Cardiac nursing is one of the most critical areas tested on the NCLEX-RN and NCLEX-PN exams. To help you prepare effectively, we’ve compiled 100 carefully designed NCLEX cardiac nursing questions with rationales.
These practice questions cover cardiac pharmacology, arrhythmias, ECG interpretation, heart failure, hypertension, and emergency cardiac care. Each question includes a clear rationale to strengthen your understanding and boost your test confidence.
❤️ NCLEX Cardiac Nursing Questions [1–100] with Rationales
1. Which medication is commonly prescribed to control heart rate in atrial fibrillation?
A. Furosemide
B. Metoprolol
C. Digoxin
D. Enalapril
Answer: B. Metoprolol
Rationale: Beta-blockers like metoprolol slow the heart rate and reduce myocardial oxygen demand. Digoxin may also help, but beta-blockers are typically first-line for rate control.
2. The nurse recognizes that chest pain unrelieved by nitroglycerin may indicate:
A. Stable angina
B. Myocardial infarction
C. Gastroesophageal reflux
D. Anxiety attack
Answer: B. Myocardial infarction
Rationale: Persistent chest pain after taking nitroglycerin suggests myocardial ischemia or infarction, requiring emergency evaluation and ECG monitoring.
3. Which ECG change is most characteristic of hyperkalemia?
A. Peaked T waves
B. U waves
C. ST-segment depression
D. Flattened T waves
Answer: A. Peaked T waves
Rationale: Elevated potassium levels cause tall, peaked T waves due to changes in cardiac repolarization.
4. A nurse should hold digoxin if the patient’s pulse is:
A. Below 100 bpm
B. Below 90 bpm
C. Below 60 bpm
D. Below 70 bpm
Answer: C. Below 60 bpm
Rationale: Digoxin slows conduction through the AV node. If pulse <60 bpm, it can cause bradycardia or heart block — medication should be withheld and reported.
5. Which symptom suggests left-sided heart failure?
A. Peripheral edema
B. Jugular vein distension
C. Crackles in lungs
D. Weight gain
Answer: C. Crackles in lungs
Rationale: Left-sided failure leads to pulmonary congestion, resulting in dyspnea and crackles from fluid accumulation in the alveoli.
6. The nurse understands that the first-line drug for hypertensive emergency is:
A. Captopril
B. Labetalol
C. Furosemide
D. Hydralazine
Answer: B. Labetalol
Rationale: Labetalol, a combined alpha- and beta-blocker, rapidly lowers blood pressure without major reflex tachycardia.
7. Which cardiac enzyme rises first after a myocardial infarction?
A. CK-MB
B. Troponin I
C. LDH
D. Myoglobin
Answer: D. Myoglobin
Rationale: Myoglobin elevates within 1–2 hours after myocardial injury but is non-specific; troponin is more specific for cardiac tissue damage.
8. Which of the following is a priority nursing action during a chest pain episode?
A. Administer aspirin
B. Place the patient in Trendelenburg position
C. Encourage deep breathing
D. Increase fluid intake
Answer: A. Administer aspirin
Rationale: Aspirin inhibits platelet aggregation, limiting clot formation during an acute coronary event.
9. The nurse should question which order for a patient with heart failure?
A. Digoxin
B. Furosemide
C. Verapamil
D. Spironolactone
Answer: C. Verapamil
Rationale: Calcium channel blockers like verapamil can depress cardiac function, worsening heart failure.
10. What is the primary purpose of a pacemaker?
A. Reduce chest pain
B. Regulate heart rhythm
C. Strengthen contractions
D. Lower blood pressure
Answer: B. Regulate heart rhythm
Rationale: Pacemakers deliver electrical impulses to maintain an adequate heart rate and rhythm in bradycardia or conduction disorders.
11. In pericarditis, which assessment finding is common?
A. Bounding pulse
B. Pericardial friction rub
C. Cyanosis
D. Crackles
Answer: B. Pericardial friction rub
Rationale: A scratchy, high-pitched sound heard over the left sternal border indicates inflamed pericardial layers rubbing together.
12. The nurse recognizes that orthopnea in heart failure is caused by:
A. Increased venous return in a supine position
B. Poor oxygenation
C. Anxiety
D. Electrolyte imbalance
Answer: A. Increased venous return in a supine position
Rationale: Lying flat increases venous return to the heart, worsening pulmonary congestion and dyspnea.
13. Which intervention is appropriate for a patient with peripheral arterial disease (PAD)?
A. Elevate legs above heart
B. Encourage walking until pain starts
C. Apply cold compress
D. Restrict activity
Answer: B. Encourage walking until pain starts
Rationale: Intermittent walking promotes collateral circulation and improves tissue perfusion in PAD patients.
14. Which electrolyte imbalance increases the risk of digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hyponatremia
Answer: B. Hypokalemia
Rationale: Low potassium enhances digoxin’s effect on myocardial cells, increasing toxicity risk.
15. Which medication is contraindicated in patients with severe bradycardia?
A. Atropine
B. Propranolol
C. Epinephrine
D. Isoproterenol
Answer: B. Propranolol
Rationale: Beta-blockers further decrease heart rate, worsening bradycardia.
16. A nurse suspects cardiac tamponade when observing:
A. Narrowed pulse pressure
B. Bounding pulses
C. Crackles
D. Irregular heart rhythm
Answer: A. Narrowed pulse pressure
Rationale: Fluid accumulation compresses the heart, reducing stroke volume and narrowing pulse pressure.
17. Which test confirms deep vein thrombosis (DVT)?
A. ECG
B. Echocardiogram
C. D-dimer
D. Doppler ultrasound
Answer: D. Doppler ultrasound
Rationale: Doppler imaging detects venous obstruction and confirms the presence of a thrombus.
18. Which lifestyle change is most important for hypertension management?
A. High-protein diet
B. Low-sodium intake
C. Increased fluids
D. Weight gain
Answer: B. Low-sodium intake
Rationale: Reducing sodium lowers fluid retention and vascular resistance, effectively controlling BP.
19. Which cardiac condition is characterized by “pulsus paradoxus”?
A. Aortic stenosis
B. Pericardial tamponade
C. Mitral regurgitation
D. Heart failure
Answer: B. Pericardial tamponade
Rationale: An exaggerated decrease in systolic pressure during inspiration is a hallmark of tamponade.
20. Which drug is used to dissolve a coronary thrombus?
A. Heparin
B. Warfarin
C. Streptokinase
D. Aspirin
Answer: C. Streptokinase
Rationale: Thrombolytic agents like streptokinase dissolve clots and restore perfusion during MI.
21. What is the primary action of nitroglycerin?
A. Increase heart rate
B. Dilate coronary arteries
C. Reduce preload and afterload
D. Increase contractility
Answer: C. Reduce preload and afterload
Rationale: Nitroglycerin decreases myocardial oxygen demand by dilating veins and arteries.
22. Which ECG finding indicates ventricular fibrillation?
A. Regular P waves
B. Chaotic, irregular waves
C. Prolonged PR interval
D. Flat T waves
Answer: B. Chaotic, irregular waves
Rationale: Ventricular fibrillation is a life-threatening arrhythmia requiring immediate defibrillation.
23. Which drug is given to increase cardiac contractility in acute heart failure?
A. Dopamine
B. Propranolol
C. Captopril
D. Furosemide
Answer: A. Dopamine
Rationale: Dopamine at moderate doses improves contractility and cardiac output via beta-1 stimulation.
24. A patient taking ACE inhibitors reports a dry cough. The nurse should:
A. Stop the drug immediately
B. Reassure the patient it’s normal
C. Inform the physician for substitution
D. Increase the dose
Answer: C. Inform the physician for substitution
Rationale: ACE inhibitors can cause dry cough; switching to ARBs (like losartan) is often recommended.
25. Which finding indicates improvement in heart failure therapy?
A. Weight gain
B. Decreased urine output
C. Fewer crackles
D. Edema in ankles
Answer: C. Fewer crackles
Rationale: Reduced pulmonary congestion and improved breathing show effective therapy response.
26. Which symptom best indicates worsening right-sided heart failure?
A. Crackles in lungs
B. Orthopnea
C. Peripheral edema
D. Dyspnea on exertion
Answer: C. Peripheral edema
Rationale: Right-sided failure leads to systemic congestion, causing ankle swelling and weight gain due to fluid retention.
27. Which instruction is most appropriate for a patient taking warfarin?
A. Eat more green vegetables
B. Report bleeding gums
C. Avoid all vitamin K foods
D. Take double dose if missed
Answer: B. Report bleeding gums
Rationale: Warfarin increases bleeding risk; patients should report any signs of bleeding but maintain consistent vitamin K intake.
28. The nurse recognizes that a patient in ventricular tachycardia is at risk for:
A. Bradycardia
B. Stroke
C. Cardiac arrest
D. Heart murmur
Answer: C. Cardiac arrest
Rationale: Sustained ventricular tachycardia decreases cardiac output and may degenerate into ventricular fibrillation.
29. Which lab result should be monitored for a patient taking furosemide?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Answer: B. Potassium
Rationale: Furosemide (loop diuretic) increases urinary potassium excretion, risking hypokalemia and arrhythmias.
30. Which heart sound is associated with heart failure?
A. S1
B. S2
C. S3
D. S4
Answer: C. S3
Rationale: An S3 (ventricular gallop) occurs from rapid ventricular filling and indicates left ventricular dysfunction.
31. The nurse should administer oxygen to a cardiac patient when oxygen saturation drops below:
A. 98%
B. 94%
C. 92%
D. 90%
Answer: C. 92%
Rationale: Oxygen saturation below 92% indicates inadequate tissue oxygenation; supplemental oxygen prevents hypoxia.
32. Which patient statement indicates correct understanding of nitroglycerin use?
A. “I can take up to three tablets five minutes apart.”
B. “I’ll chew the tablet for faster relief.”
C. “I should take it only before bedtime.”
D. “I’ll store it in the bathroom cabinet.”
Answer: A. “I can take up to three tablets five minutes apart.”
Rationale: Nitroglycerin may be repeated every 5 minutes (up to three doses) for chest pain; if unrelieved, call emergency services.
33. Which diagnostic test measures cardiac ejection fraction?
A. ECG
B. Echocardiogram
C. Cardiac catheterization
D. Chest X-ray
Answer: B. Echocardiogram
Rationale: Echocardiography assesses heart function, including ejection fraction and wall motion abnormalities.
34. Which symptom is most characteristic of mitral valve prolapse?
A. Diastolic murmur
B. Systolic click
C. Bounding pulse
D. Bradycardia
Answer: B. Systolic click
Rationale: Mitral valve prolapse produces a midsystolic click followed by a murmur due to leaflet bulging.
35. The nurse expects to give which medication to prevent thromboembolism after myocardial infarction?
A. Aspirin
B. Atropine
C. Amiodarone
D. Epinephrine
Answer: A. Aspirin
Rationale: Aspirin reduces platelet aggregation and prevents further thrombus formation post-MI.
36. The nurse recognizes pulsus alternans as a sign of:
A. Cardiac tamponade
B. Heart failure
C. Aortic stenosis
D. Pericarditis
Answer: B. Heart failure
Rationale: Pulsus alternans — alternating strong and weak pulses — reflects left ventricular dysfunction.
37. Which complication is associated with uncontrolled hypertension?
A. Hypoglycemia
B. Stroke
C. Pulmonary embolism
D. Bronchospasm
Answer: B. Stroke
Rationale: Chronic hypertension damages cerebral vessels, increasing the risk of hemorrhagic or ischemic stroke.
38. The nurse should instruct a patient with pacemaker to:
A. Avoid using microwaves
B. Avoid MRI scans
C. Restrict driving
D. Sleep only on the right side
Answer: B. Avoid MRI scans
Rationale: MRI can interfere with pacemaker function; special MRI-compatible models are exceptions.
39. Which lab value confirms therapeutic digoxin levels?
A. 0.2–0.5 ng/mL
B. 0.5–2.0 ng/mL
C. 2.0–4.0 ng/mL
D. 3.0–5.0 ng/mL
Answer: B. 0.5–2.0 ng/mL
Rationale: Digoxin’s therapeutic range is 0.5–2.0 ng/mL; higher levels increase toxicity risk.
40. Which drug class is contraindicated in patients with asthma and hypertension?
A. ACE inhibitors
B. Beta-blockers
C. Diuretics
D. Calcium channel blockers
Answer: B. Beta-blockers
Rationale: Non-selective beta-blockers (like propranolol) may induce bronchospasm in asthmatic patients.
41. Which of the following findings indicates fluid overload in a heart failure patient?
A. Flat neck veins
B. Weight loss
C. Crackles and edema
D. Increased urine output
Answer: C. Crackles and edema
Rationale: These symptoms reflect excess intravascular volume and poor cardiac output.
42. What is the normal range for serum potassium?
A. 2.5–3.0 mEq/L
B. 3.5–5.0 mEq/L
C. 5.5–6.0 mEq/L
D. 6.0–7.0 mEq/L
Answer: B. 3.5–5.0 mEq/L
Rationale: Maintaining normal potassium is essential for cardiac rhythm stability.
43. Which position helps relieve symptoms in pericarditis?
A. Supine
B. Semi-Fowler’s
C. Sitting forward
D. Trendelenburg
Answer: C. Sitting forward
Rationale: Leaning forward reduces pericardial pressure and chest pain associated with pericardial inflammation.
44. Which sign indicates digitalis toxicity?
A. Bradycardia
B. Polyuria
C. Hypertension
D. Headache
Answer: A. Bradycardia
Rationale: Digoxin slows conduction; toxicity causes bradycardia, nausea, and visual changes.
45. The nurse monitors a patient on heparin by checking:
A. INR
B. aPTT
C. Platelet count
D. PT
Answer: B. aPTT
Rationale: Activated partial thromboplastin time (aPTT) evaluates heparin’s anticoagulant effect.
46. What is the primary goal in managing a patient with angina pectoris?
A. Increase oxygen demand
B. Reduce myocardial workload
C. Restrict fluids
D. Increase heart rate
Answer: B. Reduce myocardial workload
Rationale: Decreasing oxygen demand and improving coronary blood flow prevent angina episodes.
47. Which drug is a calcium channel blocker?
A. Lisinopril
B. Verapamil
C. Metoprolol
D. Losartan
Answer: B. Verapamil
Rationale: Calcium channel blockers relax arterial smooth muscles, lowering blood pressure and reducing cardiac workload.
48. The nurse identifies jugular venous distension as a sign of:
A. Pulmonary edema
B. Right-sided heart failure
C. Left-sided heart failure
D. Aortic stenosis
Answer: B. Right-sided heart failure
Rationale: Blood backs up into the systemic veins, causing distension of neck veins.
49. Which drug should be avoided in patients taking nitrates?
A. Aspirin
B. Sildenafil (Viagra)
C. Metformin
D. Furosemide
Answer: B. Sildenafil (Viagra)
Rationale: Combining nitrates with phosphodiesterase inhibitors can cause life-threatening hypotension.
50. The nurse should instruct a patient with varicose veins to:
A. Avoid walking
B. Elevate legs when resting
C. Sit with legs crossed
D. Reduce fluid intake
Answer: B. Elevate legs when resting
Rationale: Elevating legs improves venous return and reduces swelling in varicose vein patients.
51. A patient with atrial fibrillation is at greatest risk for:
A. Myocardial infarction
B. Pulmonary embolism
C. Stroke
D. Heart block
Answer: C. Stroke
Rationale: Irregular atrial contractions cause blood stasis and clot formation in the atria, which may embolize to the brain.
52. The nurse should hold digoxin if the apical pulse is below:
A. 70 bpm
B. 60 bpm
C. 90 bpm
D. 50 bpm
Answer: B. 60 bpm
Rationale: Digoxin slows heart rate; it should be held if the apical pulse is under 60 bpm to prevent severe bradycardia.
53. Which electrolyte imbalance increases digoxin toxicity risk?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Answer: B. Hypokalemia
Rationale: Low potassium enhances digoxin binding to cardiac tissue, leading to toxicity.
54. Which of the following is a side effect of ACE inhibitors?
A. Bradycardia
B. Dry cough
C. Hypernatremia
D. Constipation
Answer: B. Dry cough
Rationale: ACE inhibitors can cause accumulation of bradykinin, leading to persistent dry cough.
55. The nurse should monitor a patient taking spironolactone for:
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypocalcemia
Answer: B. Hyperkalemia
Rationale: Spironolactone is a potassium-sparing diuretic that may cause elevated potassium levels.
56. Which finding indicates improvement in a heart failure patient?
A. Weight gain
B. Dyspnea on exertion
C. Decreased edema
D. Jugular vein distension
Answer: C. Decreased edema
Rationale: Reduced swelling and weight indicate effective diuretic therapy and improved cardiac function.
57. Which diagnostic test identifies myocardial ischemia?
A. ECG
B. Chest X-ray
C. CT scan
D. Echocardiogram
Answer: A. ECG
Rationale: ST depression or T-wave inversion on ECG suggests myocardial ischemia.
58. What is the normal adult cardiac output range?
A. 1–3 L/min
B. 4–8 L/min
C. 8–12 L/min
D. 2–4 L/min
Answer: B. 4–8 L/min
Rationale: Cardiac output equals stroke volume × heart rate; the normal range ensures adequate tissue perfusion.
59. Which artery supplies blood to the heart muscle itself?
A. Carotid artery
B. Pulmonary artery
C. Coronary artery
D. Aortic arch
Answer: C. Coronary artery
Rationale: The coronary arteries originate from the aorta and supply oxygenated blood to the myocardium.
60. Which intervention is most effective during ventricular fibrillation?
A. CPR
B. Defibrillation
C. Intubation
D. Oxygen administration
Answer: B. Defibrillation
Rationale: Immediate defibrillation is the only effective treatment for ventricular fibrillation.
61. The nurse should instruct a patient on statin therapy to:
A. Take medication in the morning
B. Avoid grapefruit juice
C. Double dose if missed
D. Take with dairy products
Answer: B. Avoid grapefruit juice
Rationale: Grapefruit inhibits statin metabolism, increasing risk of toxicity and muscle damage.
62. A patient with left-sided heart failure may develop:
A. Ascites
B. Crackles in lungs
C. Peripheral edema
D. Jugular vein distention
Answer: B. Crackles in lungs
Rationale: Left-sided failure leads to pulmonary congestion, manifesting as crackles and shortness of breath.
63. Which ECG change indicates hyperkalemia?
A. Prolonged QT interval
B. Tall, peaked T waves
C. ST depression
D. Inverted P wave
Answer: B. Tall, peaked T waves
Rationale: Elevated potassium levels cause tall T waves and may lead to cardiac arrest if untreated.
64. Which intervention is appropriate for a patient post-cardiac catheterization?
A. Encourage ambulation
B. Keep affected leg straight
C. Increase fluid restriction
D. Remove pressure dressing early
Answer: B. Keep affected leg straight
Rationale: Keeping the leg straight prevents bleeding from the femoral puncture site.
65. Which lifestyle change helps manage hypertension?
A. High-sodium diet
B. Smoking cessation
C. Reduced fluid intake
D. Increased caffeine
Answer: B. Smoking cessation
Rationale: Stopping smoking decreases blood pressure and lowers cardiovascular risk.
66. Which lab value indicates myocardial infarction?
A. Elevated troponin
B. Low hemoglobin
C. High cholesterol
D. Increased calcium
Answer: A. Elevated troponin
Rationale: Troponin rises within hours of myocardial cell damage and remains elevated for days.
67. The nurse should avoid administering nitroglycerin if:
A. Patient has chest pain
B. Blood pressure is 85/50 mmHg
C. Pulse is 90 bpm
D. Patient reports mild headache
Answer: B. Blood pressure is 85/50 mmHg
Rationale: Nitroglycerin causes vasodilation and can dangerously lower blood pressure.
68. Which sign is common in peripheral artery disease (PAD)?
A. Warm extremities
B. Bounding pulses
C. Intermittent claudication
D. Dependent edema
Answer: C. Intermittent claudication
Rationale: PAD causes pain in the legs during walking due to poor arterial circulation.
69. Which nursing action prevents thrombus formation in immobile patients?
A. Apply cold compress
B. Elevate legs above heart
C. Perform leg exercises
D. Restrict fluid intake
Answer: C. Perform leg exercises
Rationale: Regular movement improves venous return and prevents deep vein thrombosis.
70. The nurse recognizes pulsus paradoxus as a sign of:
A. Pericardial tamponade
B. Heart block
C. Aortic stenosis
D. Bradycardia
Answer: A. Pericardial tamponade
Rationale: Pulsus paradoxus — a drop in systolic pressure during inspiration — indicates cardiac compression.
71. Which drug is used for emergency treatment of bradycardia?
A. Atropine
B. Amiodarone
C. Lisinopril
D. Nitroglycerin
Answer: A. Atropine
Rationale: Atropine increases heart rate by blocking parasympathetic stimulation.
72. The nurse should report which finding after pacemaker insertion?
A. Heart rate 75 bpm
B. Minor incision pain
C. Hiccups
D. Systolic BP 110 mmHg
Answer: C. Hiccups
Rationale: Persistent hiccups may indicate pacemaker lead dislodgment stimulating the diaphragm.
73. Which medication is used to dissolve a coronary thrombus during myocardial infarction?
A. Aspirin
B. Heparin
C. Alteplase (tPA)
D. Furosemide
Answer: C. Alteplase (tPA)
Rationale: Thrombolytic agents dissolve clots to restore coronary perfusion in acute MI.
74. The nurse should assess for which symptom of pulmonary edema?
A. Cough with frothy sputum
B. Weight loss
C. Bradycardia
D. Warm skin
Answer: A. Cough with frothy sputum
Rationale: Pulmonary edema causes fluid accumulation in alveoli, leading to pink frothy sputum.
75. Which is the priority nursing diagnosis for heart failure?
A. Risk for infection
B. Impaired gas exchange
C. Deficient knowledge
D. Activity intolerance
Answer: B. Impaired gas exchange
Rationale: Oxygenation is the most critical priority in heart failure management.
76. Which assessment finding is most concerning after administration of IV furosemide?
A. Urine output of 1200 mL in 4 hours
B. Serum potassium 3.0 mEq/L
C. Blood pressure 110/70 mmHg
D. Weight loss of 1 kg overnight
Answer: B. Serum potassium 3.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium loss, risking arrhythmias at levels below 3.5 mEq/L.
77. A patient receiving heparin infusion has an aPTT of 110 seconds. The nurse should:
A. Continue infusion
B. Stop heparin immediately
C. Notify physician and reduce dose
D. Increase heparin dose
Answer: C. Notify physician and reduce dose
Rationale: Therapeutic aPTT range is 60–80 seconds. 110 indicates overdose and bleeding risk.
78. Which nursing intervention reduces the risk of post-MI complications?
A. Encourage early ambulation
B. Limit oxygen use
C. Delay beta-blocker therapy
D. Restrict anticoagulants
Answer: A. Encourage early ambulation
Rationale: Early mobilization prevents DVT, improves circulation, and supports cardiac recovery.
79. Which ECG rhythm requires immediate defibrillation?
A. Asystole
B. Atrial flutter
C. Ventricular fibrillation
D. Sinus tachycardia
Answer: C. Ventricular fibrillation
Rationale: VF is a life-threatening arrhythmia that demands immediate defibrillation.
80. Which drug should be available when giving nitroglycerin?
A. Atropine
B. Epinephrine
C. Normal saline
D. Oxygen
Answer: D. Oxygen
Rationale: Oxygen supports cardiac tissue perfusion during episodes of chest pain.
81. Which heart sound indicates heart failure?
A. S1
B. S2
C. S3
D. Murmur
Answer: C. S3
Rationale: S3 (ventricular gallop) suggests increased ventricular filling pressure, common in heart failure.
82. A patient on warfarin has an INR of 5.0. The nurse should:
A. Hold the dose and notify physician
B. Continue current dose
C. Increase dose
D. Give additional dose
Answer: A. Hold the dose and notify physician
Rationale: Therapeutic INR is 2–3; an INR of 5.0 increases bleeding risk.
83. Which food should be avoided when taking warfarin?
A. Bananas
B. Broccoli
C. Apples
D. Potatoes
Answer: B. Broccoli
Rationale: Vitamin K–rich foods like broccoli reduce warfarin’s effectiveness.
84. Which of the following is a symptom of right-sided heart failure?
A. Crackles
B. Peripheral edema
C. Dyspnea
D. Cough
Answer: B. Peripheral edema
Rationale: Right-sided failure leads to systemic congestion and swelling in the legs.
85. The nurse recognizes jugular vein distention as a sign of:
A. Left ventricular failure
B. Pulmonary embolism
C. Right heart failure
D. Cardiac tamponade
Answer: C. Right heart failure
Rationale: Venous return backs up into the jugular veins due to poor right ventricular pumping.
86. Which medication reduces afterload in heart failure patients?
A. Digoxin
B. Lisinopril
C. Furosemide
D. Nitroglycerin
Answer: B. Lisinopril
Rationale: ACE inhibitors reduce vascular resistance, decreasing afterload.
87. Which statement shows effective understanding of nitroglycerin use?
A. “I’ll take it with food.”
B. “I can take up to three doses five minutes apart.”
C. “If pain persists, I’ll wait an hour.”
D. “I’ll store it in the bathroom cabinet.”
Answer: B. “I can take up to three doses five minutes apart.”
Rationale: If chest pain persists after three doses, emergency care is required.
88. A nurse notes a pericardial friction rub. This indicates:
A. Valve stenosis
B. Myocardial infarction
C. Pericarditis
D. Heart failure
Answer: C. Pericarditis
Rationale: A friction rub results from inflamed pericardial layers rubbing against each other.
89. Which medication should not be given with sildenafil (Viagra)?
A. Furosemide
B. Metoprolol
C. Nitroglycerin
D. Aspirin
Answer: C. Nitroglycerin
Rationale: Both drugs cause vasodilation, leading to dangerous hypotension.
90. The nurse should suspect cardiac tamponade if the patient has:
A. Bounding pulses
B. Muffled heart sounds
C. Crackles in lungs
D. High urine output
Answer: B. Muffled heart sounds
Rationale: Fluid accumulation in the pericardium dampens heart sounds.
91. Which intervention is appropriate during chest pain due to angina?
A. Position patient supine
B. Administer nitroglycerin
C. Encourage walking
D. Provide cold water
Answer: B. Administer nitroglycerin
Rationale: Nitroglycerin dilates coronary arteries and relieves angina pain.
92. A nurse caring for a patient on beta-blockers should monitor:
A. Blood pressure and heart rate
B. Temperature
C. Urine output
D. Potassium levels
Answer: A. Blood pressure and heart rate
Rationale: Beta-blockers lower both heart rate and BP, risking bradycardia or hypotension.
93. Which complication is common after myocardial infarction?
A. Heart block
B. Hypertension
C. Pulmonary embolism
D. Hyperglycemia
Answer: A. Heart block
Rationale: Ischemia of conduction tissue can cause heart rhythm abnormalities post-MI.
94. Which finding is expected after administering metoprolol?
A. Heart rate 58 bpm
B. BP 160/90 mmHg
C. Tremors
D. Tachycardia
Answer: A. Heart rate 58 bpm
Rationale: Metoprolol slows the heart rate to reduce myocardial workload.
95. Which lab result indicates digoxin toxicity?
A. Digoxin level 2.5 ng/mL
B. Potassium 4.0 mEq/L
C. Creatinine 1.0 mg/dL
D. Calcium 9.0 mg/dL
Answer: A. Digoxin level 2.5 ng/mL
Rationale: Levels above 2.0 ng/mL suggest toxicity, especially with nausea and visual disturbances.
96. A nurse should teach a patient on furosemide to consume:
A. Apples
B. Bananas
C. Milk
D. Cheese
Answer: B. Bananas
Rationale: Bananas are potassium-rich and help replace losses caused by furosemide.
97. Which action should the nurse take first for a patient with chest pain?
A. Obtain vital signs
B. Administer oxygen
C. Give aspirin
D. Start IV line
Answer: B. Administer oxygen
Rationale: Oxygen is the immediate priority to improve myocardial oxygen supply.
98. Which statement shows understanding of DASH diet teaching?
A. “I will limit red meat and salt intake.”
B. “I’ll eat processed foods daily.”
C. “I’ll avoid fruits.”
D. “I’ll increase my caffeine.”
Answer: A. “I will limit red meat and salt intake.”
Rationale: DASH emphasizes low sodium and lean protein to reduce BP.
99. Which lab test monitors heparin therapy?
A. PT/INR
B. aPTT
C. Platelet count
D. Fibrinogen
Answer: B. aPTT
Rationale: aPTT measures the therapeutic effect of heparin anticoagulation.
100. The nurse knows cardioversion is used for:
A. Asystole
B. Ventricular fibrillation
C. Atrial fibrillation
D. Pulseless VT
Answer: C. Atrial fibrillation
Rationale: Synchronized cardioversion restores normal rhythm in atrial fibrillation or flutter.
✅ Conclusion
This comprehensive NCLEX Cardiac Nursing Questions and Answers guide combines 100 real-style MCQs with detailed rationales to strengthen your understanding of cardiac concepts tested on the NCLEX-RN. Review these carefully, understand the rationales, and focus on medication safety, cardiac monitoring, and emergency interventions — all essential for U.S. NCLEX success.
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