1
CARDIAC NCLEX EXAM 2025–2026 | ACTUAL 300
EXAM QUESTIONS & CORRECT ANSWERS WITH
RATIONALES | NCLEX CARDIAC MASTERY
Question 1
A nurse is caring for a 65-year-old client admitted with chest pain radiating to the left arm,
diaphoresis, and shortness of breath. The ECG shows ST-segment elevation in leads II, III, and
aVF. The client is diagnosed with an acute inferior wall myocardial infarction. The provider
orders IV morphine, oxygen, nitroglycerin, and aspirin. Thirty minutes after administering
nitroglycerin, the client becomes hypotensive (BP 84/50 mmHg) and reports dizziness. What is
the nurse’s priority action?
A. Re-administer nitroglycerin to relieve ongoing chest pain
B. Elevate the head of the bed to promote breathing
C. Place the client in Trendelenburg position and notify the provider
D. Discontinue the oxygen and reassess in 15 minutes
Correct Answer: C. Place the client in Trendelenburg position and notify the provider
Rationale: Nitroglycerin is a potent vasodilator that can significantly lower blood pressure,
,2
particularly in clients with inferior wall myocardial infarction, where right ventricular
involvement may be present. These clients are preload dependent, and vasodilation can
precipitate severe hypotension. Placing the client in Trendelenburg (or supine with legs
elevated) promotes venous return and cardiac output. The nurse must also notify the provider
immediately for further guidance. Re-administering nitroglycerin could worsen hypotension.
📚 Reference: Lewis’s Medical-Surgical Nursing, 11th ed., Ch. 34; Saunders NCLEX Review,
10th ed., Cardiac Section
Question 2
A 72-year-old client with a history of hypertension and diabetes presents with sudden onset of
chest pain, described as a “pressure” in the center of the chest that began 1 hour ago. The
ECG shows no ST elevation, but troponin I is elevated. The provider diagnoses a non-ST-
elevation myocardial infarction (NSTEMI). The nurse prepares to administer the prescribed
medications. Which of the following medications should the nurse question before
administration?
A. Enoxaparin subcutaneously
B. Metoprolol IV push
C. Aspirin 325 mg chewable
D. Sildenafil taken earlier for erectile dysfunction
Correct Answer: D. Sildenafil taken earlier for erectile dysfunction
Rationale: Sildenafil (Viagra) is a phosphodiesterase-5 inhibitor that causes vasodilation.
When combined with nitrates or other vasodilators, it can lead to life-threatening hypotension.
,3
Before giving medications like nitroglycerin, the nurse must screen for recent sildenafil use
(typically within 24–48 hours). In clients presenting with chest pain and possible MI, sildenafil
use is a critical contraindication. All other listed drugs are appropriate in managing NSTEMI.
📚 Reference: Lehne’s Pharmacology, 10th ed., p. 533; Lewis’s Med-Surg, 11th ed., Ch. 34
✅ Question 3
A client is admitted to the telemetry unit with atrial fibrillation and a heart rate of 148 bpm. The
client is asymptomatic with a stable blood pressure and no signs of heart failure. The provider
orders a loading dose of diltiazem IV. The nurse administers the medication as ordered. After
15 minutes, the heart rate decreases to 92 bpm, and the client remains hemodynamically stable.
What is the most appropriate nursing action?
A. Prepare for immediate cardioversion
B. Notify the provider of bradycardia
C. Continue monitoring the client’s response to the drug
D. Administer atropine to prevent further slowing
Correct Answer: C. Continue monitoring the client’s response to the drug
Rationale: Diltiazem, a calcium channel blocker, is commonly used for rate control in atrial
fibrillation, especially in stable clients. A decrease in heart rate from 148 to 92 bpm is a desired
therapeutic effect, not a complication. As long as the client remains stable, the nurse should
continue monitoring vitals and cardiac rhythm. Cardioversion is not indicated unless the client
becomes unstable.
, 4
📚 Reference: Lehne’s Pharmacology, 10th ed., p. 517; Saunders NCLEX Review, Cardiac
Disorders
✅ Question 4
A nurse is caring for a client who is post-op day 2 following a coronary artery bypass graft
(CABG). The client’s telemetry monitor shows sinus rhythm with occasional premature
ventricular contractions (PVCs). The client denies chest pain and vital signs are within normal
limits. Which of the following is the most appropriate nursing action?
A. Notify the rapid response team immediately
B. Assess serum potassium and magnesium levels
C. Prepare for defibrillation
D. Administer atropine 0.5 mg IV
Correct Answer: B. Assess serum potassium and magnesium levels
Rationale: Occasional PVCs after cardiac surgery are common and often related to electrolyte
imbalances, especially hypokalemia or hypomagnesemia. These disturbances increase
myocardial irritability. Since the client is stable and asymptomatic, the priority is to assess labs
and correct underlying causes. No emergent interventions are warranted unless PVCs become
frequent or the rhythm deteriorates.
📚 Reference: Lewis’s Medical-Surgical Nursing, 11th ed., Ch. 35; ATI RN Cardiac Nursing
Module
CARDIAC NCLEX EXAM 2025–2026 | ACTUAL 300
EXAM QUESTIONS & CORRECT ANSWERS WITH
RATIONALES | NCLEX CARDIAC MASTERY
Question 1
A nurse is caring for a 65-year-old client admitted with chest pain radiating to the left arm,
diaphoresis, and shortness of breath. The ECG shows ST-segment elevation in leads II, III, and
aVF. The client is diagnosed with an acute inferior wall myocardial infarction. The provider
orders IV morphine, oxygen, nitroglycerin, and aspirin. Thirty minutes after administering
nitroglycerin, the client becomes hypotensive (BP 84/50 mmHg) and reports dizziness. What is
the nurse’s priority action?
A. Re-administer nitroglycerin to relieve ongoing chest pain
B. Elevate the head of the bed to promote breathing
C. Place the client in Trendelenburg position and notify the provider
D. Discontinue the oxygen and reassess in 15 minutes
Correct Answer: C. Place the client in Trendelenburg position and notify the provider
Rationale: Nitroglycerin is a potent vasodilator that can significantly lower blood pressure,
,2
particularly in clients with inferior wall myocardial infarction, where right ventricular
involvement may be present. These clients are preload dependent, and vasodilation can
precipitate severe hypotension. Placing the client in Trendelenburg (or supine with legs
elevated) promotes venous return and cardiac output. The nurse must also notify the provider
immediately for further guidance. Re-administering nitroglycerin could worsen hypotension.
📚 Reference: Lewis’s Medical-Surgical Nursing, 11th ed., Ch. 34; Saunders NCLEX Review,
10th ed., Cardiac Section
Question 2
A 72-year-old client with a history of hypertension and diabetes presents with sudden onset of
chest pain, described as a “pressure” in the center of the chest that began 1 hour ago. The
ECG shows no ST elevation, but troponin I is elevated. The provider diagnoses a non-ST-
elevation myocardial infarction (NSTEMI). The nurse prepares to administer the prescribed
medications. Which of the following medications should the nurse question before
administration?
A. Enoxaparin subcutaneously
B. Metoprolol IV push
C. Aspirin 325 mg chewable
D. Sildenafil taken earlier for erectile dysfunction
Correct Answer: D. Sildenafil taken earlier for erectile dysfunction
Rationale: Sildenafil (Viagra) is a phosphodiesterase-5 inhibitor that causes vasodilation.
When combined with nitrates or other vasodilators, it can lead to life-threatening hypotension.
,3
Before giving medications like nitroglycerin, the nurse must screen for recent sildenafil use
(typically within 24–48 hours). In clients presenting with chest pain and possible MI, sildenafil
use is a critical contraindication. All other listed drugs are appropriate in managing NSTEMI.
📚 Reference: Lehne’s Pharmacology, 10th ed., p. 533; Lewis’s Med-Surg, 11th ed., Ch. 34
✅ Question 3
A client is admitted to the telemetry unit with atrial fibrillation and a heart rate of 148 bpm. The
client is asymptomatic with a stable blood pressure and no signs of heart failure. The provider
orders a loading dose of diltiazem IV. The nurse administers the medication as ordered. After
15 minutes, the heart rate decreases to 92 bpm, and the client remains hemodynamically stable.
What is the most appropriate nursing action?
A. Prepare for immediate cardioversion
B. Notify the provider of bradycardia
C. Continue monitoring the client’s response to the drug
D. Administer atropine to prevent further slowing
Correct Answer: C. Continue monitoring the client’s response to the drug
Rationale: Diltiazem, a calcium channel blocker, is commonly used for rate control in atrial
fibrillation, especially in stable clients. A decrease in heart rate from 148 to 92 bpm is a desired
therapeutic effect, not a complication. As long as the client remains stable, the nurse should
continue monitoring vitals and cardiac rhythm. Cardioversion is not indicated unless the client
becomes unstable.
, 4
📚 Reference: Lehne’s Pharmacology, 10th ed., p. 517; Saunders NCLEX Review, Cardiac
Disorders
✅ Question 4
A nurse is caring for a client who is post-op day 2 following a coronary artery bypass graft
(CABG). The client’s telemetry monitor shows sinus rhythm with occasional premature
ventricular contractions (PVCs). The client denies chest pain and vital signs are within normal
limits. Which of the following is the most appropriate nursing action?
A. Notify the rapid response team immediately
B. Assess serum potassium and magnesium levels
C. Prepare for defibrillation
D. Administer atropine 0.5 mg IV
Correct Answer: B. Assess serum potassium and magnesium levels
Rationale: Occasional PVCs after cardiac surgery are common and often related to electrolyte
imbalances, especially hypokalemia or hypomagnesemia. These disturbances increase
myocardial irritability. Since the client is stable and asymptomatic, the priority is to assess labs
and correct underlying causes. No emergent interventions are warranted unless PVCs become
frequent or the rhythm deteriorates.
📚 Reference: Lewis’s Medical-Surgical Nursing, 11th ed., Ch. 35; ATI RN Cardiac Nursing
Module
