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NCLEX cardiac practice questions

20 free NCLEX-style cardiovascular questions: myocardial infarction, heart failure, digoxin and beta-blocker hold parameters, DVT and pulmonary embolism, with the answer and rationale.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

A client with acute decompensated heart failure and chronic kidney disease (creatinine 2.8 mg/dL) who is also receiving IV gentamicin has a prescription for furosemide 160 mg IV now. The pharmacy sends 160 mg in 50 mL. How should the nurse give the dose?

  1. As an IV push over 2 minutes, the same as for a usual dose
  2. As two 80-mg pushes given 15 minutes apart
  3. On an infusion pump at a rate no faster than 4 mg/min
  4. Infused from the 50-mL bag over 5 minutes using a pump
Show the answer and rationale

Answer: C

The furosemide label says high-dose IV therapy is given as a controlled infusion no faster than 4 mg/min, so 160 mg รท 4 mg/min = at least 40 minutes, and this client has three ototoxicity risks named in the label: rapid injection, severe kidney impairment and an aminoglycoside. A push over 1 to 2 minutes is the runner-up because it is correct for a usual dose such as 40 mg, but 160 mg over 2 minutes is 80 mg/min. Two 80-mg pushes are just as fast, and 50 mL over 5 minutes still delivers 32 mg/min.

๐Ÿ“š Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops

Question 2 of 20

A 72-year-old client develops atrial fibrillation with a ventricular rate of 168 beats/min. The blood pressure has fallen to 78/46 mm Hg, the client reports chest pressure, and the skin is cool and clammy. The client has not been taking an anticoagulant. Which action should the nurse take first?

  1. Start a heparin infusion before any cardioversion
  2. Prepare for synchronized cardioversion
  3. Coach the client to bear down as if having a bowel movement
  4. Give IV diltiazem to slow the ventricular rate
Show the answer and rationale

Answer: B

A tachycardia that causes hypotension, chest pain, and signs of shock is unstable, and the treatment is immediate synchronized cardioversion, with sedation when feasible; the shock is timed to the R wave so it does not fall on the vulnerable T wave. IV diltiazem is the runner-up because it is a standard rate-control drug for atrial fibrillation, but it lowers the pressure further and is for stable clients. Anticoagulation matters for stroke prevention but must not delay cardioversion in an unstable client, and bearing down is a vagal maneuver for a stable, regular supraventricular tachycardia.

๐Ÿ“š Learn it: MI and Heart Failure: Minutes and Pounds

Question 3 of 20

A 52-year-old client with an acute proximal deep vein thrombosis of the left leg received the first dose of therapeutic enoxaparin 4 hours ago. The calf is swollen and aches, with pain rated 3 on a 0-to-10 scale. The client asks, 'Do I have to stay in bed so the clot doesn't travel to my lungs?' Which response by the nurse is best?

  1. 'No, but massage the calf before you walk to loosen the stiff muscles.'
  2. 'Yes. Stay in bed until a repeat ultrasound shows that the clot has completely dissolved.'
  3. 'Yes. Bed rest for the first 48 hours keeps the clot from breaking loose.'
  4. 'No. Walking as you can tolerate is encouraged now that the anticoagulant has started.'
Show the answer and rationale

Answer: D

Once anticoagulation has started, early walking does not raise the rate of new pulmonary emboli or clot extension compared with bed rest, and it can ease leg pain sooner, so guidelines suggest early ambulation as tolerated, with the leg elevated when sitting. Bed rest for the first days is the runner-up because it was standard advice for decades, but it adds venous stasis without preventing emboli. Massaging the calf could dislodge the clot, and waiting for the clot to dissolve would keep the client in bed for weeks.

๐Ÿ“š Learn it: DVT Prevention and the Pulmonary Embolism You Must Not Miss

Question 4 of 20

A 68-year-old client with benign prostatic hyperplasia has a new prescription for terazosin 1 mg daily. Which statement by the client indicates understanding of the teaching?

  1. 'I'll take two tablets the next night if I miss one dose to catch up.'
  2. 'I'll take my first dose in the morning and get up slowly if I feel dizzy.'
  3. 'I'll take the first dose at bedtime and get up slowly at night.'
  4. 'I'll take it at bedtime nightly, then stop it once my urine stream improves.'
Show the answer and rationale

Answer: C

Terazosin can cause a sudden fall in blood pressure and fainting after the first dose, so the 1 mg first dose is taken at bedtime and the client rises slowly in stages at night. The runner-up, taking the first dose in the morning with slow position changes, sounds cautious but leaves the client upright through the drug's peak effect. The drug is taken nightly on an ongoing basis, not stopped once the urine stream improves, because symptoms return, and a missed dose is never made up by taking two tablets, which would deepen the blood pressure drop.

๐Ÿ“š Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops

Question 5 of 20

A client with an anterior ST-elevation myocardial infarction arrives at a rural hospital 2 hours after the pain began. The nearest center that performs percutaneous coronary intervention (PCI) is more than 3 hours away, so the provider plans fibrinolytic therapy. Which finding should the nurse report to the provider before the drug is given?

  1. Chewed aspirin 325 mg given by the paramedics
  2. A menstrual period that started yesterday
  3. A blood pressure of 164/94 mm Hg
  4. An ischemic stroke 10 weeks ago, with full recovery
Show the answer and rationale

Answer: D

An ischemic stroke within the past 3 months is an absolute contraindication to fibrinolytic therapy, even after a full recovery, because the injured brain can bleed; the provider must know before the drug is given and may arrange transfer for PCI instead. The blood pressure is the runner-up, but only a pressure above 180/110 mm Hg weighs against the drug, so 164/94 mm Hg is monitored rather than a barrier. Menstrual bleeding is specifically excluded from the active-bleeding contraindication, and chewed aspirin is standard early treatment for an acute coronary syndrome.

๐Ÿ“š Learn it: MI and Heart Failure: Minutes and Pounds

Question 6 of 20 ยท Select all that apply

A client who had a deep vein thrombosis 2 years ago and no longer takes an anticoagulant is planning a 10-hour flight. Which instructions should the nurse include? Select all that apply.

  1. While seated, raise and lower your heels and toes and tighten your calf muscles often.
  2. Take an aspirin before the flight to keep a clot from forming.
  3. Take a sleep aid so you can rest through the whole flight without getting up.
  4. Choose an aisle seat so it is easier to get up and walk every 2 to 3 hours.
  5. Ask your provider before the trip whether you should wear compression stockings or take medicine.
  6. Limit fluids during the flight so you will not need to use the restroom.
Show the answer and rationale

Answer: A, D, E

Hours of sitting slow venous return from the legs, and a past DVT adds risk, so the client walks every 2 to 3 hours, which an aisle seat makes easier, does heel, toe and calf exercises while seated, and asks the provider before the trip about compression stockings or medicine, which are considered for travelers with extra risk factors. CDC does not recommend aspirin to prevent travel-related clots, a sleep aid keeps the client still for hours, and limiting fluids leads to dehydration, which adds to the clot risk.

๐Ÿ“š Learn it: DVT Prevention and the Pulmonary Embolism You Must Not Miss

Question 7 of 20

A nurse on a surgical unit receives handoff on four clients. Which client should the nurse see first?

  1. A client receiving a heparin infusion for a DVT whose aPTT is 94 seconds (protocol goal 60 to 80) with no signs of bleeding
  2. A client 1 day after a cesarean birth with a BMI of 41 who wants to skip the evening enoxaparin injection
  3. A 78-year-old client 3 days after a hip arthroplasty who is newly restless, with a heart rate of 106 beats/min and an SpO2 of 91% on room air (97% this morning)
  4. A client 2 days after a hysterectomy whose right calf is 3 cm larger than the left, warm and tender, with stable vital signs
Show the answer and rationale

Answer: C

New restlessness, tachycardia and a falling oxygen saturation in an older client after hip surgery can be the first signs of a pulmonary embolism, which can deteriorate quickly, so this breathing and circulation problem comes first: the nurse raises the head of the bed, applies oxygen and calls the rapid response team. The client with a swollen, warm calf is the runner-up because a DVT needs prompt reporting and anticoagulation, but the vital signs are stable. The high aPTT without bleeding needs the protocol's rate change, and the client refusing enoxaparin needs teaching, but neither is unstable.

๐Ÿ“š Learn it: DVT Prevention and the Pulmonary Embolism You Must Not Miss

Question 8 of 20

A nurse on a cardiac step-down unit receives reports on four clients. Which client should the nurse see first?

  1. A client who started amlodipine 2 weeks ago and has 2+ edema of both ankles
  2. A client on an IV nitroglycerin infusion who reports a throbbing headache rated 6 out of 10
  3. A client taking furosemide who has calf cramps and a potassium of 3.3 mEq/L this morning
  4. A client taking lisinopril for 6 years whose lower lip began swelling an hour ago
Show the answer and rationale

Answer: D

Lip swelling in a client taking an ACE inhibitor is angioedema until proven otherwise, and it can appear months or years into therapy, not only after the first doses. The bradykinin-driven swelling can spread to the tongue and larynx, so this client's airway is assessed first. A potassium of 3.3 mEq/L with cramps is the runner-up: it needs replacement and monitoring, but it is not an airway threat. Ankle edema is a common, non-urgent effect of amlodipine, and headache is an expected effect of nitroglycerin's vasodilation that is treated rather than an emergency.

๐Ÿ“š Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops

Question 9 of 20

A nurse is reinforcing discharge teaching with a client who has heart failure. Which statement by the client indicates a need for further teaching?

  1. 'I'll take a short walk most days, even though my heart is weak.'
  2. 'I'll ask my provider before I use a salt substitute in place of salt.'
  3. 'I'll wait a minute on the edge of the bed before I stand up.'
  4. 'I'll wait until my next visit to mention needing extra pillows at night.'
Show the answer and rationale

Answer: D

Needing more pillows to breathe at night (orthopnea) or waking up breathless signals worsening left-sided failure with fluid in the lungs, which should be reported promptly rather than saved for a routine visit. Waiting a minute on the edge of the bed before standing also involves a delay, but it is correct teaching, because diuretics and blood pressure drugs can cause dizziness on standing. Walking most days may sound hard on a weak heart, but regular physical activity is recommended in heart failure to build strength and endurance, and checking before using a salt substitute is correct because most contain potassium, which can build up to dangerous levels with drugs such as ACE inhibitors or spironolactone.

๐Ÿ“š Learn it: MI and Heart Failure: Minutes and Pounds

Question 10 of 20

A nurse is reviewing the records of four clients on a surgical unit. Which client is at greatest risk for a venous thromboembolism?

  1. A 76-year-old on day 1 after hip fracture repair with a previous DVT
  2. A 45-year-old with varicose veins after outpatient knee arthroscopy
  3. A 34-year-old taking estrogen birth control pills, after a laparoscopic appendectomy
  4. A 58-year-old with obesity on day 2 after an open bowel resection
Show the answer and rationale

Answer: A

Hip fracture surgery brings together all three parts of Virchow's triad: venous stasis from immobility, vessel injury at the operative site, and the hypercoagulable state that follows trauma and surgery. Older age and a previous DVT raise the risk further, so this client needs the prescribed anticoagulant, mechanical prophylaxis, and early mobility. Obesity and an open bowel resection also carry real risk, but hip fracture surgery in an older adult with a past clot ranks higher. Estrogen-containing pills add some risk for a young adult after a brief laparoscopic procedure, and varicose veins with an outpatient arthroscopy add only modest risk.

๐Ÿ“š Learn it: DVT Prevention and the Pulmonary Embolism You Must Not Miss

Practice 10 more Cardiac questions free โ†’

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Question 11 of 20

A client who has a nasogastric feeding tube because of dysphagia after head and neck cancer surgery now receives all medications through the tube. The client's prescriptions include nifedipine extended-release 60 mg daily for hypertension, and the blood pressure is 148/88 mm Hg. Which action should the nurse take?

  1. Ask the pharmacist or provider for a tube-compatible form
  2. Hold the dose and document that the client cannot take the tablet
  3. Open an immediate-release nifedipine capsule and squeeze the liquid into the tube
  4. Crush the tablet, dissolve it in 15 mL of water and flush it through the tube
Show the answer and rationale

Answer: A

Extended-release nifedipine tablets must be swallowed whole and not bitten or divided, because breaking the controlled-release system can release the whole day's dose at once and drop the blood pressure sharply, so the nurse asks the provider or pharmacist for a tube-compatible alternative. Crushing and flushing is the runner-up because it is the usual way to give tablets by tube, but it is unsafe for this product. Holding the dose leaves the hypertension untreated without telling anyone, and substituting an immediate-release capsule is a prescription change the nurse cannot make, and a dangerous one: immediate-release nifedipine is not used for hypertension because its liquid can drop the blood pressure suddenly and severely.

๐Ÿ“š Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops

Question 12 of 20

A client reports palpitations, and the monitor shows a regular narrow-complex tachycardia at 188 beats/min. The client is alert, with a blood pressure of 118/76 mm Hg and no chest pain. Which action should the nurse take first?

  1. Coach the client to bear down as if having a bowel movement
  2. Prepare the client for immediate synchronized cardioversion
  3. Give adenosine 6 mg by rapid IV push with a saline flush
  4. Give metoprolol IV to slow the ventricular rate
Show the answer and rationale

Answer: A

A stable client with supraventricular tachycardia is treated first with a vagal maneuver such as bearing down (the Valsalva maneuver), which slows conduction through the AV node and can end the rhythm. Adenosine 6 mg by rapid IV push followed at once by a saline flush is the correct drug and technique, which makes it tempting, but it is the next step if the vagal maneuver fails; it lasts only seconds, which is why it is pushed rapidly. A beta blocker such as metoprolol comes later if the rhythm persists, and synchronized cardioversion is reserved for unstable clients.

๐Ÿ“š Learn it: MI and Heart Failure: Minutes and Pounds

Question 13 of 20

On day 3 after a total knee arthroplasty, a client suddenly becomes short of breath and anxious. Arterial blood gas results on room air: pH 7.49, PaCO2 30 mm Hg, HCO3 24 mEq/L, PaO2 61 mm Hg. Which interpretation is most accurate?

  1. Partly compensated respiratory alkalosis from postoperative pain
  2. Respiratory alkalosis with hypoxemia, as seen in pulmonary embolism
  3. Respiratory acidosis from opioid-induced hypoventilation
  4. Respiratory alkalosis with hypoxemia from anxiety and hyperventilation
Show the answer and rationale

Answer: B

A high pH with a low PaCO2 and a normal bicarbonate is uncompensated respiratory alkalosis, and the low PaO2 shows the client is hypoxemic despite breathing fast, the pattern of a pulmonary embolism that blocks blood flow to ventilated lung. Anxiety can cause hyperventilation, but fast breathing with healthy lungs keeps the PaO2 normal or raises it rather than dropping it to 61 mm Hg, so the nurse raises the head of the bed, applies oxygen, and calls for help. Partial compensation would require a bicarbonate below the normal range of 22 to 26 mEq/L, and opioid hypoventilation would raise the PaCO2.

๐Ÿ“š Learn it: DVT Prevention and the Pulmonary Embolism You Must Not Miss

Question 14 of 20

A nurse is teaching a client with stable angina who has a new prescription for a transdermal nitroglycerin patch. Which statement by the client indicates understanding?

  1. 'I'll take the patch off at bedtime and put on a new one in the morning.'
  2. 'I'll use the patch in place of my tablets when I have chest pain.'
  3. 'I'll put each new patch on the same spot so I don't forget where it goes.'
  4. 'I'll leave the patch on around the clock so my heart stays protected.'
Show the answer and rationale

Answer: A

Continuous nitrate exposure causes tolerance within about a day, so the patch is worn for about 12 to 14 hours and removed for a nitrate-free period of 10 to 12 hours, usually overnight. Wearing it around the clock sounds more protective, but it brings on that tolerance. The patch prevents angina and does not replace sublingual nitroglycerin for an attack, and sites are rotated to prevent skin irritation.

๐Ÿ“š Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops

Question 15 of 20

A 68-year-old client with heart failure with reduced ejection fraction, stable for a year, is admitted with a weight gain of 3.2 kg (7 lb), ankle edema, and orthopnea. Which item in the medication history most likely triggered the exacerbation?

  1. Dapagliflozin daily, started 2 months ago
  2. Naproxen twice daily for knee pain, started 10 days ago
  3. Carvedilol twice daily at the same dose for a year
  4. Acetaminophen as needed for headaches
Show the answer and rationale

Answer: B

NSAIDs such as naproxen block the prostaglandins that keep blood flowing into the kidneys, so the body holds on to sodium and water and diuretics work less well; a new NSAID is a common, preventable trigger of a heart failure flare, and the client is taught to use acetaminophen instead. Dapagliflozin is the runner-up because it is also a recent addition, but SGLT2 inhibitors are recommended heart failure therapy and increase sodium and water loss in the urine. Carvedilol at an unchanged dose is core therapy, and acetaminophen does not cause fluid retention.

๐Ÿ“š Learn it: MI and Heart Failure: Minutes and Pounds

Question 16 of 20

Assistive personnel (AP) are applying knee-length antiembolism stockings to a client after surgery. Which action by the AP requires the nurse to intervene?

  1. Rolls the top of each stocking down because it feels tight
  2. Removes the stockings for a short period each day to inspect skin and circulation
  3. Applies the stockings before the client stands, while leg swelling is lowest
  4. Smooths wrinkles out of the fabric over the foot and ankle
Show the answer and rationale

Answer: A

Rolling the top of a stocking down forms a tight band that acts like a tourniquet, slowing venous return and raising the risk of the clot the stocking is meant to prevent; a stocking that feels tight should be remeasured and refitted instead. Removing the stockings for a short period each day to inspect skin and circulation is the runner-up because it interrupts compression, but brief daily removal for skin assessment is expected care. Applying the stockings before the client stands, while leg swelling is lowest, gives the greatest benefit, and smoothing wrinkles out of the fabric prevents pressure points that can injure skin.

๐Ÿ“š Learn it: DVT Prevention and the Pulmonary Embolism You Must Not Miss

Question 17 of 20

A 31-year-old client with chronic hypertension who takes losartan 50 mg daily calls the clinic to say that a home pregnancy test this morning was positive. She is about 6 weeks pregnant, and her first prenatal visit is in 3 weeks. Which response by the nurse is best?

  1. 'Take half of your usual dose until the visit to lower the baby's exposure.'
  2. 'Keep taking the losartan until your visit, since stopping a blood pressure pill on your own is risky.'
  3. 'Keep taking it for now, because these drugs harm the baby only later in pregnancy.'
  4. 'Stop the losartan, and your provider will call you today about a different medicine.'
Show the answer and rationale

Answer: D

Losartan carries a boxed warning that drugs acting on the renin-angiotensin system can injure and kill the developing fetus, and the label says to stop it as soon as pregnancy is detected, so the client stops it and the provider chooses a drug suited to pregnancy today. Continuing until the visit is the runner-up because it sounds cautious, but it ignores the label and carries the fetus toward the second trimester. Fetal kidney injury is documented mainly in the second and third trimesters, which makes waiting tempting, but the drug is still stopped now, and halving the dose is an unprescribed change that still exposes the fetus.

๐Ÿ“š Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops

Question 18 of 20

A client had a permanent pacemaker inserted yesterday through the left subclavian vein. Which finding should the nurse report to the provider?

  1. A paced rhythm at 70/min, with a few seconds of palpitations reported
  2. Mild swelling of the left arm with equal pulses in both arms
  3. Persistent hiccups that started this morning
  4. Mild soreness and a small bruise spreading at the insertion site
Show the answer and rationale

Answer: C

Persistent hiccups after pacemaker insertion can mean a lead has moved or perforated the heart wall and is stimulating the diaphragm or phrenic nerve, so the nurse reports it promptly and anticipates an ECG, a chest x-ray, and a device check. The runner-up is the few seconds of palpitations on an otherwise paced rhythm at 70/min: palpitations raise concern about capture, but a brief episode with a regular paced rhythm is assessed and monitored, while hiccups are the classic lead-displacement clue. Mild soreness with a small bruise at the site and mild arm swelling with equal pulses are expected the day after subclavian insertion.

๐Ÿ“š Learn it: MI and Heart Failure: Minutes and Pounds

Question 19 of 20

A nurse in an urgent care center reviews four clients who have just checked in. Which client should the nurse see first?

  1. A 74-year-old woman with diabetes who has felt unusually tired, nauseated, and short of breath for 2 hours, with cool, damp skin
  2. A 66-year-old with stable angina who had chest pressure while shoveling snow an hour ago that went away after one nitroglycerin tablet
  3. A 45-year-old with sharp chest pain for 2 days that is worse when lying flat and eases when leaning forward
  4. A 28-year-old with chest wall pain that is reproduced by pressing on the sternum, after starting a new weight-lifting program
Show the answer and rationale

Answer: A

Women, older adults, and people with diabetes often have an acute coronary syndrome without classic chest pain, and new fatigue, nausea, and breathlessness with cool, damp skin are active symptoms that need a 12-lead ECG within minutes. The client with exertional pressure relieved by one nitroglycerin is the runner-up, but the episode fits a known stable angina pattern and the client is now pain-free. Sharp pain that eases when leaning forward suggests pericarditis, and pain reproduced by pressing on the chest wall is musculoskeletal; both are seen after the client with ongoing symptoms.

๐Ÿ“š Learn it: MI and Heart Failure: Minutes and Pounds

Question 20 of 20

A nurse is reviewing the telemetry strips of four clients on a cardiac unit. Which client's rhythm requires action first?

  1. PR intervals that lengthen until a QRS complex drops, after an inferior MI
  2. Occasional unifocal premature ventricular contractions at rest
  3. Dropped QRS complexes with a constant PR interval after an anterior MI
  4. A PR interval of 0.24 seconds on each beat in a client on metoprolol
Show the answer and rationale

Answer: C

A constant PR interval with QRS complexes that suddenly drop out is second-degree AV block type II (Mobitz II), which, especially after an anterior MI, can progress without warning to complete heart block, so the nurse assesses the client, notifies the provider, and places transcutaneous pacing pads. PR intervals that lengthen until a beat drops is Mobitz I (Wenckebach), which also drops beats but, after an inferior MI, usually arises in the AV node, is often transient, and is monitored unless the client becomes symptomatic. A stable first-degree AV block, a known effect of beta-blockers such as metoprolol, and occasional unifocal PVCs are also usually monitored rather than treated urgently.

๐Ÿ“š Learn it: MI and Heart Failure: Minutes and Pounds

Practice 10 more Cardiac questions free โ†’

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