NCLEX RN CARDIOVASCULAR SYSTEM QUESTIONS AND
ANSWERS WITH RATIONALES UPDATE 2025/2026
14. Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
A) Lower back pain, increased BP, decreased RBC, increased WBC
B) Severe lower back pain, decreased BP, decreased RBC, increased WBC
C) Severe lower back pain, decreased BP, decreased RBC, decreased WBC
D) Intermittent lower back pain, decreased BP, decreased RBC, increased WBC
B) Severe lower back pain, decreased BP, decreased RBC, increased WBC
Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal
cavity. When rupture occurs, the pain is constant because it can't be alleviated until the aneurysm is repaired. Blood
pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood
volume is lost, so blood pressure wouldn't increase. For the same reason, the RBC count is decreased - not increase.
The WBC count increases as cells migrate to the site of injury.
A 76 year old man enters the ER with complaints of back pain and feeling fatigued. Upon examination, his blood
pressure is 190/100, pulse is 118, and hematocrit and hemoglobin are both low. The nurse palpates the abdomen
which is soft, non-tender and auscultates an abdominal pulse. The most likely diagnosis is:
A) Buerger's disease
B) CHF
C) Secondary hypertension
D) Aneurysm
D) Aneurysm
Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). Which
heart rhythm will the nurse most anticipate in this client if PVCs are occurring?
1.A P wave preceding every QRS complex
2.QRS complexes that are short and narrow
3.Inverted P waves before the QRS complexes
,4.Premature beats followed by a compensatory pause
4.Premature beats followed by a compensatory pause
A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation
should the nurse observe for when performing the client's focused assessment?
1.Flat neck veins
2.Nausea and vomiting
3.Hypotension and dizziness
4.Clubbed fingertips and headache
3.Hypotension and dizziness
A client has experienced a myocardial infarction. The nurse plans care for the client, knowing that the person's chest
pain is caused by tissue hypoxia in which layer of the heart?
1.Myocardium
2.Endocardium
3.Parietal pericardium
4.Visceral pericardium
1.Myocardium
A client has received antidysrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The
nurse evaluates this therapy as most effective if the client's PVCs continued to exhibit which finding?
1.Occur in pairs
2.Appear to be multifocal
3.Fall on the second half of the T wave
4.Decrease to a frequency of less than 6 per minute
4.Decrease to a frequency of less than 6 per minute
,A client is admitted with suspected abdominal aortic aneurysm (AAA). A common complaint of the client with an
abdominal aortic aneurysm is:
A) Loss of sensation in the lower extremities
B) Back pain that lessens when standing
C) Decreased urinary output
D) Pulsations in the periumbilical area
D) Pulsations in the periumbilical area
A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse places
highest priority on telling the client to report which sensation during the procedure?
1.Chest pain
2.Urge to cough
3.Warm, flushed feeling
4.Pressure at the insertion site
1.Chest pain
The client is scheduled for implantable cardioverter defibrillators (ICD) for treatment of a dysrhythmia. The nurse
explains that the action of this procedure is to:
A) Trigger electrical impulses to the heart.
B) Take over SA node function.
C) Block AV node transmission of impulses.
D) Increase ventricular conduction.
A) Trigger electrical impulses to the heart.
A client is scheduled to undergo cardiac catheterization for the first time, and the nurse provides instructions to the
client. Which client statement indicates an understanding of the instructions?
, 1."It will really hurt when the catheter is first put in."
2."I will receive general anesthesia for the procedure."
3."I will have to go to the operating room for this procedure."
4."I probably will feel tired after the test from lying on a hard x-ray table for a few hours."
4."I probably will feel tired after the test from lying on a hard x-ray table for a few hours."
A client is seen in the emergency department for complaints of chest pain that began 3 hours ago. The nurse should
suspect myocardial injury or infarction if which laboratory value came back elevated?
1.Myoglobin
2.Cardiac troponin
3.C-reactive protein
4.Creatine kinase (CK)
2.Cardiac troponin
A client's electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/min. The PR interval is
0.16 second, the QRS complex measures 0.06 second, and the PP interval is slightly irregular. How should the nurse
interpret this rhythm?
1.Sinus tachycardia
2.Sinus dysrhythmia
3.Sinus bradycardia
4.Normal sinus rhythm
2.Sinus dysrhythmia
A client who had coronary artery bypass surgery states to the home health nurse: "get so frustrated. I can't even do
my gardening." The nurse then assesses the client for activity level since the surgery. Which client statement
indicates a need for further teaching?
1."I pace my activities throughout the day."
2."I plan regular rest periods during the day."
3."I avoid outdoor physical activity during the heat of the day."
ANSWERS WITH RATIONALES UPDATE 2025/2026
14. Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
A) Lower back pain, increased BP, decreased RBC, increased WBC
B) Severe lower back pain, decreased BP, decreased RBC, increased WBC
C) Severe lower back pain, decreased BP, decreased RBC, decreased WBC
D) Intermittent lower back pain, decreased BP, decreased RBC, increased WBC
B) Severe lower back pain, decreased BP, decreased RBC, increased WBC
Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal
cavity. When rupture occurs, the pain is constant because it can't be alleviated until the aneurysm is repaired. Blood
pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood
volume is lost, so blood pressure wouldn't increase. For the same reason, the RBC count is decreased - not increase.
The WBC count increases as cells migrate to the site of injury.
A 76 year old man enters the ER with complaints of back pain and feeling fatigued. Upon examination, his blood
pressure is 190/100, pulse is 118, and hematocrit and hemoglobin are both low. The nurse palpates the abdomen
which is soft, non-tender and auscultates an abdominal pulse. The most likely diagnosis is:
A) Buerger's disease
B) CHF
C) Secondary hypertension
D) Aneurysm
D) Aneurysm
Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). Which
heart rhythm will the nurse most anticipate in this client if PVCs are occurring?
1.A P wave preceding every QRS complex
2.QRS complexes that are short and narrow
3.Inverted P waves before the QRS complexes
,4.Premature beats followed by a compensatory pause
4.Premature beats followed by a compensatory pause
A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation
should the nurse observe for when performing the client's focused assessment?
1.Flat neck veins
2.Nausea and vomiting
3.Hypotension and dizziness
4.Clubbed fingertips and headache
3.Hypotension and dizziness
A client has experienced a myocardial infarction. The nurse plans care for the client, knowing that the person's chest
pain is caused by tissue hypoxia in which layer of the heart?
1.Myocardium
2.Endocardium
3.Parietal pericardium
4.Visceral pericardium
1.Myocardium
A client has received antidysrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The
nurse evaluates this therapy as most effective if the client's PVCs continued to exhibit which finding?
1.Occur in pairs
2.Appear to be multifocal
3.Fall on the second half of the T wave
4.Decrease to a frequency of less than 6 per minute
4.Decrease to a frequency of less than 6 per minute
,A client is admitted with suspected abdominal aortic aneurysm (AAA). A common complaint of the client with an
abdominal aortic aneurysm is:
A) Loss of sensation in the lower extremities
B) Back pain that lessens when standing
C) Decreased urinary output
D) Pulsations in the periumbilical area
D) Pulsations in the periumbilical area
A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse places
highest priority on telling the client to report which sensation during the procedure?
1.Chest pain
2.Urge to cough
3.Warm, flushed feeling
4.Pressure at the insertion site
1.Chest pain
The client is scheduled for implantable cardioverter defibrillators (ICD) for treatment of a dysrhythmia. The nurse
explains that the action of this procedure is to:
A) Trigger electrical impulses to the heart.
B) Take over SA node function.
C) Block AV node transmission of impulses.
D) Increase ventricular conduction.
A) Trigger electrical impulses to the heart.
A client is scheduled to undergo cardiac catheterization for the first time, and the nurse provides instructions to the
client. Which client statement indicates an understanding of the instructions?
, 1."It will really hurt when the catheter is first put in."
2."I will receive general anesthesia for the procedure."
3."I will have to go to the operating room for this procedure."
4."I probably will feel tired after the test from lying on a hard x-ray table for a few hours."
4."I probably will feel tired after the test from lying on a hard x-ray table for a few hours."
A client is seen in the emergency department for complaints of chest pain that began 3 hours ago. The nurse should
suspect myocardial injury or infarction if which laboratory value came back elevated?
1.Myoglobin
2.Cardiac troponin
3.C-reactive protein
4.Creatine kinase (CK)
2.Cardiac troponin
A client's electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/min. The PR interval is
0.16 second, the QRS complex measures 0.06 second, and the PP interval is slightly irregular. How should the nurse
interpret this rhythm?
1.Sinus tachycardia
2.Sinus dysrhythmia
3.Sinus bradycardia
4.Normal sinus rhythm
2.Sinus dysrhythmia
A client who had coronary artery bypass surgery states to the home health nurse: "get so frustrated. I can't even do
my gardening." The nurse then assesses the client for activity level since the surgery. Which client statement
indicates a need for further teaching?
1."I pace my activities throughout the day."
2."I plan regular rest periods during the day."
3."I avoid outdoor physical activity during the heat of the day."
