Medical-Surgical Cardiovascular Disorders Exam Prep – Real
Practice Questions, Answers & Detailed Rationales (Updated
2026) | Heart Failure & Coronary Artery Disease,
Hypertension & Shock Management, Dysrhythmias & ECG
Interpretation, Myocardial Infarction & Angina, Cardiac
Pharmacology, Hemodynamic Monitoring, Nursing Interventions,
Patient Education & NCLEX-Style Clinical Scenarios
Question 1: A patient with acute coronary syndrome is admitted to the cardiac unit.
Which assessment finding requires immediate intervention by the nurse?
A. Heart rate of 88 beats per minute
B. Blood pressure of 138/86 mmHg
C. New-onset ST-segment elevation on ECG
D. Occasional premature ventricular contractions
CORRECT ANSWER: C. New-onset ST-segment elevation on ECG
Rationale: ST-segment elevation on electrocardiogram is a critical indicator of acute
myocardial infarction requiring immediate reperfusion therapy (e.g., PCI or
thrombolytics). While vital sign variations and occasional PVCs warrant monitoring,
they do not represent the same time-sensitive emergency as STEMI, where every minute
of delay increases myocardial damage and mortality risk.
Question 2: When administering metoprolol to a patient with heart failure with
reduced ejection fraction (HFrEF), which parameter should the nurse assess first?
A. Urine output
B. Apical heart rate
C. Peripheral edema
D. Serum potassium level
CORRECT ANSWER: B. Apical heart rate
Rationale: Beta-blockers like metoprolol decrease heart rate and contractility. Before
administration, the nurse must assess the apical pulse; if the heart rate is below 60 bpm
(or per institutional protocol), the dose should be withheld and the provider notified to
prevent bradycardia, heart block, or hemodynamic compromise. While other
parameters are relevant to heart failure management, heart rate is the priority safety
check for beta-blocker administration.
Question 3: A patient with peripheral artery disease (PAD) reports calf pain that
occurs with walking and resolves with rest. The nurse documents this symptom as:
A. Rest pain
B. Claudication
C. Paresthesia
D. Ischemic ulceration
,CORRECT ANSWER: B. Claudication
Rationale: Intermittent claudication is the classic symptom of PAD, characterized by
reproducible muscle pain (typically calf, thigh, or buttock) induced by exercise and
relieved within minutes of rest due to inadequate oxygen supply during increased
demand. Rest pain indicates critical limb ischemia, paresthesia suggests nerve
involvement, and ulceration represents tissue breakdown from chronic ischemia.
Question 4: Which laboratory value is most specific for diagnosing acute
myocardial infarction?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Cardiac troponin I
D. Lactate dehydrogenase (LDH)
CORRECT ANSWER: C. Cardiac troponin I
Rationale: Cardiac troponins (I or T) are highly specific to myocardial tissue and rise
within 3–6 hours of myocardial injury, remaining elevated for 7–10 days. They are the
gold standard biomarker for MI diagnosis per current guidelines. CK-MB is less specific
(found in skeletal muscle), myoglobin rises early but lacks cardiac specificity, and LDH
is neither sensitive nor specific for cardiac injury.
Question 5: A patient with a newly implanted permanent pacemaker is being
discharged. Which instruction is essential for the nurse to include?
A. Avoid all electronic devices permanently
B. Carry a pacemaker identification card at all times
C. Limit arm movement on the implant side for 6 weeks
D. Schedule MRI scans only with cardiology approval
CORRECT ANSWER: B. Carry a pacemaker identification card at all times
Rationale: Patients with pacemakers must carry an identification card detailing device
type, implant date, and settings to inform healthcare providers and security personnel.
While avoiding strong electromagnetic fields is advised, most household electronics
are safe. Arm movement restrictions typically last 2–4 weeks, not 6. MRI compatibility
depends on device type; many modern pacemakers are MRI-conditional, but
verification is required—not an absolute prohibition.
Question 6: In a patient with acute decompensated heart failure, which medication
should the nurse anticipate administering first to reduce preload?
A. Furosemide
B. Lisinopril
C. Digoxin
D. Metoprolol
CORRECT ANSWER: A. Furosemide
,Rationale: Loop diuretics like furosemide are first-line for acute decompensated heart
failure to rapidly reduce intravascular volume and preload, alleviating pulmonary
congestion and dyspnea. ACE inhibitors (lisinopril) and beta-blockers (metoprolol) are
chronic management agents and may worsen acute symptoms. Digoxin improves
contractility but does not address preload reduction urgently.
Question 7: Which ECG change is characteristic of hypokalemia in a patient
receiving diuretic therapy?
A. Tall, peaked T waves
B. ST-segment depression
C. Prominent U waves
D. Widened QRS complex
CORRECT ANSWER: C. Prominent U waves
Rationale: Hypokalemia commonly causes prominent U waves (following the T wave),
ST-segment depression, and flattened T waves on ECG. Tall, peaked T waves and
widened QRS are signs of hyperkalemia. Recognizing these changes is critical as
hypokalemia increases risk of ventricular arrhythmias, especially in patients on
diuretics.
Question 8: A patient with aortic stenosis is being assessed. Which finding is most
consistent with this valvular disorder?
A. Holosystolic murmur at the apex
B. Crescendo-decrescendo systolic murmur at the right sternal border
C. Diastolic rumble at the left lower sternal border
D. Continuous machinery murmur below the clavicle
CORRECT ANSWER: B. Crescendo-decrescendo systolic murmur at the right
sternal border
Rationale: Aortic stenosis produces a harsh, crescendo-decrescendo (ejection)
systolic murmur best heard at the right upper sternal border (aortic area), often
radiating to the carotids. A holosystolic murmur at the apex suggests mitral
regurgitation; a diastolic rumble indicates mitral stenosis; a continuous machinery
murmur is classic for patent ductus arteriosus.
Question 9: When preparing a patient for cardiac catheterization via the femoral
approach, which pre-procedure action is the nurse's priority?
A. Administer sedation 30 minutes prior
B. Verify informed consent is signed
C. Assess peripheral pulses bilaterally
D. Initiate continuous cardiac monitoring
CORRECT ANSWER: B. Verify informed consent is signed
, Rationale: Verifying informed consent is a legal and ethical priority before any invasive
procedure, ensuring the patient understands risks, benefits, and alternatives. While
assessing pulses, monitoring, and sedation are important, they occur after consent is
confirmed. Failure to verify consent can result in procedure cancellation or legal
liability.
Question 10: A patient with hypertensive urgency has a blood pressure of 198/112
mmHg. Which intervention should the nurse implement first?
A. Administer sublingual nifedipine
B. Place the patient in a supine position
C. Obtain a stat 12-lead ECG
D. Recheck blood pressure in 5 minutes with proper technique
CORRECT ANSWER: D. Recheck blood pressure in 5 minutes with proper technique
Rationale: Before initiating treatment for hypertensive urgency, the nurse must confirm
the reading using proper technique (correct cuff size, patient seated, arm supported,
feet flat) to rule out pseudohypertension or measurement error. Rapid-acting sublingual
nifedipine is no longer recommended due to risk of precipitous BP drop and ischemia.
ECG and positioning are secondary to verification.
Question 11: Which statement by a patient with coronary artery disease indicates
understanding of nitroglycerin use for angina?
A. "I will take three tablets at once if pain is severe."
B. "I should call 911 if pain persists after one dose."
C. "I can store nitroglycerin in my bathroom cabinet."
D. "I will take a dose every 10 minutes until pain stops."
CORRECT ANSWER: B. "I should call 911 if pain persists after one dose."
Rationale: Current guidelines advise patients to take one nitroglycerin dose for angina;
if pain persists after 5 minutes, they should call 911 immediately (not wait for three
doses) as this may indicate acute MI. Taking multiple doses delays emergency care.
Nitroglycerin degrades with light/heat, so it should be stored in its original dark bottle,
not a bathroom cabinet.
Question 12: In a patient with suspected pulmonary embolism secondary to deep
vein thrombosis, which diagnostic test is most definitive?
A. D-dimer assay
B. Ventilation-perfusion (V/Q) scan
C. CT pulmonary angiography
D. Lower extremity Doppler ultrasound
CORRECT ANSWER: C. CT pulmonary angiography
Rationale: CT pulmonary angiography is the gold standard for diagnosing pulmonary
embolism, providing direct visualization of pulmonary artery clots. D-dimer is sensitive
Practice Questions, Answers & Detailed Rationales (Updated
2026) | Heart Failure & Coronary Artery Disease,
Hypertension & Shock Management, Dysrhythmias & ECG
Interpretation, Myocardial Infarction & Angina, Cardiac
Pharmacology, Hemodynamic Monitoring, Nursing Interventions,
Patient Education & NCLEX-Style Clinical Scenarios
Question 1: A patient with acute coronary syndrome is admitted to the cardiac unit.
Which assessment finding requires immediate intervention by the nurse?
A. Heart rate of 88 beats per minute
B. Blood pressure of 138/86 mmHg
C. New-onset ST-segment elevation on ECG
D. Occasional premature ventricular contractions
CORRECT ANSWER: C. New-onset ST-segment elevation on ECG
Rationale: ST-segment elevation on electrocardiogram is a critical indicator of acute
myocardial infarction requiring immediate reperfusion therapy (e.g., PCI or
thrombolytics). While vital sign variations and occasional PVCs warrant monitoring,
they do not represent the same time-sensitive emergency as STEMI, where every minute
of delay increases myocardial damage and mortality risk.
Question 2: When administering metoprolol to a patient with heart failure with
reduced ejection fraction (HFrEF), which parameter should the nurse assess first?
A. Urine output
B. Apical heart rate
C. Peripheral edema
D. Serum potassium level
CORRECT ANSWER: B. Apical heart rate
Rationale: Beta-blockers like metoprolol decrease heart rate and contractility. Before
administration, the nurse must assess the apical pulse; if the heart rate is below 60 bpm
(or per institutional protocol), the dose should be withheld and the provider notified to
prevent bradycardia, heart block, or hemodynamic compromise. While other
parameters are relevant to heart failure management, heart rate is the priority safety
check for beta-blocker administration.
Question 3: A patient with peripheral artery disease (PAD) reports calf pain that
occurs with walking and resolves with rest. The nurse documents this symptom as:
A. Rest pain
B. Claudication
C. Paresthesia
D. Ischemic ulceration
,CORRECT ANSWER: B. Claudication
Rationale: Intermittent claudication is the classic symptom of PAD, characterized by
reproducible muscle pain (typically calf, thigh, or buttock) induced by exercise and
relieved within minutes of rest due to inadequate oxygen supply during increased
demand. Rest pain indicates critical limb ischemia, paresthesia suggests nerve
involvement, and ulceration represents tissue breakdown from chronic ischemia.
Question 4: Which laboratory value is most specific for diagnosing acute
myocardial infarction?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Cardiac troponin I
D. Lactate dehydrogenase (LDH)
CORRECT ANSWER: C. Cardiac troponin I
Rationale: Cardiac troponins (I or T) are highly specific to myocardial tissue and rise
within 3–6 hours of myocardial injury, remaining elevated for 7–10 days. They are the
gold standard biomarker for MI diagnosis per current guidelines. CK-MB is less specific
(found in skeletal muscle), myoglobin rises early but lacks cardiac specificity, and LDH
is neither sensitive nor specific for cardiac injury.
Question 5: A patient with a newly implanted permanent pacemaker is being
discharged. Which instruction is essential for the nurse to include?
A. Avoid all electronic devices permanently
B. Carry a pacemaker identification card at all times
C. Limit arm movement on the implant side for 6 weeks
D. Schedule MRI scans only with cardiology approval
CORRECT ANSWER: B. Carry a pacemaker identification card at all times
Rationale: Patients with pacemakers must carry an identification card detailing device
type, implant date, and settings to inform healthcare providers and security personnel.
While avoiding strong electromagnetic fields is advised, most household electronics
are safe. Arm movement restrictions typically last 2–4 weeks, not 6. MRI compatibility
depends on device type; many modern pacemakers are MRI-conditional, but
verification is required—not an absolute prohibition.
Question 6: In a patient with acute decompensated heart failure, which medication
should the nurse anticipate administering first to reduce preload?
A. Furosemide
B. Lisinopril
C. Digoxin
D. Metoprolol
CORRECT ANSWER: A. Furosemide
,Rationale: Loop diuretics like furosemide are first-line for acute decompensated heart
failure to rapidly reduce intravascular volume and preload, alleviating pulmonary
congestion and dyspnea. ACE inhibitors (lisinopril) and beta-blockers (metoprolol) are
chronic management agents and may worsen acute symptoms. Digoxin improves
contractility but does not address preload reduction urgently.
Question 7: Which ECG change is characteristic of hypokalemia in a patient
receiving diuretic therapy?
A. Tall, peaked T waves
B. ST-segment depression
C. Prominent U waves
D. Widened QRS complex
CORRECT ANSWER: C. Prominent U waves
Rationale: Hypokalemia commonly causes prominent U waves (following the T wave),
ST-segment depression, and flattened T waves on ECG. Tall, peaked T waves and
widened QRS are signs of hyperkalemia. Recognizing these changes is critical as
hypokalemia increases risk of ventricular arrhythmias, especially in patients on
diuretics.
Question 8: A patient with aortic stenosis is being assessed. Which finding is most
consistent with this valvular disorder?
A. Holosystolic murmur at the apex
B. Crescendo-decrescendo systolic murmur at the right sternal border
C. Diastolic rumble at the left lower sternal border
D. Continuous machinery murmur below the clavicle
CORRECT ANSWER: B. Crescendo-decrescendo systolic murmur at the right
sternal border
Rationale: Aortic stenosis produces a harsh, crescendo-decrescendo (ejection)
systolic murmur best heard at the right upper sternal border (aortic area), often
radiating to the carotids. A holosystolic murmur at the apex suggests mitral
regurgitation; a diastolic rumble indicates mitral stenosis; a continuous machinery
murmur is classic for patent ductus arteriosus.
Question 9: When preparing a patient for cardiac catheterization via the femoral
approach, which pre-procedure action is the nurse's priority?
A. Administer sedation 30 minutes prior
B. Verify informed consent is signed
C. Assess peripheral pulses bilaterally
D. Initiate continuous cardiac monitoring
CORRECT ANSWER: B. Verify informed consent is signed
, Rationale: Verifying informed consent is a legal and ethical priority before any invasive
procedure, ensuring the patient understands risks, benefits, and alternatives. While
assessing pulses, monitoring, and sedation are important, they occur after consent is
confirmed. Failure to verify consent can result in procedure cancellation or legal
liability.
Question 10: A patient with hypertensive urgency has a blood pressure of 198/112
mmHg. Which intervention should the nurse implement first?
A. Administer sublingual nifedipine
B. Place the patient in a supine position
C. Obtain a stat 12-lead ECG
D. Recheck blood pressure in 5 minutes with proper technique
CORRECT ANSWER: D. Recheck blood pressure in 5 minutes with proper technique
Rationale: Before initiating treatment for hypertensive urgency, the nurse must confirm
the reading using proper technique (correct cuff size, patient seated, arm supported,
feet flat) to rule out pseudohypertension or measurement error. Rapid-acting sublingual
nifedipine is no longer recommended due to risk of precipitous BP drop and ischemia.
ECG and positioning are secondary to verification.
Question 11: Which statement by a patient with coronary artery disease indicates
understanding of nitroglycerin use for angina?
A. "I will take three tablets at once if pain is severe."
B. "I should call 911 if pain persists after one dose."
C. "I can store nitroglycerin in my bathroom cabinet."
D. "I will take a dose every 10 minutes until pain stops."
CORRECT ANSWER: B. "I should call 911 if pain persists after one dose."
Rationale: Current guidelines advise patients to take one nitroglycerin dose for angina;
if pain persists after 5 minutes, they should call 911 immediately (not wait for three
doses) as this may indicate acute MI. Taking multiple doses delays emergency care.
Nitroglycerin degrades with light/heat, so it should be stored in its original dark bottle,
not a bathroom cabinet.
Question 12: In a patient with suspected pulmonary embolism secondary to deep
vein thrombosis, which diagnostic test is most definitive?
A. D-dimer assay
B. Ventilation-perfusion (V/Q) scan
C. CT pulmonary angiography
D. Lower extremity Doppler ultrasound
CORRECT ANSWER: C. CT pulmonary angiography
Rationale: CT pulmonary angiography is the gold standard for diagnosing pulmonary
embolism, providing direct visualization of pulmonary artery clots. D-dimer is sensitive
