Which finding during fibrinolytic therapy for STEMI best indicates that the artery has reopened?

ST elevation falls by at least 50% within 60-90 minutes

Deep Q waves appear in the same leads

A new left bundle branch block appears

Troponin returns to normal within 6 hours

During CPR on an intubated patient, the waveform capnography reading rises suddenly from 12 to 40 mm Hg. This most likely means:

Return of spontaneous circulation

The patient has been over-ventilated

Chest compressions have become too shallow

The tube has slipped into the oesophagus

A patient with heart failure is taught to monitor daily weight at home. The weight should be taken:

At the same time each morning, after voiding and before breakfast

Only on days when the ankles look swollen

Before and after each dose of the diuretic

In the evening after the last meal, wearing any clothes

Two hours after PCI through the right femoral artery, a patient says he feels something warm and wet in his groin. The dressing is soaked with bright red blood. The nurse's first action is to:

Apply firm manual pressure just above the puncture site

Ask the patient to bend the right knee

Remove the dressing to look for the exact bleeding point

Raise the head of the bed to 45 degrees

Unlike the pain of stable angina, the chest pain of an acute myocardial infarction typically:

Lasts over 20 minutes and is not relieved by rest or nitroglycerin

Is brought on by exertion and settles within 5 minutes of rest

Is sharp, stabbing and made worse by deep breathing

Is relieved by sitting up and leaning forward

Cardiovascular: MI, heart failure and shock

34 AIIMS NORCET (Nursing Officer) practice questions on Cardiovascular: MI, heart failure and shock, part of Medical-Surgical Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Which finding during fibrinolytic therapy for STEMI best indicates that the artery has reopened?
1. AST elevation falls by at least 50% within 60-90 minutes
2. BDeep Q waves appear in the same leads
3. CA new left bundle branch block appears
4. DTroponin returns to normal within 6 hours
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Answer: A · ST elevation falls by at least 50% within 60-90 minutes
Reperfusion is shown by relief of chest pain, resolution of ST elevation by at least half within 60-90 minutes, and often reperfusion arrhythmias such as accelerated idioventricular rhythm. Troponin actually rises sharply after reperfusion as it is washed out of the damaged tissue. Q waves reflect necrosis already present. If ST elevation persists, the patient needs rescue PCI.
- B: Q waves show necrosis and can develop even when reperfusion succeeds.
- C: A new LBBB suggests extensive ischaemia, not successful reperfusion.
- D: Troponin washout makes levels peak early and stay high for days after reperfusion.
Question 2 · Medium
During CPR on an intubated patient, the waveform capnography reading rises suddenly from 12 to 40 mm Hg. This most likely means:
1. AThe patient has been over-ventilated
2. BChest compressions have become too shallow
3. CThe tube has slipped into the oesophagus
4. DReturn of spontaneous circulation
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Answer: D · Return of spontaneous circulation
End-tidal CO2 during CPR reflects blood flow through the lungs. When the heart starts beating on its own, flow and CO2 delivery jump, so an abrupt rise to 35-40 mm Hg or more is a strong sign of ROSC. The team then checks the pulse and rhythm. A persistently low reading below 10 mm Hg suggests poor compressions.
- A: Over-ventilation washes CO2 out and lowers the reading.
- B: Shallow compressions lower the reading, often below 10 mm Hg.
- C: Oesophageal placement gives a near-zero, flat reading, not a rise.
Question 3 · Easy
A patient with heart failure is taught to monitor daily weight at home. The weight should be taken:
1. AOnly on days when the ankles look swollen
2. BBefore and after each dose of the diuretic
3. CIn the evening after the last meal, wearing any clothes
4. DAt the same time each morning, after voiding and before breakfast
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Answer: D · At the same time each morning, after voiding and before breakfast
Daily weight is the most sensitive home measure of fluid retention, because 1 kg of weight gain is about 1 litre of fluid. Weighing at the same time, after voiding, before eating, on the same scale and in similar clothing removes other causes of change. A gain of about 1-1.5 kg in a day or 2 kg in a week should be reported. Swelling appears only after several litres have accumulated.
- A: Oedema is a late sign; waiting for it misses early fluid gain.
- B: Weighing around each dose gives no consistent daily trend.
- C: Evening weights after meals vary with food and drink, hiding the fluid trend.
Question 4 · Medium
Two hours after PCI through the right femoral artery, a patient says he feels something warm and wet in his groin. The dressing is soaked with bright red blood. The nurse's first action is to:
1. AAsk the patient to bend the right knee
2. BRemove the dressing to look for the exact bleeding point
3. CRaise the head of the bed to 45 degrees
4. DApply firm manual pressure just above the puncture site
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Answer: D · Apply firm manual pressure just above the puncture site
Bright bleeding from a femoral sheath site is arterial and can quickly cause haematoma or shock. The first step is firm manual pressure just proximal to the skin puncture, over the arterial entry point, while calling for help. Vital signs and distal pulses are then checked and the physician informed. The leg is kept straight and the head of the bed low to avoid flexing the groin.
- A: Bending the knee flexes the hip and worsens femoral bleeding.
- B: Removing the dressing delays pressure while the patient keeps bleeding.
- C: Raising the head flexes the hip and increases bleeding from the groin.
Question 5 · Easy
Unlike the pain of stable angina, the chest pain of an acute myocardial infarction typically:
1. ALasts over 20 minutes and is not relieved by rest or nitroglycerin
2. BIs brought on by exertion and settles within 5 minutes of rest
3. CIs sharp, stabbing and made worse by deep breathing
4. DIs relieved by sitting up and leaning forward
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Answer: A · Lasts over 20 minutes and is not relieved by rest or nitroglycerin
Infarction pain comes from ongoing ischaemia and cell death, so it persists beyond 20-30 minutes and does not ease with rest or sublingual nitroglycerin. Stable angina is brief, predictable with exertion and relieved by rest or nitrates. Pain that persists after nitroglycerin is a red flag that must be treated as possible MI, with an ECG within 10 minutes. Diabetics and older adults may have little or no pain.
- B: Exertional pain settling within minutes of rest describes stable angina.
- C: Sharp pain worse on breathing suggests pleurisy or pericarditis.
- D: Relief on leaning forward is typical of pericarditis.
Question 6 · Medium
Which finding is an absolute contraindication to fibrinolytic therapy in a patient with STEMI?
1. AWarfarin therapy with an INR of 2.0
2. BCurrent pregnancy of 20 weeks
3. CA haemorrhagic stroke two years ago
4. DBlood pressure of 170/100 mm Hg
Answer and explanation in LearnFree account
Question 7 · Easy
For a patient with STEMI who arrives at a hospital that can perform primary PCI, the target door-to-balloon time is:
1. A30 minutes or less
2. B90 minutes or less
3. C6 hours or less
4. D12 hours or less
Answer and explanation in LearnFree account
Question 8 · Medium
Six hours after CABG, a patient's mediastinal chest tube drainage, which had been 150 mL/h, suddenly stops. BP falls to 82/60 mm Hg, CVP rises to 18 mm Hg and heart sounds are muffled. The most likely cause is:
1. ACardiac tamponade
2. BTension pneumothorax
3. CLeft ventricular failure
4. DHypovolaemic shock
Answer and explanation in LearnFree account
Question 9 · Hard
A day after an extensive anterior MI, a patient is confused, with cold, clammy skin, BP 78/52 mm Hg, pulse 118/min and crackles to the mid-zones. Haemodynamics: cardiac index 1.6 L/min/m2 (normal 2.5-4.0), PCWP 26 mm Hg (normal 6-12) and SVR 1,900 dyn·s/cm5 (normal 800-1,200). Which type of shock is this?
1. AHypovolaemic shock
2. BCardiogenic shock
3. CSeptic shock
4. DNeurogenic shock
Answer and explanation in LearnFree account
Question 10 · Medium
A patient with suspected acute coronary syndrome has SpO2 96% on room air. According to AHA guidance, supplemental oxygen should be started when SpO2 falls below:
1. A94%
2. B98%
3. C90%
4. D85%
Answer and explanation in LearnFree account
Question 11 · Hard
A 60 kg woman with urosepsis has BP 84/48 mm Hg and lactate 4.6 mmol/L. The Surviving Sepsis Campaign 30 mL/kg crystalloid is to be given over the first 3 hours. At what hourly rate should the fluid run?
1. A900 mL/h
2. B1,800 mL/h
3. C600 mL/h
4. D200 mL/h
Answer and explanation in LearnFree account
Question 12 · Hard
A patient with chest pain has ST elevation in leads II, III and aVF and in right-sided lead V4R. BP is 84/56 mm Hg, JVP is raised and the lungs are clear. Which is the most appropriate nursing action?
1. AGive sublingual nitroglycerin 0.4 mg to relieve the chest pain
2. BRestrict fluids and place the patient flat
3. CWithhold nitroglycerin and prepare an IV normal saline bolus as ordered
4. DGive IV furosemide 40 mg to treat the raised JVP
Answer and explanation in LearnFree account
Question 13 · Medium
In a breathless patient arriving in the emergency department, a B-type natriuretic peptide (BNP) level is mainly used to:
1. AHelp tell heart failure apart from lung causes of breathlessness
2. BDetect a pulmonary embolism in the lower lobes
3. CConfirm that an acute myocardial infarction has occurred
4. DMeasure the dose of digoxin the patient needs
Answer and explanation in LearnFree account
Question 14 · Hard
A 70 kg patient in cardiogenic shock is ordered dopamine at 5 mcg/kg/min. The infusion contains 400 mg dopamine in 250 mL of 5% dextrose. At what rate should the infusion pump be set?
1. A26.3 mL/h
2. B21.0 mL/h
3. C13.1 mL/h
4. D0.22 mL/h
Answer and explanation in LearnFree account
Question 15 · Easy
Which cardiac biomarker is the earliest to rise after a myocardial infarction, within 1-3 hours, but is not specific to heart muscle?
1. AMyoglobin
2. BCardiac troponin I
3. CLactate dehydrogenase
4. DCK-MB
Answer and explanation in LearnFree account
Question 16 · Medium
During CPR for an adult in asystole, intravenous adrenaline 1 mg should be given:
1. AOnly when the rhythm changes to ventricular fibrillation
2. BAs soon as possible, then every 3-5 minutes
3. COnce, after 10 minutes of CPR without response
4. DOnly after the second shock has been delivered
Answer and explanation in LearnFree account
Question 17 · Medium
Ten minutes after an IV antibiotic, a 35-year-old woman has stridor, widespread urticaria and BP 76/40 mm Hg. Which treatment should the nurse expect to give first?
1. AAdrenaline 0.5 mg (1 mg/mL) intramuscularly into the thigh
2. BChlorpheniramine 10 mg by slow IV injection
3. CHydrocortisone 200 mg by slow IV injection
4. DAdrenaline 1 mg (1 mg/mL) as a rapid IV push
Answer and explanation in LearnFree account
Question 18 · Hard
A patient in cardiogenic shock has an intra-aortic balloon pump inserted through the right femoral artery. An hour later, the nurse finds the left radial pulse much weaker than before, while the right radial pulse and urine output are unchanged. What is the most likely cause?
1. AA femoral haematoma is forming at the insertion site
2. BThe balloon is inflating too late, after the dicrotic notch
3. CThe balloon has migrated down, blocking the renal arteries
4. DThe balloon has migrated up, blocking the left subclavian artery
Answer and explanation in LearnFree account
Question 19 · Hard
A 49-year-old woman reaches the emergency department 1 hour after the onset of central chest pressure. Her 12-lead ECG shows no ST elevation and her first troponin is within the reference range. The pain continues. What should the nurse anticipate next?
1. AA CK-MB test, which rises earlier than troponin
2. BFibrinolytic therapy now, because the pain is continuing
3. CDischarge home, because the normal troponin has excluded MI
4. DSerial ECGs and a repeat troponin at the protocol interval
Answer and explanation in LearnFree account
Question 20 · Easy
During vasopressor treatment of septic shock, the initial target mean arterial pressure recommended by the Surviving Sepsis Campaign is:
1. A65 mm Hg
2. B90 mm Hg
3. C110 mm Hg
4. D50 mm Hg
Answer and explanation in LearnFree account
Question 21 · Easy
The most common cause of death in the first few hours after an acute myocardial infarction is:
1. ADressler syndrome
2. BPulmonary embolism
3. CCardiac tamponade from wall rupture
4. DVentricular fibrillation
Answer and explanation in LearnFree account
Question 22 · Medium
During an in-hospital cardiac arrest, the patient has been intubated and compressions are continuing. The nurse giving bag ventilation through the tube should give:
1. A2 breaths after every 30 compressions
2. B1 breath every 15 seconds during compression pauses
3. C1 breath every 2 seconds without pausing compressions
4. D1 breath every 6 seconds without pausing compressions
Answer and explanation in LearnFree account
Question 23 · Medium
Three weeks after an MI, a patient has fever, chest pain that worsens on lying flat and eases on leaning forward, and a pericardial friction rub. The most likely diagnosis is:
1. APapillary muscle rupture
2. BDressler syndrome
3. CReinfarction
4. DVentricular aneurysm
Answer and explanation in LearnFree account
Question 24 · Medium
A patient recovering from MI asks when it is safe to resume sexual activity. The usual guide the nurse gives is when he can:
1. AWalk slowly across the room and back without stopping
2. BSit up in a chair for one hour
3. CClimb two flights of stairs briskly without chest pain or breathlessness
4. DLie flat at night without needing extra pillows
Answer and explanation in LearnFree account
Question 25 · Medium
A 24-year-old man has a C6 spinal cord injury after a fall. His BP is 80/50 mm Hg, pulse 48/min, and his skin is warm and dry below the injury. Which type of shock is most likely?
1. ANeurogenic shock
2. BCardiogenic shock
3. CHypovolaemic shock
4. DSeptic shock
Answer and explanation in LearnFree account

9 more Cardiovascular: MI, heart failure and shock questions

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Cardiovascular: MI, heart failure and shock

Which finding during fibrinolytic therapy for STEMI best indicates that the artery has reopened?

During CPR on an intubated patient, the waveform capnography reading rises suddenly from 12 to 40 mm Hg. This most likely means:

A patient with heart failure is taught to monitor daily weight at home. The weight should be taken:

Two hours after PCI through the right femoral artery, a patient says he feels something warm and wet in his groin. The dressing is soaked with bright red blood. The nurse's first action is to:

Unlike the pain of stable angina, the chest pain of an acute myocardial infarction typically:

Which finding is an absolute contraindication to fibrinolytic therapy in a patient with STEMI?

For a patient with STEMI who arrives at a hospital that can perform primary PCI, the target door-to-balloon time is:

Six hours after CABG, a patient's mediastinal chest tube drainage, which had been 150 mL/h, suddenly stops. BP falls to 82/60 mm Hg, CVP rises to 18 mm Hg and heart sounds are muffled. The most likely cause is:

A patient with suspected acute coronary syndrome has SpO2 96% on room air. According to AHA guidance, supplemental oxygen should be started when SpO2 falls below:

A 60 kg woman with urosepsis has BP 84/48 mm Hg and lactate 4.6 mmol/L. The Surviving Sepsis Campaign 30 mL/kg crystalloid is to be given over the first 3 hours. At what hourly rate should the fluid run?

A patient with chest pain has ST elevation in leads II, III and aVF and in right-sided lead V4R. BP is 84/56 mm Hg, JVP is raised and the lungs are clear. Which is the most appropriate nursing action?

In a breathless patient arriving in the emergency department, a B-type natriuretic peptide (BNP) level is mainly used to:

A 70 kg patient in cardiogenic shock is ordered dopamine at 5 mcg/kg/min. The infusion contains 400 mg dopamine in 250 mL of 5% dextrose. At what rate should the infusion pump be set?

Which cardiac biomarker is the earliest to rise after a myocardial infarction, within 1-3 hours, but is not specific to heart muscle?

During CPR for an adult in asystole, intravenous adrenaline 1 mg should be given:

Ten minutes after an IV antibiotic, a 35-year-old woman has stridor, widespread urticaria and BP 76/40 mm Hg. Which treatment should the nurse expect to give first?

A patient in cardiogenic shock has an intra-aortic balloon pump inserted through the right femoral artery. An hour later, the nurse finds the left radial pulse much weaker than before, while the right radial pulse and urine output are unchanged. What is the most likely cause?

A 49-year-old woman reaches the emergency department 1 hour after the onset of central chest pressure. Her 12-lead ECG shows no ST elevation and her first troponin is within the reference range. The pain continues. What should the nurse anticipate next?

During vasopressor treatment of septic shock, the initial target mean arterial pressure recommended by the Surviving Sepsis Campaign is:

The most common cause of death in the first few hours after an acute myocardial infarction is:

During an in-hospital cardiac arrest, the patient has been intubated and compressions are continuing. The nurse giving bag ventilation through the tube should give:

Three weeks after an MI, a patient has fever, chest pain that worsens on lying flat and eases on leaning forward, and a pericardial friction rub. The most likely diagnosis is:

A patient recovering from MI asks when it is safe to resume sexual activity. The usual guide the nurse gives is when he can:

A 24-year-old man has a C6 spinal cord injury after a fall. His BP is 80/50 mm Hg, pulse 48/min, and his skin is warm and dry below the injury. Which type of shock is most likely?