Medical-Surgical Nursing: Cardiovascular Medical-Surgical Nursing Practice Questions
Test yourself on Cardiovascular Medical-Surgical Nursing with 13 original NCLEX-RN practice questions. Pick an answer to see instant feedback and a full explanation.
Free original practice questions for study purposes. Open Exam Prep is an independent study resource and is not affiliated with, endorsed by, or sponsored by the makers of NCLEX-RN.
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1. A client with acute decompensated heart failure is admitted with dyspnea, crackles, and an oxygen saturation of 88% on room air. Which intervention should the nurse implement FIRST?
Explanation. Using the airway/breathing priority, placing the client in high-Fowler's position immediately reduces venous return and improves lung expansion and oxygenation. Diagnostic tests like ECG and BNP are important but do not take precedence over an action that directly improves the client's breathing.
2. A client receiving IV furosemide for heart failure has a potassium level of 3.0 mEq/L. Which assessment finding is the nurse's GREATEST concern?
Explanation. Hypokalemia increases myocardial irritability and can cause life-threatening dysrhythmias. An irregular pulse with premature ventricular contractions signals cardiac instability and is the greatest concern. Cramping, decreased peristalsis, and thirst are less acutely dangerous.
3. A nurse is teaching a client newly prescribed digoxin. Which statement indicates the client understands the teaching?
Explanation. Clients should check the apical/radial pulse for a full minute and withhold digoxin if it is below 60 bpm, reporting it to the provider, because bradycardia signals toxicity. Antacids reduce absorption, the drug should not be abruptly stopped, and doubling doses risks toxicity.
4. A client is admitted with chest pain. Which lab value is the MOST specific indicator of myocardial infarction?
Explanation. Troponin I (and T) is the most cardiac-specific biomarker and remains elevated for days. Myoglobin rises early but is not specific to cardiac muscle, CRP indicates general inflammation, and total CK is not cardiac-specific (CK-MB is more specific but still less so than troponin).
5. A client with a new diagnosis of hypertension is prescribed lisinopril. Which finding should the nurse report to the provider immediately?
Explanation. Swelling of the lips and tongue indicates angioedema, a potentially life-threatening ACE-inhibitor reaction that can compromise the airway and requires immediate discontinuation. A dry cough is a common but non-emergent side effect, orthostatic dizziness is expected initially, and 138/86 is a reasonable response.
6. A nurse is monitoring a client on a heparin infusion. The aPTT result is reported as more than twice the control value and the client has bleeding gums. Which medication should the nurse anticipate administering?
Explanation. Protamine sulfate is the specific antidote for heparin. Vitamin K reverses warfarin, not heparin. FFP is used for multiple clotting factor deficiencies, and aminocaproic acid is used for fibrinolytic-related bleeding, not as the standard heparin reversal agent.
7. A client recovering from a femoral arterial cardiac catheterization 1 hour ago should be assessed for which priority complication?
Explanation. After femoral catheterization, the priority is monitoring the access site for bleeding/hematoma and checking distal pulses, color, and sensation, because arterial puncture carries a hemorrhage risk. The other findings are less urgent and not immediately life-threatening.
8. A client with chronic stable angina takes sublingual nitroglycerin. Which instruction is correct regarding its use?
Explanation. Current teaching: take one tablet, and if chest pain is unrelieved after 5 minutes, call 911, then may take up to 3 tablets total at 5-minute intervals. The tablet dissolves under the tongue (not swallowed), and it is used for acute episodes, not daily prophylaxis in this manner.
9. A nurse identifies a regular rhythm with absent P waves, a wide QRS, and a rate of 160 on the monitor; the client is awake with a blood pressure of 96/60. Which rhythm is most likely and what is the priority action?
Explanation. Wide QRS, absent P waves, and a regular fast rate describe ventricular tachycardia. In a stable client with a pulse, antidysrhythmics or synchronized cardioversion are used per ACLS. Atrial fibrillation is irregular, asystole has no rhythm, and bradycardia is slow.
10. A client with peripheral arterial disease (PAD) reports leg pain. Which teaching should the nurse provide?
Explanation. In arterial disease, dependent positioning promotes arterial blood flow to the legs, so keeping legs dependent (and not crossed) is correct. Elevation worsens arterial inflow, direct heat risks burns due to impaired sensation, and tight compression can further reduce arterial perfusion.
11. A client is being discharged on warfarin. Which dietary instruction is appropriate?
Explanation. Warfarin clients should maintain consistent vitamin K intake so the INR remains stable, rather than suddenly increasing or eliminating it, both of which alter anticoagulation. Citrus restriction is not a warfarin requirement (though grapefruit can affect some drugs).
12. A client presents with crushing substernal chest pain radiating to the left arm, diaphoresis, and ST-segment elevation on ECG. Which action is the priority?
Explanation. For suspected STEMI, chewable aspirin is given early to inhibit platelet aggregation and limit clot extension, along with rapid activation of reperfusion (PCI). A chest x-ray and stress test are not priority emergent interventions, and delaying assessment is unsafe.
13. A nurse notes that a client's central venous pressure (CVP) is elevated and the client has jugular vein distention and peripheral edema. These findings are most consistent with which condition?
Explanation. Elevated CVP, JVD, and peripheral edema indicate fluid backup into the venous system, characteristic of right-sided heart failure. Hypovolemia and dehydration would lower CVP, and early septic vasodilation typically lowers filling pressures.
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FAQ
How should I approach cardiovascular NCLEX questions about prioritization?
Use the ABCs (airway, breathing, circulation) and Maslow's hierarchy. For cardiac clients, an action that directly improves oxygenation or perfusion usually outranks diagnostic tests. Identify whether the question asks for the FIRST action, the priority assessment, or what to report, and answer accordingly.
What key drug-safety facts repeat on cardiac NCLEX items?
Memorize antidotes (protamine for heparin, vitamin K for warfarin), apical pulse <60 to hold digoxin and beta blockers, ACE-inhibitor angioedema as an emergency, hypokalemia risk with loop diuretics, and consistent vitamin K intake for warfarin. These appear repeatedly.
How do I distinguish arterial from venous peripheral disease teaching?
For arterial disease (PAD), keep legs dependent to promote blood flow and avoid heat/compression that limit perfusion; pain worsens with elevation. For venous insufficiency, elevate the legs and use compression stockings to promote venous return. Matching positioning to the underlying problem is a common test point.