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Cardiac NCLEX practice questions
Cardiac questions test recognition (what is this rhythm or presentation) and action (what do you do first). Work each one and read why the wrong answers are wrong.
Question 1 · Physiological Adaptation
Which findings are consistent with left-sided heart failure? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, B, E, F. Left-sided heart failure causes blood to back up into the lungs, producing crackles, dyspnea, orthopnea, and pink frothy sputum, since 'left' failure affects the 'lungs.' Jugular vein distention and hepatomegaly are signs of right-sided heart failure, where blood backs up into the systemic venous system rather than the lungs. Distinguishing these symptom clusters helps the nurse identify which side of the heart is failing.
Checked against: OpenStax Fundamentals of Nursing, 43.2; OpenStax Medical-Surgical Nursing, 12.3
Question 2 · Pharmacological and Parenteral Therapies
Before administering a scheduled dose of digoxin, the nurse should perform which assessment?
Show answer and rationale
Answer: B. Digoxin can cause bradycardia, so the apical pulse must be assessed for a full 60 seconds before every dose to accurately detect rate and rhythm irregularities. A radial pulse for only 30 seconds is less accurate and does not directly reflect cardiac rate. Blood pressure alone does not assess heart rate, which is the key safety parameter for digoxin. Respiratory rate is not the priority assessment for this medication.
Checked against: OpenStax Clinical Nursing Skills, 15.5
Question 3 · Pharmacological and Parenteral Therapies
A client's medication order includes a parameter to hold metoprolol for a heart rate below 60 beats/min or systolic blood pressure below 90 mmHg. The client's vital signs are heart rate 54 beats/min and blood pressure 118/76 mmHg. What should the nurse do?
Show answer and rationale
Answer: B. The heart rate of 54 beats/min falls below the hold parameter of 60 beats/min, so the nurse should withhold the beta-blocker and notify the provider even though the blood pressure is acceptable. Administering the dose despite the low heart rate could cause further bradycardia. Giving half the dose is not an appropriate independent nursing action. Rechecking later without holding the current dose ignores the safety parameter already met.
Checked against: OpenStax Pharmacology for Nurses, 17.3
Question 4 · Pharmacological and Parenteral Therapies
The nurse suspects digoxin toxicity in a client who has hypokalemia. Which findings support this suspicion? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: C, D, E, F. Classic signs of digoxin toxicity include gastrointestinal symptoms (nausea, vomiting, anorexia), visual disturbances (halos, yellow-green vision), and bradycardia or other dysrhythmias. Hypertension is not a typical toxicity sign; digoxin toxicity is more associated with bradycardia and hypotension from decreased cardiac output. Hyperactivity is not a recognized symptom of digoxin toxicity, which more often causes lethargy and confusion. Low potassium potentiates these toxic effects, making monitoring essential.
Checked against: OpenStax Pharmacology for Nurses, 19.6
Question 5 · Physiological Adaptation
A client post-myocardial infarction develops hypotension, cold clammy skin, crackles, and decreased urine output. Which findings support a diagnosis of cardiogenic shock? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: C, D, E, F. Cardiogenic shock following a large MI presents with hypotension, cold clammy skin from poor perfusion, crackles from pulmonary congestion, and decreased urine output from reduced renal perfusion, reflecting a failing pump. Warm, flushed skin is more characteristic of distributive shock, such as septic or neurogenic shock, not cardiogenic shock. Polyuria is not expected in shock states; instead, oliguria occurs due to decreased renal blood flow. Fluids must be given cautiously in cardiogenic shock since the heart is failing as a pump, not lacking volume.
Checked against: OpenStax Medical-Surgical Nursing, 35.2; OpenStax Pharmacology for Nurses, 22.1
Question 6 · Physiological Adaptation
A client reports chest pain that occurs at rest and is not relieved after taking 3 sublingual nitroglycerin tablets 5 minutes apart. Which action should the nurse take?
Show answer and rationale
Answer: C. Chest pain occurring at rest and unrelieved by the maximum nitroglycerin doses is a sign of unstable angina, which is treated as a pre-MI event requiring immediate ECG, troponin testing, and continuous monitoring. Reassuring the client that this is stable angina is incorrect and dangerous, since stable angina is relieved by rest and nitroglycerin. Waiting an additional 30 minutes delays urgent evaluation of a possible myocardial infarction. Giving a fourth nitroglycerin dose exceeds the maximum of 3 doses and does not address the underlying emergency.
Checked against: OpenStax Pharmacology for Nurses, 18.7; OpenStax Pharmacology for Nurses, 22.3
Question 7 · Pharmacological and Parenteral Therapies
A client receiving furosemide and digoxin is scheduled for the next dose of digoxin. Which laboratory value is most important for the nurse to review first?
Show answer and rationale
Answer: B. Furosemide is a loop diuretic that wastes potassium, and low potassium potentiates digoxin toxicity, making serum potassium the priority lab to check before administering digoxin. Serum sodium is not directly linked to dig toxicity risk in this combination. Serum creatinine reflects renal function, which matters for digoxin clearance but is not the classic paired concern with furosemide. Serum glucose is unrelated to this drug interaction.
Checked against: OpenStax Pharmacology for Nurses, 34.1; OpenStax Pharmacology for Nurses, 40.4
Question 8 · Health Promotion and Maintenance
The nurse is teaching a client with heart failure how to obtain an accurate daily weight. Which instructions should be included? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: B, C, E, F. Accurate daily weight monitoring requires consistency: same time, same scale, and same clothing to eliminate variables that could skew results, plus recording and reporting significant changes so early fluid retention can be treated. Weighing after eating adds inconsistency because food and fluid intake affect weight throughout the day. Weighing only once a week does not allow for early detection of fluid retention, which is the entire purpose of daily weights in heart failure management.
Checked against: OpenStax Clinical Nursing Skills, 19.2; OpenStax Pharmacology for Nurses, 34.1
Question 9 · Pharmacological and Parenteral Therapies
The nurse assesses an apical pulse of 52 beats/min before administering the scheduled dose of digoxin to an adult client. Which action should the nurse take?
Show answer and rationale
Answer: C. An apical pulse below 60 beats/min in an adult is a standard hold parameter for digoxin because the drug can further slow the heart rate and lead to dangerous bradycardia. The nurse should withhold the dose and notify the provider rather than give it as scheduled. Giving half the dose is not an appropriate independent nursing decision. Waiting several hours delays necessary provider notification and risks missing worsening bradycardia.
Checked against: OpenStax Pharmacology for Nurses, 19.6
Question 10 · Physiological Adaptation
The nurse notes a client is in ventricular tachycardia at a rate of 160/min. The client is awake, alert, and has a palpable pulse with a blood pressure of 100/62 mm Hg. Which intervention should the nurse anticipate?
Show answer and rationale
Answer: B. Ventricular tachycardia (VT) with a pulse is treated with synchronized cardioversion or antiarrhythmic medication, not defibrillation, because the client has a perfusing rhythm. Unsynchronized defibrillation is used for pulseless VT or VF. CPR and epinephrine are for pulseless arrest, which is not the case here. This client is stable for now (awake, alert, with a BP of 100/62 mm Hg), but VT at 160/min can deteriorate quickly, so it requires prompt treatment, not observation alone.
Checked against: OpenStax Medical-Surgical Nursing, 12.2; OpenStax Fundamentals of Nursing, 19.2
Question 11 · Health Promotion and Maintenance
The nurse is teaching a client with heart failure about daily weight monitoring. Which weight change should the client be instructed to report to the provider?
Show answer and rationale
Answer: B. A gain of 2-3 lb overnight or 5 lb in a week suggests fluid retention and worsening heart failure, requiring prompt provider notification. A 1 lb daily gain alone is not typically significant enough to trigger concern. A gradual weight loss is a positive sign, not a warning sign, in heart failure management. No change in weight indicates stability and does not require reporting.
Checked against: OpenStax Pharmacology for Nurses, 19.5; OpenStax Pharmacology for Nurses, 34.5
Question 12 · Physiological Adaptation
A client's cardiac monitor shows asystole, and the client is unresponsive and pulseless. Which intervention is appropriate?
Show answer and rationale
Answer: B. Asystole and pulseless electrical activity (PEA) are not shockable rhythms; treatment is high-quality CPR and epinephrine per ACLS protocol. Defibrillating a flat line will not restore organized electrical activity and is a classic exam distractor. Synchronized cardioversion requires an organized rhythm with a pulse, which is absent here. Asystole is treated aggressively with CPR and medications, not abandoned.
Checked against: OpenStax Medical-Surgical Nursing, 12.2
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Frequently asked questions
What cardiac topics are on the NCLEX?
Heart failure, myocardial infarction, dysrhythmias, cardiac medications and their safety checks come up often. The test plan places most of them in Physiological Adaptation and Pharmacological and Parenteral Therapies.
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About these questions
Every question on this page was approved by a licensed RN, and its answer was checked against open nursing references (mostly OpenStax nursing textbooks) before publishing. They are NCLEX-style practice, not real NCLEX items. NurseLingo is not affiliated with NCSBN. Spot a problem? Tell us.