Free NCLEX cardiac questions with full rationales
Four free NCLEX-RN cardiac questions covering decompensated heart failure, nitroglycerin titration, post-cath assessment, and inferior STEMI management. Cardiac is one of the highest-weighted NCLEX content areas — get it right and you secure a large chunk of the test.
What cardiac topics dominate the NCLEX?
- Acute coronary syndrome. STEMI, NSTEMI, unstable angina. EKG lead interpretation, MONA-B mnemonic, contraindications to nitroglycerin (RV infarct, sildenafil within 24 hr).
- Heart failure. Left- vs right-sided, HFrEF vs HFpEF, BNP interpretation, diuretic management, ACE inhibitor side effects, beta-blocker initiation rules.
- Dysrhythmias. Atrial fibrillation (rate vs rhythm control, anticoagulation), bradycardia (atropine, pacing), V-tach (pulseless vs with pulse), V-fib (defibrillation), torsades de pointes (magnesium).
- Hemodynamics. Cardiac tamponade triad (Beck's), aortic dissection, cardiogenic shock, pulmonary embolism.
- Post-procedure. Cardiac catheterization site assessment, distal pulse monitoring, restrictions, watch for retroperitoneal bleed.
The 5 cardiac patterns that win NCLEX cardiac questions
- Unstable = priority. Hypotension, new dysrhythmia, decreasing LOC — these clients beat stable ones every time.
- EKG changes drive action. ST elevation in 2+ contiguous leads = STEMI = cath lab. Peaked T waves = hyperkalemia.
- Right-sided MI = preload-dependent. Avoid nitroglycerin, give fluids, watch for hypotension.
- Heart failure backs up. Left = lungs (crackles, dyspnea). Right = systemic (JVD, edema, ascites).
- The antidote rule. Heparin → protamine. Warfarin → vitamin K. Digoxin → digoxin immune Fab.
Try these 4 questions now
No signup required. Tap an answer to reveal the rationale.
- Question 1 · Cardiac · MCQ
A client with a history of HFrEF presents with worsening dyspnea, JVD, and 3+ pitting edema. Vitals: BP 92/58, HR 118, SpO2 90% on RA. Which provider order would the nurse question?
- a.Furosemide 40 mg IV push
- b.Oxygen 2 L via nasal cannula
- c.Metoprolol 25 mg PO now
- d.Daily weights
Show answer + rationale
Correct: C. Beta-blockers are essential in chronic HFrEF management but should be held or reduced during acute decompensation with hypotension and tachycardia. Initiating or escalating metoprolol while the client is hypotensive can worsen cardiac output. Furosemide treats volume overload, oxygen treats hypoxia, daily weights monitor fluid status.
- Question 2 · Cardiac · MCQ
Which finding indicates that a client receiving IV nitroglycerin for unstable angina is having an adverse reaction?
- a.Throbbing headache rated 5/10
- b.Blood pressure drop from 140/86 to 84/52
- c.Heart rate increase from 76 to 92
- d.Resolved chest pain
Show answer + rationale
Correct: B. Nitroglycerin causes venodilation and can drop preload severely, especially in clients who are volume-depleted or have right ventricular involvement. Systolic below 90 requires holding the drug and notifying the provider. Headache is expected. Reflex tachycardia is expected. Resolved chest pain is the desired outcome.
- Question 3 · Cardiac · MCQ
A client returns from cardiac catheterization with a right femoral access site. Which finding requires immediate intervention?
- a.Pedal pulses 2+ bilaterally
- b.Small ecchymosis around access site
- c.Cool, mottled right foot with weak posterior tibial pulse
- d.Mild groin discomfort 3/10
Show answer + rationale
Correct: C. Cool, mottled extremity with diminished pulse distal to a femoral access site suggests arterial compromise from hematoma, thrombus, or vessel injury. Requires immediate provider notification and ultrasound. Bilateral 2+ pulses are reassuring. Small ecchymosis is expected. Mild discomfort is normal.
- Question 4 · Cardiac · NGN case study
A 62-year-old client arrives in the ED with crushing substernal chest pain radiating to the left arm, diaphoresis, and a heart rate of 112 bpm. The 12-lead ECG shows ST elevation in leads II, III, and aVF. Troponin is 4.8 ng/mL. The provider orders aspirin 325 mg, sublingual nitroglycerin, and prepares for cardiac catheterization. Which finding would most prompt the nurse to hold the nitroglycerin?
- a.Blood pressure 88/52 mmHg
- b.Heart rate 102 bpm
- c.Reports pain of 7/10
- d.SpO2 95% on 2L nasal cannula
Show answer + rationale
Correct: A. Inferior wall MI (II, III, aVF) frequently involves the right ventricle, which is preload-dependent. Nitroglycerin causes venodilation, dropping preload, and in RV infarction can precipitate profound hypotension and shock. A systolic of 88 with an inferior STEMI is an absolute contraindication. Heart rate 102 is appropriate sympathetic response, pain warrants treatment, and SpO2 95% is acceptable.
These are 5 of 5,000+ NCLEX questions in the Clarity bank. The full bank includes real NGN case studies, bow-tie items, AI tutor follow-up, and 5 readiness exams.
Get 5,000+ more questions free for 10/day →Frequently asked questions
What's the most-tested NCLEX cardiac topic?
Heart failure assessment and acute coronary syndrome management consistently appear on every NCLEX-RN. Together they make up roughly half of all cardiac items.
How do I memorize EKG strips for NCLEX?
Memorize 8 rhythms cold: NSR, sinus brady, sinus tach, A-fib, A-flutter, V-tach, V-fib, asystole. For each, know the priority intervention. You don't need 12-lead interpretation depth on NCLEX.
Is nitroglycerin ever contraindicated in chest pain?
Yes. Hold nitroglycerin if systolic BP <90, suspected right-ventricular MI, or use of PDE-5 inhibitors (sildenafil, tadalafil) within 24–48 hours due to severe hypotension risk.
What's the priority assessment after cardiac catheterization?
Distal pulses, color, temperature, and capillary refill in the affected extremity. Compare to the opposite side. Diminished pulse or cool/mottled extremity suggests arterial compromise requiring immediate notification.