EAQ WITH NGN: CARDIAC EXAM QUESTIONS
AND ANSWERS 2026
Topic: Cardiac Exam – NGN-Style Questions
Case Study 1: Acute Coronary Syndrome
A 62-year-old male presents to the ED with substernal chest pressure radiating to the jaw,
diaphoresis, and nausea for 2 hours. He has a history of hypertension and hyperlipidemia.
Vital signs: HR 110, BP 150/90, RR 22, O2 sat 94% on room air. ECG shows ST-segment
elevation in leads V2–V4.
1. What is the most likely diagnosis?
A) Unstable angina
B) Non-ST elevation MI
C) ST-elevation myocardial infarction (STEMI)
D) Pericarditis
Rationale: ST-segment elevation in contiguous precordial leads (V2–V4) with symptoms of
ischemia indicates STEMI. Unstable angina and NSTEMI do not have ST elevation.
Pericarditis typically shows diffuse ST elevation without reciprocal changes.
2. Which immediate intervention should the nurse anticipate?
A) Administer sublingual nitroglycerin every 5 minutes x3
B) Activate the cardiac catheterization lab for percutaneous coronary intervention
(PCI)
C) Administer thrombolytics immediately
D) Obtain a chest x-ray before any treatment
*Rationale: For STEMI, the goal is reperfusion within 90 minutes via PCI. Thrombolytics are
used if PCI is unavailable within 120 minutes. Nitroglycerin is given but not the priority.
Chest x-ray should not delay PCI activation.*
3. The patient's pain is not relieved after morphine and oxygen. Which medication is
most appropriate to reduce preload and afterload?
A) Metoprolol
B) Nitroglycerin IV
C) Aspirin
D) Clopidogrel
Rationale: IV nitroglycerin dilates coronary arteries, reduces preload, and lowers
afterload, relieving ischemic pain. Metoprolol reduces heart rate but not primarily
preload/afterload. Aspirin and clopidogrel are antiplatelet agents.
,Bow-Tie Question: Heart Failure
A 78-year-old female with a history of heart failure with reduced ejection fraction (HFrEF)
is admitted with worsening dyspnea, orthopnea, and 3+ pitting edema in both legs. She is
on lisinopril, furosemide, and carvedilol.
4. Complete the bow-tie by selecting the priority assessment (center), two potential
causes (left), and two priority interventions (right).
Center (Assessment):
A) Blood glucose
B) Daily weight
C) Serum potassium
D) Pain level
Left – Potential Causes (select two):
o A) Excess dietary sodium
o B) Missed furosemide dose
o C) High carbohydrate intake
o D) Decreased activity level
Right – Priority Interventions (select two):
o A) Administer IV furosemide
o B) Place on fluid restriction (2L/day)
o C) Increase beta-blocker dose
o D) Encourage high-protein diet
Rationale: Daily weight is the most sensitive indicator of fluid status in HF. Causes of
exacerbation include sodium retention (dietary) and medication nonadherence.
Interventions include loop diuretics (furosemide) to remove fluid and fluid restriction to
prevent overload.
Hot Spot Question: ECG Interpretation
Select the area on the ECG strip below that indicates ventricular repolarization.
(Description: Standard ECG with P wave, QRS complex, and T wave labeled)
5. Answer: The T wave
Rationale: The T wave represents ventricular repolarization. The P wave is atrial
depolarization; the QRS complex is ventricular depolarization; the PR interval is AV
conduction time.
Multiple Choice – Cardiac Medications
6. A patient is prescribed digoxin for heart failure. Which finding indicates digoxin
toxicity?
, A) Heart rate 72 and regular
B) Visual disturbances (yellow-green halos)
C) Blood pressure 130/80
D) Urine output 50 mL/hr
Rationale: Classic signs of digoxin toxicity include nausea, vomiting, bradycardia,
arrhythmias, and visual changes (yellow or green halos around lights). A normal HR and
BP and adequate urine output are not toxic signs.
7. Which medication is a direct thrombin inhibitor used in the management of
heparin-induced thrombocytopenia (HIT)?
A) Warfarin
B) Enoxaparin
C) Argatroban
D) Clopidogrel
Rationale: Argatroban is a direct thrombin inhibitor indicated for HIT. Warfarin is a
vitamin K antagonist; enoxaparin is a low-molecular-weight heparin (contraindicated in
HIT); clopidogrel is an antiplatelet agent.
Enhanced Hot Spot (Matrix) – Infective Endocarditis
A 45-year-old IV drug user presents with fever, a new heart murmur, and Janeway lesions.
Blood cultures are positive for Staphylococcus aureus.
Assessment Finding Consistent with Endocarditis (Yes/No)
Splinter hemorrhages Yes
Osler's nodes Yes
Roth spots Yes
Painless plantar nodules No (these are not typical)
8. Which of the above findings are classic for infective endocarditis?
Answer: Splinter hemorrhages, Osler's nodes, Roth spots
Rationale: Splinter hemorrhages (linear hemorrhages under nails), Osler's nodes (painful
fingertip nodules), and Roth spots (retinal hemorrhages with white centers) are all classic
peripheral stigmata of infective endocarditis. Painless plantar nodules are not typical.
, Case Study 2: Valvular Heart Disease
A 68-year-old female reports progressive dyspnea on exertion, syncope during exercise,
and angina. On auscultation, a harsh, late-peaking systolic murmur is heard at the right
second intercostal space with radiation to the carotids.
9. Which valvular disorder is most likely?
A) Mitral regurgitation
B) Aortic stenosis
C) Aortic regurgitation
D) Mitral stenosis
Rationale: Aortic stenosis presents with the classic triad: angina, syncope, and exertional
dyspnea. The murmur is harsh, crescendo-decrescendo, systolic, best heard at the right
2nd intercostal space (aortic area), radiating to the carotids. Mitral regurgitation is
holosystolic at the apex; aortic regurgitation is diastolic; mitral stenosis is diastolic with an
opening snap.
10. The patient's echocardiogram shows an aortic valve area of 0.8 cm². Which
intervention is indicated?
A) Start digoxin
B) Aortic valve replacement
C) Increase beta-blocker dose
D) Pulmonary artery catheterization
Rationale: Severe aortic stenosis is defined as valve area <1.0 cm². Symptomatic severe AS
requires surgical or transcatheter aortic valve replacement (TAVR). Digoxin and beta-
blockers are not definitive. Pulmonary artery catheterization is not therapeutic.
Drag and Drop: Cardiac Rhythms
Match the rhythm description to the correct name:
11. Rhythm: Irregularly irregular, no distinct P waves, narrow QRS, ventricular rate 140.
Answer: Atrial fibrillation
Rationale: Atrial fibrillation is characterized by chaotic atrial activity (no P waves),
irregularly irregular ventricular response, and narrow QRS if conduction is normal.
12. Rhythm: Regular, rate 42, P wave before each QRS, PR interval normal.
Answer: Sinus bradycardia
Rationale: Sinus bradycardia originates from the SA node with a rate <60 bpm,
regular rhythm, and normal P waves and PR interval.
AND ANSWERS 2026
Topic: Cardiac Exam – NGN-Style Questions
Case Study 1: Acute Coronary Syndrome
A 62-year-old male presents to the ED with substernal chest pressure radiating to the jaw,
diaphoresis, and nausea for 2 hours. He has a history of hypertension and hyperlipidemia.
Vital signs: HR 110, BP 150/90, RR 22, O2 sat 94% on room air. ECG shows ST-segment
elevation in leads V2–V4.
1. What is the most likely diagnosis?
A) Unstable angina
B) Non-ST elevation MI
C) ST-elevation myocardial infarction (STEMI)
D) Pericarditis
Rationale: ST-segment elevation in contiguous precordial leads (V2–V4) with symptoms of
ischemia indicates STEMI. Unstable angina and NSTEMI do not have ST elevation.
Pericarditis typically shows diffuse ST elevation without reciprocal changes.
2. Which immediate intervention should the nurse anticipate?
A) Administer sublingual nitroglycerin every 5 minutes x3
B) Activate the cardiac catheterization lab for percutaneous coronary intervention
(PCI)
C) Administer thrombolytics immediately
D) Obtain a chest x-ray before any treatment
*Rationale: For STEMI, the goal is reperfusion within 90 minutes via PCI. Thrombolytics are
used if PCI is unavailable within 120 minutes. Nitroglycerin is given but not the priority.
Chest x-ray should not delay PCI activation.*
3. The patient's pain is not relieved after morphine and oxygen. Which medication is
most appropriate to reduce preload and afterload?
A) Metoprolol
B) Nitroglycerin IV
C) Aspirin
D) Clopidogrel
Rationale: IV nitroglycerin dilates coronary arteries, reduces preload, and lowers
afterload, relieving ischemic pain. Metoprolol reduces heart rate but not primarily
preload/afterload. Aspirin and clopidogrel are antiplatelet agents.
,Bow-Tie Question: Heart Failure
A 78-year-old female with a history of heart failure with reduced ejection fraction (HFrEF)
is admitted with worsening dyspnea, orthopnea, and 3+ pitting edema in both legs. She is
on lisinopril, furosemide, and carvedilol.
4. Complete the bow-tie by selecting the priority assessment (center), two potential
causes (left), and two priority interventions (right).
Center (Assessment):
A) Blood glucose
B) Daily weight
C) Serum potassium
D) Pain level
Left – Potential Causes (select two):
o A) Excess dietary sodium
o B) Missed furosemide dose
o C) High carbohydrate intake
o D) Decreased activity level
Right – Priority Interventions (select two):
o A) Administer IV furosemide
o B) Place on fluid restriction (2L/day)
o C) Increase beta-blocker dose
o D) Encourage high-protein diet
Rationale: Daily weight is the most sensitive indicator of fluid status in HF. Causes of
exacerbation include sodium retention (dietary) and medication nonadherence.
Interventions include loop diuretics (furosemide) to remove fluid and fluid restriction to
prevent overload.
Hot Spot Question: ECG Interpretation
Select the area on the ECG strip below that indicates ventricular repolarization.
(Description: Standard ECG with P wave, QRS complex, and T wave labeled)
5. Answer: The T wave
Rationale: The T wave represents ventricular repolarization. The P wave is atrial
depolarization; the QRS complex is ventricular depolarization; the PR interval is AV
conduction time.
Multiple Choice – Cardiac Medications
6. A patient is prescribed digoxin for heart failure. Which finding indicates digoxin
toxicity?
, A) Heart rate 72 and regular
B) Visual disturbances (yellow-green halos)
C) Blood pressure 130/80
D) Urine output 50 mL/hr
Rationale: Classic signs of digoxin toxicity include nausea, vomiting, bradycardia,
arrhythmias, and visual changes (yellow or green halos around lights). A normal HR and
BP and adequate urine output are not toxic signs.
7. Which medication is a direct thrombin inhibitor used in the management of
heparin-induced thrombocytopenia (HIT)?
A) Warfarin
B) Enoxaparin
C) Argatroban
D) Clopidogrel
Rationale: Argatroban is a direct thrombin inhibitor indicated for HIT. Warfarin is a
vitamin K antagonist; enoxaparin is a low-molecular-weight heparin (contraindicated in
HIT); clopidogrel is an antiplatelet agent.
Enhanced Hot Spot (Matrix) – Infective Endocarditis
A 45-year-old IV drug user presents with fever, a new heart murmur, and Janeway lesions.
Blood cultures are positive for Staphylococcus aureus.
Assessment Finding Consistent with Endocarditis (Yes/No)
Splinter hemorrhages Yes
Osler's nodes Yes
Roth spots Yes
Painless plantar nodules No (these are not typical)
8. Which of the above findings are classic for infective endocarditis?
Answer: Splinter hemorrhages, Osler's nodes, Roth spots
Rationale: Splinter hemorrhages (linear hemorrhages under nails), Osler's nodes (painful
fingertip nodules), and Roth spots (retinal hemorrhages with white centers) are all classic
peripheral stigmata of infective endocarditis. Painless plantar nodules are not typical.
, Case Study 2: Valvular Heart Disease
A 68-year-old female reports progressive dyspnea on exertion, syncope during exercise,
and angina. On auscultation, a harsh, late-peaking systolic murmur is heard at the right
second intercostal space with radiation to the carotids.
9. Which valvular disorder is most likely?
A) Mitral regurgitation
B) Aortic stenosis
C) Aortic regurgitation
D) Mitral stenosis
Rationale: Aortic stenosis presents with the classic triad: angina, syncope, and exertional
dyspnea. The murmur is harsh, crescendo-decrescendo, systolic, best heard at the right
2nd intercostal space (aortic area), radiating to the carotids. Mitral regurgitation is
holosystolic at the apex; aortic regurgitation is diastolic; mitral stenosis is diastolic with an
opening snap.
10. The patient's echocardiogram shows an aortic valve area of 0.8 cm². Which
intervention is indicated?
A) Start digoxin
B) Aortic valve replacement
C) Increase beta-blocker dose
D) Pulmonary artery catheterization
Rationale: Severe aortic stenosis is defined as valve area <1.0 cm². Symptomatic severe AS
requires surgical or transcatheter aortic valve replacement (TAVR). Digoxin and beta-
blockers are not definitive. Pulmonary artery catheterization is not therapeutic.
Drag and Drop: Cardiac Rhythms
Match the rhythm description to the correct name:
11. Rhythm: Irregularly irregular, no distinct P waves, narrow QRS, ventricular rate 140.
Answer: Atrial fibrillation
Rationale: Atrial fibrillation is characterized by chaotic atrial activity (no P waves),
irregularly irregular ventricular response, and narrow QRS if conduction is normal.
12. Rhythm: Regular, rate 42, P wave before each QRS, PR interval normal.
Answer: Sinus bradycardia
Rationale: Sinus bradycardia originates from the SA node with a rate <60 bpm,
regular rhythm, and normal P waves and PR interval.
