NCLEX Cardiovascular: 8 High-Yield Nursing Practice Questions
Cardiovascular nursing is consistently one of the highest-weighted NCLEX categories. These 8 questions focus on priority nursing interventions, medication safety, and clinical decision-making for cardiac patients.
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Evidence-based · For exam prep, not medical advice
update Updated October 2026
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Built by surgery and anesthesiology residents·Written for the NCLEX-RN
Question 1 of 14Score: 0 / 0
Q1Heart Failure Management
A nurse is caring for a patient with acute decompensated heart failure. The patient is sitting upright, SpO2 is 88% on room air, and has bilateral crackles. What is the priority nursing intervention?
Explanation: Priority: airway/breathing first — SpO2 88% requires immediate supplemental oxygen. IV furosemide addresses the underlying fluid overload causing respiratory compromise. This is an acute situation requiring immediate action. Oral beta-blockers are never started during acute decompensation (can worsen acute HF). Fluids would worsen pulmonary edema. While CXR is important, treatment should not be delayed pending imaging when the patient is acutely hypoxic.
Q2Acute MI Nursing Care
A patient with acute MI receives thrombolytic therapy (alteplase). Two hours later, the nurse notices the patient has ST segments returning toward baseline and an accelerated idioventricular rhythm on the monitor. What is the priority action?
Explanation: Accelerated idioventricular rhythm (AIVR) is a reperfusion arrhythmia — a sign that thrombolysis is working (coronary artery is reopening). Along with ST-segment resolution, it indicates successful reperfusion. AIVR is typically self-limiting, hemodynamically stable, and does NOT require treatment. Cardioversion and lidocaine are unnecessary and potentially harmful. The nurse should document the finding and continue monitoring for sustained hemodynamic instability.
Q3Cardiac Medications
The nurse is preparing to administer digoxin 0.25mg to a patient with atrial fibrillation. The patient's apical pulse is 48 bpm. What is the priority action?
Explanation: Digoxin standard protocol: HOLD if apical pulse <60 bpm (some institutions use <60 or <50 depending on policy — always follow the specific order and facility protocol, but the standard threshold is <60). Digoxin slows conduction through the AV node; giving it when the HR is already 48 risks profound bradycardia or complete heart block. Notify the physician and document the withheld dose. Never give a partial dose without a specific order to do so.
Q4Anticoagulation Nursing
A patient is receiving IV heparin for DVT. The current aPTT is 220 seconds (therapeutic range 60-100 seconds). The patient has no active bleeding. What is the priority action?
Explanation: aPTT 220 seconds is supratherapeutic (>3× normal/therapeutic range). Per standard heparin protocols, a significantly elevated aPTT without active bleeding typically requires a rate reduction (per weight-based heparin protocol) and recheck in 6 hours — not complete cessation. Protamine sulfate reverses heparin and is reserved for active major bleeding, not supratherapeutic aPTT alone. Always follow the facility's heparin protocol; most include instructions for reducing the infusion rate based on specific aPTT values.
Q5Cardiac Catheterization Care
A nurse is monitoring a patient post-cardiac catheterization via the right femoral artery. Which assessment finding requires the most immediate action?
Explanation: A rapidly expanding hematoma at the femoral arterial access site indicates arterial bleeding — a potentially life-threatening vascular complication requiring immediate manual pressure and physician notification. Retroperitoneal hemorrhage (presents with lower back/flank pain, hypotension, and large hematoma) is the most feared complication. Mild back pain could indicate retroperitoneal bleed — worth monitoring. The urge to void is expected (contrast dye causes diuresis). BP 122/78 is normal.
Q6Diuretics and Electrolytes
A patient with heart failure is prescribed spironolactone. The nurse reviews the lab results before administration: potassium 5.8 mEq/L, sodium 139 mEq/L, creatinine 1.8 mg/dL. What is the priority action?
Explanation: Spironolactone is a potassium-SPARING diuretic (aldosterone antagonist). It raises serum potassium. A K+ of 5.8 mEq/L is already hyperkalemic — administering spironolactone could cause dangerous hyperkalemia (ventricular arrhythmia, cardiac arrest). Hold the medication and notify the physician. The physician may choose to hold, dose-reduce, or discontinue. A potassium supplement with spironolactone would be contraindicated and dangerous.
Q7STEMI Recognition
A patient is admitted with chest pain. 12-lead ECG shows ST elevation in leads II, III, and aVF with reciprocal changes in I and aVL. This pattern is most consistent with:
Explanation: ST elevation in II, III, aVF = inferior STEMI (right coronary artery most commonly). Critical nursing action: obtain right-sided ECG leads (V3R-V6R, especially V4R) to rule out right ventricular infarction, which occurs in 30-50% of inferior MIs. WHY this matters: RV infarction causes preload-dependent hypotension — treating with nitroglycerin or diuretics can cause profound hypotension. These patients need IV fluids, not vasodilators. Anterior STEMI: V1-V4/V5 elevation; Posterior STEMI: ST depression in V1-V3 with tall R waves.
Q8Anticoagulation Education
The nurse is educating a patient starting warfarin for mechanical heart valve. Which patient statement indicates a need for further teaching?
Explanation: NSAIDs (ibuprofen, naproxen) increase bleeding risk with warfarin through: (1) platelet inhibition (independent antiplatelet effect) and (2) potential for GI mucosal irritation/bleeding. Patients on warfarin should use ACETAMINOPHEN for pain management (though high-dose acetaminophen >2g/day can also increase INR — use the lowest effective dose). Statement 2 requires clarification: patients should maintain a CONSISTENT vitamin K intake, not eliminate it — sudden changes in dietary vitamin K affect INR. Statement 1 and 3 reflect correct understanding.
Q9Dysrhythmias
A client’s monitor shows ventricular fibrillation and the client is unresponsive and pulseless. What is the priority?
Explanation: Ventricular fibrillation produces no cardiac output. Start high-quality CPR and defibrillate as soon as a defibrillator is available; assessments like a 12-lead ECG come after.
Q10Heart failure
Which finding should a client with heart failure report right away?
Explanation: A gain of about 1 kg (2–3 lb) in a day, or about 2 kg (5 lb) in a week, signals fluid retention and worsening heart failure, so it should be reported. Increased urine after a diuretic is expected.
Q11Medications
Before giving metoprolol, which finding should make the nurse hold the dose and notify the provider?
Explanation: Beta-blockers slow the heart rate and lower blood pressure. A heart rate under about 60 (per facility parameters) or low blood pressure is a reason to hold the dose and notify the provider.
Q12Hypertension
A client starting lisinopril reports a dry, persistent cough. What does the nurse explain?
Explanation: A dry cough is a common side effect of ACE inhibitors such as lisinopril. The client should report it; the provider may switch to another class. Angioedema is a rare but serious reaction that needs emergency care.
Q13Peripheral vascular
Which finding is typical of peripheral arterial disease rather than venous disease?
Explanation: Intermittent claudication, calf pain with walking relieved by rest, is a classic sign of arterial insufficiency. Edema, brown discoloration and medial-ankle ulcers suggest venous disease.
Q14Anticoagulants
A client taking warfarin has an INR of 5.8 and no bleeding. What does the nurse anticipate?
Explanation: An INR well above the target range raises bleeding risk. Expect the provider to hold warfarin and possibly order vitamin K; protamine reverses heparin, not warfarin.
What is the standard protocol for holding digoxin?
The standard nursing protocol is to hold digoxin and notify the physician if the apical pulse is less than 60 beats per minute (some facilities use <50 bpm — always follow your specific facility protocol and physician orders). Digoxin toxicity is also a concern: early signs include nausea, vomiting, and visual disturbances ('yellow-green halos'). The drug has a narrow therapeutic window (0.5-2.0 ng/mL for HF; 0.5-0.9 ng/mL preferred for rate control). Hypokalemia, hypomagnesemia, and renal failure increase toxicity risk.
What are the priority nursing assessments after cardiac catheterization via femoral access?
Post-femoral cardiac catheterization: (1) Vascular access site — check for bleeding, hematoma, expanding mass every 15 min × 4, then every 30 min × 4, then every hour × 4. (2) Distal pulses — posterior tibial and dorsalis pedis pulses on the affected leg every 15-30 minutes. (3) Assess for limb ischemia — 5 Ps: Pain, Pallor, Pulselessness, Paresthesias, Paralysis. (4) Retroperitoneal hematoma signs — back/flank pain, dropping BP, tachycardia, increasing abdominal girth. (5) Urine output — contrast nephropathy risk; encourage fluids. Keep HOB ≤30 degrees and affected leg straight for 4-6 hours.
What cardiovascular topics are high yield for the NCLEX?
Heart failure, acute coronary syndrome, dysrhythmias, hypertension, anticoagulants (heparin and warfarin), and post-procedure care such as cardiac catheterization come up often. Practice prioritizing which client or finding needs action first.
How do I get better at NCLEX cardiac questions?
Learn the key medication hold parameters and lab values, then practice mixed questions that ask what to do first. Read every rationale, including why the other options are wrong.
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