NCLEX Cardiac & Perfusion questions
The PrepScore bank has 76 Cardiac & Perfusion questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Recognize cues and Take action, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Recognize the cluster behind chest pain, heart failure, and shock — and never give the wrong drug to a failing pump.
Three worked questions
Q1. A 62-year-old male with ESRD missed his last hemodialysis session 3 days ago. He arrives in the ED reporting weakness and palpitations. ECG monitoring shows the rhythm changing over the past 30 minutes. Labs return: K+ 6.8 mEq/L, Na 138, Cl 105, HCO3 18. Which ECG finding is MOST CONSISTENT with his hyperkalemia?
- A. Peaked symmetric T waves with progressive widening of the QRS complex and loss of P waves as the potassium rises
- B. Flattened T waves with prominent U waves following the T wave on the precordial leads
- C. ST-segment depression with inverted T waves in the lateral precordial leads V4–V6
- D. Prolonged QT interval (>500 ms) with a normal T-wave morphology and no QRS changes
Show answer and rationale
Answer: Peaked symmetric T waves with progressive widening of the QRS complex and loss of P waves as the potassium rises
Hyperkalemia produces a predictable ECG progression: peaked T waves → PR prolongation/P-wave loss → wide QRS → sine-wave morphology → asystole. Flat T + U waves are HYPOkalemia; ST depression/inverted T are ischemia; prolonged QT alone is medication or congenital LQTS, not hyperkalemia.
Q2. A 65-year-old male with newly diagnosed stable angina is being discharged with a prescription for sublingual nitroglycerin 0.4 mg PRN for chest pain. The discharge nurse is providing teaching. Which statement made by the patient REQUIRES FURTHER TEACHING (indicates a misunderstanding)?
- A. I will take one tablet under my tongue every morning to prevent angina episodes during the day
- B. I will keep my tablets in the original dark glass container and replace them every 6 months
- C. I will sit down before taking a tablet so that I don't fall if I get lightheaded
- D. If chest pain persists after 3 tablets taken 5 minutes apart, I will call 911
Show answer and rationale
Answer: I will take one tablet under my tongue every morning to prevent angina episodes during the day
SL nitroglycerin is taken PRN for acute angina, NOT scheduled prophylaxis — scheduling produces nitrate tolerance and loss of effect. The other three statements are correct: dark container preserves potency, sitting prevents syncope, and 3-tab failure activates EMS.
Q3. A hospital nurse takes morning report on 4 patients on the cardiology unit, each with chronic HF. She has 20 minutes before the next medication pass and time to assess one patient first. Which patient should she see first?
- A. A 72-year-old male with new bibasilar crackles, dyspnea at rest, and SpO2 88% on 2 L NC since 2 AM
- B. A 68-year-old female with mild 1+ bilateral ankle edema unchanged from the prior shift assessment
- C. A 76-year-old male with HR 72 on telemetry and BP 124/78, stable since admission yesterday afternoon
- D. An 80-year-old female asking the case manager to come review her discharge planning paperwork later
Show answer and rationale
Answer: A 72-year-old male with new bibasilar crackles, dyspnea at rest, and SpO2 88% on 2 L NC since 2 AM
Acute respiratory deterioration (new crackles + resting dyspnea + hypoxia) is the highest-acuity finding and signals decompensated HF requiring immediate diuresis and O2 escalation. Stable chronic edema, stable vitals, and discharge paperwork are sequentially lower priority.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
A single negative troponin at the start of chest pain does NOT rule out an MI. Troponin lags 3–6 hours behind the event. Diagnostic ST elevation on ECG is enough to activate the cath lab — do not wait on a repeat troponin to treat a STEMI.
Inferior wall MIs often involve the right ventricle. The RV is preload-dependent — nitrates drop preload and can crash the BP. With borderline or low systolic in an inferior STEMI, hold nitroglycerin until RV involvement is excluded.
BP can stay normal or even high in worsening HF while forward flow drops. Daily weight, net I/O, and lung exam tell you whether diuresis is working. A 1–2 kg/day weight gain on diuretics means the regimen is failing — escalate, don't wait.
A patient with sequentially falling BP and sequentially rising HR over hours is in compensated shock — even before any single value crosses a 'critical' line. Trend beats snapshot. Two large-bore IVs, isotonic resuscitation, and source workup are the response — not 'wait and re-check.'
Two questions before any treatment of new atrial fibrillation: (1) Is the patient hemodynamically stable right now? (2) How long has the patient been in this rhythm? Unstable → ACLS cardioversion. Stable + rhythm > 48 h or unknown → rate control + anticoagulation strategy, NOT immediate cardioversion (embolic stroke risk).
Cardiogenic shock means the pump can't move what's already there. The reflex of 'low BP → big fluid bolus' makes it worse. Recognize the cluster: pulmonary congestion + hypotension + low EF + rising lactate. First-line: inotropes/vasopressors, source control, mechanical support if needed.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Cardiac & Perfusion questions does the bank have?
76 multiple-choice items, plus 10 unfolding cases in the Cardiac & Perfusion pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Recognize cues and Take action, though every step appears.
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