What is the priority nursing assessment for a patient with chest
Q001
pain?
Perform a focused cardiovascular assessment: assess pain
quality/radiation using PQRST, obtain 12-lead ECG within 10
ANS
minutes, monitor vital signs, and assess oxygen saturation.
Administer oxygen if SpO2 <94%.
Q002 What are the classic signs of left-sided heart failure?
Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea
ANS (PND), crackles in lung bases, S3 gallop, frothy pink-tinged sputum,
and decreased cardiac output symptoms (fatigue, cool extremities).
Q003 What are signs of right-sided heart failure?
Jugular venous distension (JVD), peripheral pitting edema
ANS (dependent), hepatomegaly, ascites, weight gain, and fatigue. Often
results from left-sided failure or pulmonary hypertension.
Q004 What do you assess BEFORE giving digoxin?
Assess apical pulse for one full minute. Hold digoxin and notify the
ANS provider if pulse <60 bpm. Also assess for signs of toxicity: nausea,
visual changes (yellow-green halos), bradycardia.
Q005 What are the therapeutic serum digoxin levels?
0.5-2.0 ng/mL. Levels >2.0 ng/mL indicate toxicity. Hypokalemia
ANS
potentiates digoxin toxicity even at therapeutic levels.
Page 1 | For study purposes only
, What nursing interventions are priority for a patient with acute
Q006
MI (MONA)?
MONA: Morphine (pain), Oxygen (if SpO2 <94%), Nitroglycerin
(sublingual), Aspirin 325 mg (chew). Obtain IV access, 12-lead ECG,
ANS
continuous cardiac monitoring, prepare for possible PCI or
fibrinolysis.
Q007 What does ST elevation on ECG indicate?
ST elevation indicates myocardial injury/infarction (STEMI).
ANS Requires emergent intervention (PCI within 90 minutes or
fibrinolytics within 30 minutes).
Q008 What are contraindications to nitroglycerin?
Systolic BP <90 mmHg, recent PDE-5 inhibitor use (e.g., sildenafil
ANS within 24-48 hrs), right ventricular infarction, and severe bradycardia
or tachycardia.
What is most important patient teaching for nitroglycerin
Q009
(sublingual)?
Take one tablet at onset of chest pain; may repeat every 5 minutes up
to 3 doses. If pain not relieved after 3 doses (15 min), call 911
ANS
immediately. Store in original dark glass bottle; discard if tingling is
absent.
Q010 What is cardiac tamponade and what are its signs?
Compression of the heart by fluid in the pericardial sac. Classic
Beck's Triad: hypotension, muffled heart sounds, JVD. Pulsus
ANS
paradoxus (>10 mmHg drop in SBP during inspiration) is also a key
sign.
Q011 What is the difference between stable and unstable angina?
Stable angina: predictable, relieved by rest/nitroglycerin, caused by
ANS
fixed coronary artery stenosis. Unstable angina: occurs at rest or
Page 2 | For study purposes only
, minimal exertion, more severe, longer lasting, not fully relieved by
nitroglycerin - a medical emergency.
Q012 What are classic ECG changes in hypokalemia?
Flattened or inverted T waves, prominent U waves (after T wave), ST
ANS depression, and prolonged QU interval. Hypokalemia increases the
risk of dysrhythmias, especially with digoxin.
Q013 What is atrial fibrillation and its major complication?
Atrial fibrillation is an irregularly irregular rhythm with no distinct P
waves and variable ventricular response. Major complication:
ANS
thromboembolic stroke due to blood pooling in the atria forming
clots.
What medication class is used for rate control in atrial
Q014
fibrillation?
Beta-blockers (metoprolol) and calcium channel blockers (diltiazem,
verapamil) slow ventricular rate. Digoxin is used in patients with
ANS
heart failure. Anticoagulation (warfarin or DOACs) is needed to
prevent stroke.
Q015 What are signs of hypovolemic shock and nursing priorities?
Signs: tachycardia, hypotension, decreased urine output (<0.5
mL/kg/hr), cool/clammy skin, decreased LOC. Priority: establish
ANS
large-bore IV access, administer isotonic fluids (NS or LR), position
supine with legs elevated, monitor vital signs continuously.
Q016 What is the first-line treatment for ventricular fibrillation?
Immediate defibrillation (unsynchronized cardioversion). CPR is
ANS performed until the defibrillator is ready. After defibrillation,
epinephrine and amiodarone may be administered per ACLS protocol.
Q017 What is the difference between cardioversion and defibrillation?
Page 3 | For study purposes only
, Cardioversion is synchronized (timed to R wave) - used for
hemodynamically unstable tachyarrhythmias (SVT, A-fib, V-tach
ANS
with pulse). Defibrillation is unsynchronized - used for pulseless V-
fib and pulseless V-tach.
Q018 What is the difference between STEMI and NSTEMI?
STEMI: ST elevation on ECG indicates complete coronary occlusion,
requires emergent PCI within 90 min. NSTEMI: no ST elevation but
ANS elevated troponin indicates partial occlusion; managed with
anticoagulation, antiplatelet therapy, and early invasive strategy
within 24-72 hrs.
Q019 What is cardiac output (CO) and how is it calculated?
CO = Heart Rate x Stroke Volume. Normal CO: 4-8 L/min.
ANS Decreased CO causes hypotension, reduced peripheral perfusion,
oliguria, altered mental status, and cool extremities.
Q020 What is pericarditis and its priority nursing care?
Inflammation of the pericardium. Pain management (NSAIDs -
ibuprofen first-line, plus colchicine), lean-forward positioning
ANS
(relieves pain), monitor for pericardial effusion/tamponade (muffled
heart sounds, JVD, hypotension), serial ECGs, and activity restriction.
Q021 What is an aortic aneurysm and signs of rupture?
Dilation of the aorta >3 cm. Rupture: sudden severe
abdominal/back/flank pain, hypotension, pulsatile abdominal mass.
ANS
Life-threatening emergency - immediately notify surgeon, large-bore
IV access, blood products, and emergency OR.
What are the differences between arterial and venous
Q022
insufficiency ulcers?
Arterial (ischemic): painful, punched out, pale base, distal location
(toes, heels), decreased/absent pulses, cool skin. Venous stasis: mild
ANS
ache, irregular margins, medial malleolus, brawny edema,
hemosiderin staining, normal pulses.
Page 4 | For study purposes only
Q001
pain?
Perform a focused cardiovascular assessment: assess pain
quality/radiation using PQRST, obtain 12-lead ECG within 10
ANS
minutes, monitor vital signs, and assess oxygen saturation.
Administer oxygen if SpO2 <94%.
Q002 What are the classic signs of left-sided heart failure?
Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea
ANS (PND), crackles in lung bases, S3 gallop, frothy pink-tinged sputum,
and decreased cardiac output symptoms (fatigue, cool extremities).
Q003 What are signs of right-sided heart failure?
Jugular venous distension (JVD), peripheral pitting edema
ANS (dependent), hepatomegaly, ascites, weight gain, and fatigue. Often
results from left-sided failure or pulmonary hypertension.
Q004 What do you assess BEFORE giving digoxin?
Assess apical pulse for one full minute. Hold digoxin and notify the
ANS provider if pulse <60 bpm. Also assess for signs of toxicity: nausea,
visual changes (yellow-green halos), bradycardia.
Q005 What are the therapeutic serum digoxin levels?
0.5-2.0 ng/mL. Levels >2.0 ng/mL indicate toxicity. Hypokalemia
ANS
potentiates digoxin toxicity even at therapeutic levels.
Page 1 | For study purposes only
, What nursing interventions are priority for a patient with acute
Q006
MI (MONA)?
MONA: Morphine (pain), Oxygen (if SpO2 <94%), Nitroglycerin
(sublingual), Aspirin 325 mg (chew). Obtain IV access, 12-lead ECG,
ANS
continuous cardiac monitoring, prepare for possible PCI or
fibrinolysis.
Q007 What does ST elevation on ECG indicate?
ST elevation indicates myocardial injury/infarction (STEMI).
ANS Requires emergent intervention (PCI within 90 minutes or
fibrinolytics within 30 minutes).
Q008 What are contraindications to nitroglycerin?
Systolic BP <90 mmHg, recent PDE-5 inhibitor use (e.g., sildenafil
ANS within 24-48 hrs), right ventricular infarction, and severe bradycardia
or tachycardia.
What is most important patient teaching for nitroglycerin
Q009
(sublingual)?
Take one tablet at onset of chest pain; may repeat every 5 minutes up
to 3 doses. If pain not relieved after 3 doses (15 min), call 911
ANS
immediately. Store in original dark glass bottle; discard if tingling is
absent.
Q010 What is cardiac tamponade and what are its signs?
Compression of the heart by fluid in the pericardial sac. Classic
Beck's Triad: hypotension, muffled heart sounds, JVD. Pulsus
ANS
paradoxus (>10 mmHg drop in SBP during inspiration) is also a key
sign.
Q011 What is the difference between stable and unstable angina?
Stable angina: predictable, relieved by rest/nitroglycerin, caused by
ANS
fixed coronary artery stenosis. Unstable angina: occurs at rest or
Page 2 | For study purposes only
, minimal exertion, more severe, longer lasting, not fully relieved by
nitroglycerin - a medical emergency.
Q012 What are classic ECG changes in hypokalemia?
Flattened or inverted T waves, prominent U waves (after T wave), ST
ANS depression, and prolonged QU interval. Hypokalemia increases the
risk of dysrhythmias, especially with digoxin.
Q013 What is atrial fibrillation and its major complication?
Atrial fibrillation is an irregularly irregular rhythm with no distinct P
waves and variable ventricular response. Major complication:
ANS
thromboembolic stroke due to blood pooling in the atria forming
clots.
What medication class is used for rate control in atrial
Q014
fibrillation?
Beta-blockers (metoprolol) and calcium channel blockers (diltiazem,
verapamil) slow ventricular rate. Digoxin is used in patients with
ANS
heart failure. Anticoagulation (warfarin or DOACs) is needed to
prevent stroke.
Q015 What are signs of hypovolemic shock and nursing priorities?
Signs: tachycardia, hypotension, decreased urine output (<0.5
mL/kg/hr), cool/clammy skin, decreased LOC. Priority: establish
ANS
large-bore IV access, administer isotonic fluids (NS or LR), position
supine with legs elevated, monitor vital signs continuously.
Q016 What is the first-line treatment for ventricular fibrillation?
Immediate defibrillation (unsynchronized cardioversion). CPR is
ANS performed until the defibrillator is ready. After defibrillation,
epinephrine and amiodarone may be administered per ACLS protocol.
Q017 What is the difference between cardioversion and defibrillation?
Page 3 | For study purposes only
, Cardioversion is synchronized (timed to R wave) - used for
hemodynamically unstable tachyarrhythmias (SVT, A-fib, V-tach
ANS
with pulse). Defibrillation is unsynchronized - used for pulseless V-
fib and pulseless V-tach.
Q018 What is the difference between STEMI and NSTEMI?
STEMI: ST elevation on ECG indicates complete coronary occlusion,
requires emergent PCI within 90 min. NSTEMI: no ST elevation but
ANS elevated troponin indicates partial occlusion; managed with
anticoagulation, antiplatelet therapy, and early invasive strategy
within 24-72 hrs.
Q019 What is cardiac output (CO) and how is it calculated?
CO = Heart Rate x Stroke Volume. Normal CO: 4-8 L/min.
ANS Decreased CO causes hypotension, reduced peripheral perfusion,
oliguria, altered mental status, and cool extremities.
Q020 What is pericarditis and its priority nursing care?
Inflammation of the pericardium. Pain management (NSAIDs -
ibuprofen first-line, plus colchicine), lean-forward positioning
ANS
(relieves pain), monitor for pericardial effusion/tamponade (muffled
heart sounds, JVD, hypotension), serial ECGs, and activity restriction.
Q021 What is an aortic aneurysm and signs of rupture?
Dilation of the aorta >3 cm. Rupture: sudden severe
abdominal/back/flank pain, hypotension, pulsatile abdominal mass.
ANS
Life-threatening emergency - immediately notify surgeon, large-bore
IV access, blood products, and emergency OR.
What are the differences between arterial and venous
Q022
insufficiency ulcers?
Arterial (ischemic): painful, punched out, pale base, distal location
(toes, heels), decreased/absent pulses, cool skin. Venous stasis: mild
ANS
ache, irregular margins, medial malleolus, brawny edema,
hemosiderin staining, normal pulses.
Page 4 | For study purposes only
