ATI MED SURG: acute coronary syndrome NCLEX
Examination sample prep Questions and Answers; certified
for accuracy 2025/2026
The client undergoing coronary artery bypass grafting (CABG) asks why the doctor has
chosen to use the internal mammary artery for the surgery. Which response by the
nurse is correct?
1. "This way you will not need to have a leg incision."
2. "The surgeon prefers this approach because it is easier."
3. "These arteries remain open longer."
4. "The surgeon has chosen this approach because of your age." - correct answer 3.
Mammary arteries have remained patent much longer than other grafts.
The client has just returned from coronary artery bypass graft (CABG) surgery. For
which finding should the nurse contact the surgeon?
1. Temperature 98.2° F
2. Chest tube drainage 175 mL last hour
3. Serum potassium 3.9 mEq/L
4. Incisional pain 6 on a scale of 1 to 10 - correct answer 2. Some bleeding is expected
after surgery; however, the nurse should report chest drainage over 150 mL per hour to
the surgeon.
The visiting nurse is seeing a client post coronary artery bypass graft. Which nursing
action should be performed first?
1. Assess coping skills.
2. Assess for postoperative pain at the client's incision site.
3. Monitor for dysrhythmias.
4. Monitor mental status. - correct answer 3. Dysrhythmias are the leading cause of
prehospital death. The nurse should monitor the client's heart rhythm.
,During discharge planning after admission for a myocardial infarction, the client says, "I
won't be able to increase my activity level. I live in an apartment, and there is no place
to walk." What is the nurse's best response?
1. "You are right. Work on your diet then."
2. "You must find someplace to walk."
3. "Walk around the edge of your apartment complex."
4. "Where might you be able to walk?" - correct answer 4. This response calls for
cooperation and participation from the client.
The older adult client, 4 hours post coronary artery bypass graft (CABG), has a blood
pressure of 80/50. What action should the nurse take?
1. No action is required; low blood pressure is normal for older adults.
2. No action is required for postsurgical CABG clients.
3. Assess pulmonary artery wedge pressure (PAWP).
4. Give ordered loop diuretics. - correct answer 3. Decreased preload as exhibited by
decreased PAWP could indicate hypovolemia secondary to hemorrhage or vasodilation.
Hypotension could cause the graft to collapse.
The nurse is assessing the client with chest pain to evaluate whether the client is
suffering from angina or myocardial infarction (MI). Which symptom is indicative of an
MI?
1. Chest pain brought on by exertion or stress
2. Substernal chest discomfort occurring at rest
3. Substernal chest discomfort relieved by nitroglycerin or rest
4. Substernal chest pressure relieved only by opioids - correct answer 4. Substernal
chest pressure relieved only by opioids is typically indicative of MI. Chest pain brought
on by exertion or stress is indicative of angina. Substernal chest discomfort that occurs
at rest is not necessarily indicative of MI; it could be a sign of unstable angina.
Substernal chest discomfort relieved by nitroglycerin or rest is indicative of angina.
The client comes to the emergency department with chest discomfort. Which action
does the nurse perform first?
1. Administers oxygen therapy
, 2. Obtains the client's description of the chest discomfort
3. Provides pain relief medication
4. Remains calm and stays with the client - correct answer 2. A description of the chest
discomfort must be obtained before further action can be taken.
Which statement by the client scheduled for a percutaneous transluminal coronary
angioplasty indicates a need for further preoperative teaching?
1. "I will be awake during this procedure."
2. "I will have a balloon in my artery to widen it."
3. "I must lie still after the procedure."
4. "My angina will be gone for good." - correct answer 4. Reocclusion of angina is
possible after the procedure. The client is typically awake, but drowsy, during this
procedure. The procedure uses a balloon to widen the artery. The client will have to lie
still after the procedure because of the large-bore venous access. Time is necessary to
allow the ìholeî to heal and prevent hemorrhage.
After receiving change-of-shift report in the coronary care unit, which client should you
assess first?
1. The client with acute coronary syndrome who has a 3-pound weight gain and
dyspnea
2. The client with percutaneous coronary angioplasty who has a dose of heparin
scheduled
3. The client who had bradycardia after a myocardial infarction and now has a paced
heart rate of 64
4. A client who has first-degree heart block, rate 68, after having an inferior myocardial
infarction - correct answer 1. Dyspnea and weight gain are symptoms of left ventricular
failure and pulmonary edema; the client needs prompt intervention.
An LPN/LVN is scheduled to work on the inpatient "step-down" cardiac unit where you
are the team leader. Which of these clients would be best to assign to the LPN/LVN?
1. A 60-year-old who was admitted today for pacemaker insertion because of third-
degree heart block and who is now reporting chest pain
Examination sample prep Questions and Answers; certified
for accuracy 2025/2026
The client undergoing coronary artery bypass grafting (CABG) asks why the doctor has
chosen to use the internal mammary artery for the surgery. Which response by the
nurse is correct?
1. "This way you will not need to have a leg incision."
2. "The surgeon prefers this approach because it is easier."
3. "These arteries remain open longer."
4. "The surgeon has chosen this approach because of your age." - correct answer 3.
Mammary arteries have remained patent much longer than other grafts.
The client has just returned from coronary artery bypass graft (CABG) surgery. For
which finding should the nurse contact the surgeon?
1. Temperature 98.2° F
2. Chest tube drainage 175 mL last hour
3. Serum potassium 3.9 mEq/L
4. Incisional pain 6 on a scale of 1 to 10 - correct answer 2. Some bleeding is expected
after surgery; however, the nurse should report chest drainage over 150 mL per hour to
the surgeon.
The visiting nurse is seeing a client post coronary artery bypass graft. Which nursing
action should be performed first?
1. Assess coping skills.
2. Assess for postoperative pain at the client's incision site.
3. Monitor for dysrhythmias.
4. Monitor mental status. - correct answer 3. Dysrhythmias are the leading cause of
prehospital death. The nurse should monitor the client's heart rhythm.
,During discharge planning after admission for a myocardial infarction, the client says, "I
won't be able to increase my activity level. I live in an apartment, and there is no place
to walk." What is the nurse's best response?
1. "You are right. Work on your diet then."
2. "You must find someplace to walk."
3. "Walk around the edge of your apartment complex."
4. "Where might you be able to walk?" - correct answer 4. This response calls for
cooperation and participation from the client.
The older adult client, 4 hours post coronary artery bypass graft (CABG), has a blood
pressure of 80/50. What action should the nurse take?
1. No action is required; low blood pressure is normal for older adults.
2. No action is required for postsurgical CABG clients.
3. Assess pulmonary artery wedge pressure (PAWP).
4. Give ordered loop diuretics. - correct answer 3. Decreased preload as exhibited by
decreased PAWP could indicate hypovolemia secondary to hemorrhage or vasodilation.
Hypotension could cause the graft to collapse.
The nurse is assessing the client with chest pain to evaluate whether the client is
suffering from angina or myocardial infarction (MI). Which symptom is indicative of an
MI?
1. Chest pain brought on by exertion or stress
2. Substernal chest discomfort occurring at rest
3. Substernal chest discomfort relieved by nitroglycerin or rest
4. Substernal chest pressure relieved only by opioids - correct answer 4. Substernal
chest pressure relieved only by opioids is typically indicative of MI. Chest pain brought
on by exertion or stress is indicative of angina. Substernal chest discomfort that occurs
at rest is not necessarily indicative of MI; it could be a sign of unstable angina.
Substernal chest discomfort relieved by nitroglycerin or rest is indicative of angina.
The client comes to the emergency department with chest discomfort. Which action
does the nurse perform first?
1. Administers oxygen therapy
, 2. Obtains the client's description of the chest discomfort
3. Provides pain relief medication
4. Remains calm and stays with the client - correct answer 2. A description of the chest
discomfort must be obtained before further action can be taken.
Which statement by the client scheduled for a percutaneous transluminal coronary
angioplasty indicates a need for further preoperative teaching?
1. "I will be awake during this procedure."
2. "I will have a balloon in my artery to widen it."
3. "I must lie still after the procedure."
4. "My angina will be gone for good." - correct answer 4. Reocclusion of angina is
possible after the procedure. The client is typically awake, but drowsy, during this
procedure. The procedure uses a balloon to widen the artery. The client will have to lie
still after the procedure because of the large-bore venous access. Time is necessary to
allow the ìholeî to heal and prevent hemorrhage.
After receiving change-of-shift report in the coronary care unit, which client should you
assess first?
1. The client with acute coronary syndrome who has a 3-pound weight gain and
dyspnea
2. The client with percutaneous coronary angioplasty who has a dose of heparin
scheduled
3. The client who had bradycardia after a myocardial infarction and now has a paced
heart rate of 64
4. A client who has first-degree heart block, rate 68, after having an inferior myocardial
infarction - correct answer 1. Dyspnea and weight gain are symptoms of left ventricular
failure and pulmonary edema; the client needs prompt intervention.
An LPN/LVN is scheduled to work on the inpatient "step-down" cardiac unit where you
are the team leader. Which of these clients would be best to assign to the LPN/LVN?
1. A 60-year-old who was admitted today for pacemaker insertion because of third-
degree heart block and who is now reporting chest pain
