolonged greater than 0.20 seconds
C. Atrial and ventricular rhythms are independent with no relationship between P waves
and QRS complexes
D. Irregularly irregular rhythm with no discernible P waves
CORRECT ANSWER: C. Atrial and ventricular rhythms are independent with no
relationship between P waves and QRS complexes
RATIONALE: In third-degree heart block, there is complete dissociation between atrial
and ventricular electrical activity due to failure of conduction through the AV node. P
waves occur at a regular atrial rate, QRS complexes occur at a slower ventricular
escape rate, and there is no consistent PR interval. Option A describes Mobitz type I, B
describes first-degree block, and D describes atrial fibrillation.
Question 11: A patient with acute decompensated heart failure is receiving
intravenous furosemide. Which assessment finding indicates the medication is
having the desired therapeutic effect?
A. Decreased serum potassium level
B. Increased urine output and decreased crackles in lung fields
C. Elevated blood urea nitrogen and creatinine
D. Heart rate increased by 20 beats per minute
CORRECT ANSWER: B. Increased urine output and decreased crackles in lung
fields
RATIONALE: Furosemide, a loop diuretic, promotes excretion of sodium and water,
reducing preload and pulmonary congestion in heart failure. Increased urine output and
resolution of pulmonary crackles indicate effective fluid removal. Hypokalemia is a side
effect requiring monitoring, elevated renal markers may indicate over-diuresis, and
tachycardia is not a therapeutic goal.
