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NCLEX RN CARDIOVASCULAR EXAM 160 QUESTIONS AND
ANSWERS WITH RATIONALES UPDATE 2025/
A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of cardiomyopathy is particularly common among young people who appear otherwise healthy?
A) Dilated cardiomyopathy (DCM).
B) Arrhythmogenic right ventricular cardiomyopathy (ARVC)
C) Hypertrophic cardiomyopathy (HCM)
D) Restrictive or constrictive cardiomyopathy (RCM)
C) Hypertrophic cardiomyopathy (HCM)
RATIONALE: With HCM, cardiac arrest (i.e., sudden cardiac death) may be the initial manifestation in young people, including athletes. DCM, ARVC, and RCM are not typically present in younger adults who appear otherwise healthy.
A 48-year-old man presents to the ED complaining of severe substernal chest pain radiating down his left arm. He is admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). What nursing assessment activity is a priority on admission to the CCU?
A) Begin ECG monitoring.
B) Obtain information about family history of heart disease.
C) Auscultate lung fields.
D) Determine if the patient smokes.
A) Begin ECG monitoring.
RATIONALE: The 12-lead ECG provides information that assists in ruling out or diagnosing an acute MI. It should be obtained within 10 minutes from the time a patient reports pain or arrives in the ED. By monitoring serial ECG changes over time, the location, evolution, and resolution of an MI can be identified and monitored; life-threatening arrhythmias are the leading cause of death in the first hours after an MI. Obtaining information about family history of heart disease and whether the patient smokes are not immediate priorities in the acute phase of MI. Data may be obtained from family members later. Lung fields are auscultated after oxygenation and pain control needs are met.
An adult patient is admitted to the ED with chest pain. The patient states that he had developed unrelieved chest pain that was present for approximately 20 minutes before coming to the hospital. To minimize cardiac damage, the nurse should expect to administer which of the following interventions?
A) Thrombolytics, oxygen administration, and nonsteroidal anti-inflammatories
B) Morphine sulphate, oxygen, and bed rest
C) Oxygen and beta-adrenergic blockers
D) Bed rest, albuterol nebulizer treatments, and oxygen
C) Morphine sulphate, oxygen, and bed rest
RATIONALE: The patient with suspected MI should immediately receive supplemental oxygen, aspirin, nitroglycerin, and morphine. Morphine sulphate reduces preload and decreases workload of the heart, along with increased oxygen from oxygen therapy and bed rest. With decreased cardiac demand, this provides the best chance of decreasing cardiac damage. NSAIDs and beta-blockers are not normally indicated. Albuterol, which is a medication used to manage asthma and respiratory conditions, will increase the heart rate.
Age-related changes associated with the cardiac system include:
a. endocardial fibrosis.
b. myocardial thinning.
c. increase in the number of SA node cells.
d. decreased size of the left atrium.
a. endocardial fibrosis.
RATIONALE: Age-related changes associated with the cardiac system include: endocardial fibrosis, increased size of the left atrium, a decreasing number of SA node cells, and myocardial thickening.
A) Decreased ejection fraction
B) Decreased heart rate
C) Ventricular hypertrophy
D) Mitral valve regurgitation
A) Decreased ejection fraction
RATIONALE: DCM is distinguished by significant dilation of the ventricles without simultaneous hypertrophy. The ventricles have elevated systolic and diastolic volumes, but a decreased ejection fraction. Bradycardia and mitral valve regurgitation do not typically occur in patients with DCM.
A cardiac surgery patient's new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurse's most appropriate action?
A) Prepare to assist with pericardiocentesis.
B) Reposition the patient into a prone position.
C) Administer a dose of metoprolol.
D) Administer a bolus of normal saline.
A) Prepare to assist with pericardiocentesis.
RATIONALE: Cardiac tamponade requires immediate pericardiocentesis. Beta-blockers and fluid boluses will not relieve the pressure on the heart and prone positioning would likely exacerbate symptoms.
A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload?
a) Atenolol
b) IV nitroglycerin
c) Amlodipine
d) IV morphine
b) IV morphine
RATIONALE: IV morphine is the analgesic of choice for the treatment of an acute MI. It is given to reduce pain and treat anxiety. It also reduces preload and afterload, which decreases the workload of the heart. IV nitroglycerin is given to alleviate chest pain. Administration of atenolol and amlodipine are not indicated in this situation.
A client diagnosed with a myocardial infarction (MI) is being moved to the rehabilitation unit for further therapy. Which statement reflects a long-term goal of rehabilitation for the client with an MI?
a) Improvement in quality of life
b) Ability to return to work and a pre-illness functional capacity
c) Limitation of the effects and progression of atherosclerosis
d) Prevention of another cardiac event
a) Improvement in quality of life
RATIONALE: Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life. Immediate objectives of rehabilitation of a client with an MI patient are to limit the effects and progression of atherosclerosis, to return the client to work and a pre-illness lifestyle, and to prevent another cardiac event.
A client diagnosed with a myocardial infarction (MI) is being moved to the rehabilitation unit for further therapy. Which statement reflects a long-term goal of rehabilitation for the client with an MI?
a) Prevention of another cardiac event
b) Limitation of the effects and progression of atherosclerosis
c) Improvement in quality of life
d) Ability to return to work and a pre-illness functional capacity
c) Improvement in quality of life
A client has had a myocardial infraction and has been diagnosed as having damage to the layer of the heart responsible for the pumping action. this client experienced damage to which area of the heart?
a. endocardium
b. pericardium
c. myocardium
d. visceral pericardium
c. myocardium
RATIONALE: The middle layer of the heart, or myocardium, is made up of muscle fibers and is responsible for the pumping action.
The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks?
a) Myoglobin
b) Troponin
c) CK-MB
d) Total creatine kinase
b) Troponin
RATIONALE: Troponin remains elevated for a long period, often as long as 2 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin peaks within 12 hours after the onset of symptoms. Total creatine kinase (CK) returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.
A client is admitted to a cardiac unit with the diagnosis of syncope. orthostatic blood pressures are ordered every 8 hours. which blood pressure readings would best indicate that the nurse should notify the health care provider of a positive finding?
a. supine 146/70, sitting 132/68, standing 130/
b. supine 110/62, sitting 108/58, standing 106/
c. supine 128/72, sitting 118/70, standing 110/
d. supine 138/76, sitting 132/66, standing 122/
d. supine 138/76, sitting 132/66, standing 122/
RATIONALE: Postural orthostatic hypotension is a significant drop in blood pressure (systolic: 20mm Hg Diastolic: 10 mm Hg) with in 3 minutes of moving from lying or sitting to a standing position to indicate a positive result.
A client is brought into the emergency department (ED) by a family member, who tells the nurse that the client grabbed their chest and reported substernal chest pain. the care team recognizes that need to monitor the clients cardiac function closely while interventions are performed. which form of monitoring should the nurse anticipate?
a. left-side heart catheterization
b. cardiac telemetry
c. transesophageal echocardiography
d. hardwire continuous electrocardiogram
d. hardwire continuous electrocardiogram (ECG) monitoring.
RATIONALE: Two types of continuous ECG monitoring techniques are used in health care setting: Hardwire cardiac monitoring(emergent) and cardiac catheterization (non emergent).
A client reports chest pain and palpitations during and after jogging in the mornings. The client's family history reveals a history of coronary artery disease (CAD). What should the nurse recommend to minimize cardiac risk?
a) Smoking cessation
b) Mild meals
c) Liquid diet
D) Smoking cessation
A) Recognizing and promptly treating streptococcal infections
RATIONALE: Group A streptococcus can cause rheumatic heart fever, resulting in rheumatic endocarditis. Being aware of signs and symptoms of streptococcal infections, identifying them quickly, and treating them promptly, are the best preventative techniques for rheumatic endocarditis. Smoking cessation, immunizations, and calcium channel blockers will not prevent rheumatic heart disease.
The critical care nurse is caring for a client with a central venous pressure CVP monitoring system. the nurse notes that the client's CVP is increasing. this may indicate:
a. psychosocial stress
b. hypervolemia
c. dislodgment of the catheter
d. hypomagnesemia
b. hypervolemia
RATIONALE: CVP is a useful hemodynamic parameter to observe when managing an unstable client's fluid volume status. an increasing pressure may be caused by hypervolemia or by a condition, such as heart failure, that results in decreased myocardial contractility.
The critical care nurse is caring for a client with a pulmonary artery pressure monitoring system. in addition to assessing left ventricular function, what is an additional function of a pulmonary artery pressure monitoring system?
a. to assess the client's response to fluid and drug administration
b. to obtain specimens for arterial blood gas measurements
c. to dislodge pulmonary emboli
d. to diagnose the etiology of chronic obstructive pulmonary disease
a. to assess the client's response to fluid and drug administration.
RATIONALE: pulmonary artery pressure monitoring is an important tool used in critical care for assessing left ventricular function (cardiac output), diagnosing the etiology of shock, and evaluating the client's response to medical interventions, such as fluid administration and vasoactive medication.
The critical care nurse is caring for a patient who is receiving cyclosporine postoperative heart transplant. The patient asks the nurse to remind him what this medication is for. How should the nurse best respond?
A) Azathioprine decreases the risk of thrombus formation.
B) Azathioprine ensures adequate cardiac output.
C) Azathioprine increases the number of white blood cells.
D) Azathioprine minimizes rejection of the transplant.
D) Azathioprine minimizes rejection of the transplant.
RATIONALE: After heart transplant, patients are constantly balancing the risk of rejection with the risk of infection. Most commonly, patients receive cyclosporine or tacrolimus (FK506, Prograf), azathioprine (Imuran), or mycophenolate mofetil (CellCept), and corticosteroids (prednisone) to minimize rejection. Cyclosporine does not prevent thrombus formation, enhance cardiac output, or increase white cell counts.
During a shift assessment, the nurse is identifying the client's point of maximum impulse (PMI). Where will the nurse best palpate the PMI?
a. Left midclavicular line of the chest at the level of the nipple
b. Left midclavicular line of the chest at the fifth intercostal space
c. Midline between the xiphoid process and the left nipple
d. Two to three centimeters to the left of the sternum
b. left midclavicular line of the chest at the fifth intercostal space
RATIONALE: The left ventricle is responsible for the apical beat or the PMI, which is normally palpated in the left midclavicular line of the chest wall at fifth intercostal space.
A) Shortness of breath
B) Chest pain
C)Anxiety
D) Numbness
E) Weakness
D) Numbness
E) Weakness
RATIONALE: Although these symptoms are not wholly absent in men, many women have been found to have atypical symptoms of MI, including indigestion, nausea, palpitations, and numbness. Shortness of breath, chest pain, and anxiety are common symptoms of MI among patients of all ages and genders.
The ED nurse is caring for a patient with a suspected MI. What drug should the nurse anticipate administering to this patient?
A) Oxycodone
B) Warfarin
C) Morphine
D) Acetaminophen
C) Morphine
RATIONALE: The patient with suspected MI is given aspirin, nitroglycerin, morphine, an IV beta- blocker, and other medications, as indicated, while the diagnosis is being confirmed. Tylenol, warfarin, and oxycodone are not typically used.
Family members bring a patient to the ED with pale cool skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best interpret these initial data?
A) The symptoms indicate angina and should be treated as such.
B) The symptoms indicate a pulmonary etiology rather than a cardiac etiology.
C) The symptoms indicate an acute coronary episode and should be treated as such.
D) Treatment should be determined pending the results of an exercise stress test.
C) The symptoms indicate an acute coronary episode and should be treated as such.
Rationale:: Angina and MI have similar symptoms and are considered the same process, but are on different points along a continuum. That the patient's symptoms are unrelieved by rest suggests an acute coronary episode rather than angina. Pale cool skin and sudden onset are inconsistent with a pulmonary etiology. Treatment should be initiated immediately regardless of diagnosis.
Following a percutaneous coronary intervention (PCI), a client is returned to the nursing unit with large peripheral vascular access sheaths in place. The nurse understands that which method to induce hemostasis after sheath is contraindicated?
a) Application of a sandbag to the area
b) Application of a vascular closure device
c) Application of a mechanical compression device
d) Direct manual pressure
a) Application of a sandbag to the area
RATIONALE: Applying a sandbag to the sheath insertion site is ineffective in reducing the incidence of bleeding and is not an acceptable standard of care. Application of a vascular closure device (Angio-Seal, VasoSeal), direct manual pressure to the sheath introduction site, and application of a mechanical compression device (a C-shaped clamp) are all appropriate methods used to induce hemostasis after removal of a peripheral sheath.
The health care provider has ordered a high sensitivity C-reactive protein (hs-CRP) drawn on a client. the results of this test will allow the nurse to evaluate the role of what process that is implicated in the development of atherosclerosis?
a. immunosuppression
b. inflammation
c. infection
d. hemostasis
b. inflammation
RATIONALE: High sensitivity CRP is a protein produced by the liver in response to systemic inflammation.
In preparation for cardiac surgery, a patient was taught about measures to prevent venous thromboembolism. What statement indicates that the patient clearly understood this education?
A) "I'll try to stay in bed for the first few days to allow myself to heal."
B) "I'll make sure that I don't cross my legs when I'm resting in bed."
C) "I'll keep pillows under my knees to help my blood circulate better."
D) "I'll put on those compression stockings if I get pain in my calves."
B) "I'll make sure that I don't cross my legs when I'm resting in bed."
RATIONALE: To prevent venous thromboembolism, patients should avoid crossing the legs. Activity is generally begun as soon as possible and pillows should not be placed under the popliteal space. Compression stockings are often used to prevent venous thromboembolism, but they would not be applied when symptoms emerge.
The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. The nurse recognizes that this value is?
a) within the optimal range.
b) above the optimal range.
c) below the optimal range.
d) extremely high.
b) above the optimal range.
RATIONALE: If the fasting LDL level ranges from 100 mg/dL to 130 mg/dL, it is considered above the optimal range. The ideal is to decrease the LDL level below 100 mg/dL (< 70 mg/dL for very high-risk patients).
A lipid profile has been ordered for a client who has been experiencing cardiac symptoms. when should the lipid profile be drawn in order to maximize the accuracy of results?
a. as a close to end of the day as possible
b. after a meal high in fat
c. after a 12 hour fast
d. thirty minutes after a normal meal
c. after a 12 fast
RATIONALE: Although cholesterol levels remain relatively constant over 24 hours, the blood specimen for a lipid profile should be obtained after a 12 hour fast.
A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)?
a) Chest discomfort not relieved by rest or nitroglycerin
b) Cool, clammy skin and a diaphoretic, pale appearance
c) Intermittent nausea and emesis for 3 days
d) Anxiousness, restlessness, and lightheadedness
a) Chest discomfort not relieved by rest or nitroglycerin
a. left midclavicular line, fifth intercostal space
b. 3 cm to the right of the sternum
c. 2.5 cm to the left of the xiphoid process
d. 5 cm to the left of the lower end of the sternum
a. left midclavicular line, fifth intercostal space.
RATIONALE: The left ventricle is responsible for the apical impulse or the point of maximum impulse, which is normally palpable in the left midclavicular line of the chest wall at the fifth intercostal space. The right ventricle lies anteriorly, just beneath the sternum. Use of inches to identify the location of the PMI is inappropriate based on variations in human anatomy. Auscultation below and to the left of the xiphoid process will detect gastrointestinal sounds, but not the PMI.
The nurse cares for a client in the emergency department who has a B-type natriuretic peptide (BNP) level of 115 pg/mL. The nurse recognizes that this finding is most indicative of which condition?
a. ventricular hypertrophy
b. heart failure
c. pulmonary edema
d. myocardial infarction
b. heart failure
RATIONALE: A BNP level greater than 100 pg/mL is suggestive of heart failure. Because this serum laboratory test can be quickly obtained, BNP levels are useful for prompt diagnosis of heart failure in settings such as the emergency department. Elevations in BNP can occur from a number of other conditions such as pulmonary embolus, myocardial infarction (MI), and ventricular hypertrophy. Therefore, the healthcare provider correlates BNP levels with abnormal physical assessment findings and other diagnostic tests before making a definitive diagnosis of heart failure.
The nurse cares for a client in the ICU diagnosed with coronary artery disease (CAD). Which assessment data indicates the client is experiencing a decrease in cardiac output?
a. reduced pulse pressure and heart murmur
b. BP 108/60 mm Hg, ascites, and crackles
c. disorientation, 20 mL of urine over the last 2 hours
d. elevated jugular venous distention and postural changes in BP
c. disorientation, 20 mL of urine over the last 2 hours
RATIONALE: Assessment findings associated with reduced cardiac output include reduced pulse pressure, hypotension, tachycardia, reduced urine output, lethargy, or disorientation.
The nurse cares for a client in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the client's CVP as 8 mm Hg and recognizes that this finding indicates the client is experiencing which condition?
a. hypervolemia
b. overdiuresis
c. excessive blood loss
d. left-sided heart failure
a. hypervolemia
RATIONALE: The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (<2 mm Hg) indicates reduced right- ventricular preload, which is most often from hypovolemia.
The nurse cares for a client prescribed warfarin orally. The nurse reviews the client's prothrombin time (PT) level to evaluate the effectiveness of the medication. Which laboratory values should the nurse also evaluate?
a. Sodium
b. partial thromboplastic time (PTT)
