For high-quality CPR on an adult, the AHA recommends a chest compression depth of:

At least 5 cm but no more than 6 cm

At least 6 cm but no more than 7 cm

At least 3 cm but no more than 4 cm

At least 4 cm but no more than 5 cm

Beck's triad, the classic sign of acute cardiac tamponade, consists of:

Hypotension, distended neck veins and muffled heart sounds

Fever, a new heart murmur and splinter haemorrhages

Chest pain, ST elevation and a raised troponin

Hypertension, bradycardia and irregular breathing

During synchronised cardioversion of a sedated patient with unstable atrial fibrillation, the first shock converts the rhythm to ventricular fibrillation and the patient has no pulse. What should the nurse do next?

Turn the sync mode off and defibrillate at once

Check a carotid pulse for 30 seconds first

Repeat the shock with the sync mode still on

Give adenosine 6 mg and reassess the rhythm

A patient 2 days after an anterior MI is cold and clammy, with crackles to the mid-lung fields. BP 90/60 mmHg, pulse 112/min, PAWP 26 mmHg (reference 6-12) and cardiac index 1.8 L/min/m2 (reference 2.5-4.0). Which new prescription should the nurse question?

0.9% sodium chloride 1,000 mL IV as a bolus

Dobutamine infusion at 5 mcg/kg/min

Oxygen to keep SpO2 at 94% or more

Cardiac care, ECG and haemodynamics

50 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Cardiac care, ECG and haemodynamics, part of Adult Health 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 · Easy
A patient with heart failure is comfortable at rest but becomes breathless while dressing or walking a short distance on level ground. Which New York Heart Association (NYHA) class is this?
1. AClass III
2. BClass II
3. CClass I
4. DClass IV
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Answer: A · Class III
NYHA class III means marked limitation: comfortable at rest, but less than ordinary activity causes fatigue, palpitations or dyspnoea. Class II is slight limitation with ordinary activity, and class IV means symptoms at rest. The class guides activity advice and helps track response to treatment. It can change as the patient improves or worsens.
- B: Class II has symptoms only with ordinary activity, such as climbing stairs.
- C: Class I has no limitation of ordinary physical activity.
- D: Class IV has symptoms at rest or with any activity.
Question 2 · Easy
For high-quality CPR on an adult, the AHA recommends a chest compression depth of:
1. AAt least 6 cm but no more than 7 cm
2. BAt least 5 cm but no more than 6 cm
3. CAt least 3 cm but no more than 4 cm
4. DAt least 4 cm but no more than 5 cm
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Answer: B · At least 5 cm but no more than 6 cm
Adult compressions should be at least 5 cm (2 inches) deep but not more than 6 cm, at 100-120 per minute, with full chest recoil between them. Shallow compressions do not generate enough coronary and cerebral perfusion pressure. Compressions deeper than 6 cm add injuries without benefit. A feedback device or capnography helps the team keep the depth right.
- A: Going beyond 6 cm increases rib, lung and liver injury.
- C: 3-4 cm is too shallow for an adult and gives poor perfusion.
- D: 4-5 cm is still below the 5 cm minimum.
Question 3 · Easy
Beck's triad, the classic sign of acute cardiac tamponade, consists of:
1. AFever, a new heart murmur and splinter haemorrhages
2. BChest pain, ST elevation and a raised troponin
3. CHypertension, bradycardia and irregular breathing
4. DHypotension, distended neck veins and muffled heart sounds
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Answer: D · Hypotension, distended neck veins and muffled heart sounds
In tamponade, fluid or blood in the pericardial sac stops the ventricles filling, so cardiac output and blood pressure fall. Venous blood backs up and the neck veins distend, while the fluid muffles the heart sounds. Pulsus paradoxus is often present too. It is an emergency treated by pericardiocentesis or surgery, and is a known risk after cardiac surgery and chest trauma.
- A: Fever, a new murmur and splinter haemorrhages suggest infective endocarditis.
- B: Chest pain, ST elevation and raised troponin describe a STEMI.
- C: Hypertension, bradycardia and irregular breathing is Cushing's triad of raised intracranial pressure.
Question 4 · Hard
During synchronised cardioversion of a sedated patient with unstable atrial fibrillation, the first shock converts the rhythm to ventricular fibrillation and the patient has no pulse. What should the nurse do next?
1. ACheck a carotid pulse for 30 seconds first
2. BRepeat the shock with the sync mode still on
3. CGive adenosine 6 mg and reassess the rhythm
4. DTurn the sync mode off and defibrillate at once
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Answer: D · Turn the sync mode off and defibrillate at once
In VF there are no R waves for the machine to sense, so a defibrillator left in sync mode may never discharge. Many defibrillators also return to unsynchronised mode after each shock, but this must be checked. Sync is turned off, an unsynchronised shock is delivered at once, and CPR is resumed by the arrest algorithm. Delay to defibrillation lowers survival with every minute.
- A: Pulse checks are limited to 10 seconds; VF needs an immediate shock.
- B: In sync mode the device waits for an R wave and may not fire in VF.
- C: Adenosine has no role in ventricular fibrillation.
Question 5 · Hard
A patient 2 days after an anterior MI is cold and clammy, with crackles to the mid-lung fields. BP 90/60 mmHg, pulse 112/min, PAWP 26 mmHg (reference 6-12) and cardiac index 1.8 L/min/m2 (reference 2.5-4.0). Which new prescription should the nurse question?
1. A0.9% sodium chloride 1,000 mL IV as a bolus
2. BDobutamine infusion at 5 mcg/kg/min
3. COxygen to keep SpO2 at 94% or more
4. DFurosemide 40 mg IV once
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Answer: A · 0.9% sodium chloride 1,000 mL IV as a bolus
A high PAWP with a low cardiac index and pulmonary crackles is cardiogenic shock with fluid overload, the left ventricle failing after a large anterior MI. A 1 L fluid bolus would raise filling pressures further and worsen pulmonary oedema. Inotropic support, cautious diuresis and oxygen for hypoxaemia fit the picture, and urgent revascularisation is considered. The nurse should clarify the fluid order before giving it.
- B: Dobutamine improves contractility and suits a low cardiac index.
- C: Oxygen treats the hypoxaemia that pulmonary oedema causes.
- D: Furosemide reduces the pulmonary congestion shown by the high PAWP.
Question 6 · Hard
A patient with heart failure (ejection fraction 25%) has new atrial fibrillation at 142/min, BP 116/72 mmHg and crackles at both lung bases. Which new prescription should the nurse question?
1. AIV digoxin 0.25 mg as a loading dose
2. BEnoxaparin 1 mg/kg by subcutaneous injection
3. CIV diltiazem 0.25 mg/kg over 2 minutes
4. DIV amiodarone 150 mg over 10 minutes
Answer and explanation in LearnFree account
Question 7 · Medium
A patient with type 2 diabetes is booked for coronary angiography with iodinated contrast. Which of his medicines should the nurse confirm with the cardiologist about withholding?
1. AAtorvastatin
2. BAspirin
3. CMetformin
4. DBisoprolol
Answer and explanation in LearnFree account
Question 8 · Medium
A 6-second rhythm strip from a patient with atrial fibrillation contains 13 QRS complexes. What is the approximate ventricular rate?
1. A216/min
2. B130/min
3. C78/min
4. D65/min
Answer and explanation in LearnFree account
Question 9 · Hard
A patient with unstable angina is prescribed an IV glyceryl trinitrate (nitroglycerin) infusion of 50 mg in 250 mL of 5% dextrose, starting at 10 mcg/min. At what rate should the pump be set?
1. A6 mL/h
2. B0.05 mL/h
3. C30 mL/h
4. D3 mL/h
Answer and explanation in LearnFree account
Question 10 · Medium
After PCI through the right radial artery, a compression band is on the patient's wrist. Which finding needs the nurse's immediate action?
1. ACool, pale fingers with slow capillary refill
2. BMild aching of the wrist when it moves
3. CSlight bruising at the edge of the band
4. DA small dot of dried blood under the band
Answer and explanation in LearnFree account
Question 11 · Medium
A patient's blood pressure is 200/124 mmHg. Which additional finding makes this a hypertensive emergency rather than an urgency?
1. AA headache relieved by paracetamol
2. BAnxiety with a heart rate of 96/min
3. CNew confusion with papilloedema
4. DThree missed doses of amlodipine
Answer and explanation in LearnFree account
Question 12 · Easy
Before a radial arterial line is inserted, which bedside test checks that the ulnar artery can supply the hand?
1. APhalen test
2. BTinel test
3. CModified Allen test
4. DTrendelenburg test
Answer and explanation in LearnFree account
Question 13 · Easy
Prominent U waves on the ECG are a classic sign of:
1. AHypokalaemia
2. BHyperkalaemia
3. CHypermagnesaemia
4. DHypercalcaemia
Answer and explanation in LearnFree account
Question 14 · Hard
Four hours after major abdominal surgery, a patient has BP 86/52 mmHg, pulse 124/min and urine output 15 mL/h. Readings: CVP 1 mmHg (reference 2-8), PAWP 4 mmHg (reference 6-12), cardiac index 1.9 L/min/m2 (reference 2.5-4.0) and raised SVR. Which prescription should the nurse expect first?
1. AA noradrenaline infusion
2. BIV furosemide 40 mg
3. CA dobutamine infusion
4. DAn IV fluid bolus
Answer and explanation in LearnFree account
Question 15 · Easy
When giving chest compressions to an adult in cardiac arrest, the rescuer places the heel of the hand:
1. ADirectly over the xiphoid process
2. BOn the upper third of the sternum
3. CLeft of the sternum over the apex
4. DOn the lower half of the sternum
Answer and explanation in LearnFree account
Question 16 · Hard
Dobutamine 500 mg in 250 mL of 5% dextrose is prescribed at 5 mcg/kg/min for an 80 kg patient. At what rate should the pump be set?
1. A12 mL/h
2. B6 mL/h
3. C24 mL/h
4. D120 mL/h
Answer and explanation in LearnFree account
Question 17 · Easy
The specific reversal agent for the direct thrombin inhibitor dabigatran is:
1. AAndexanet alfa
2. BProtamine sulphate
3. CVitamin K (phytomenadione)
4. DIdarucizumab
Answer and explanation in LearnFree account
Question 18 · Medium
A patient's cardiac monitor suddenly shows a chaotic, irregular waveform with no recognisable QRS complexes. At the bedside the nurse finds him sitting up, talking and brushing his teeth. What should the nurse do first?
1. AGive adrenaline 1 mg by IV push
2. BCall a code blue and start chest compressions
3. CCheck the electrodes and lead connections
4. DDeliver an unsynchronised shock at once
Answer and explanation in LearnFree account
Question 19 · Medium
A patient is found unresponsive with no pulse, but the monitor shows organised sinus rhythm at 70/min. After starting CPR, which drug should be given first?
1. AAtropine 1 mg by IV push
2. BAdrenaline 1 mg IV as soon as possible
3. CAmiodarone 300 mg by IV push
4. DAdenosine 6 mg by rapid IV push
Answer and explanation in LearnFree account
Question 20 · Easy
For a patient with suspected acute coronary syndrome and no contraindication, aspirin is given as:
1. A300 mg as a rectal suppository only
2. B162-325 mg non-enteric-coated, chewed
3. C75 mg enteric-coated, swallowed whole
4. D81 mg enteric-coated after a meal
Answer and explanation in LearnFree account
Question 21 · Medium
A 55-year-old man walks into the emergency department with 20 minutes of central chest tightness and sweating. What should the triage nurse do first?
1. AAsk him to wait for the doctor's review
2. BSend blood for troponin and await the result
3. CObtain a 12-lead ECG within 10 minutes
4. DGive sublingual GTN before any assessment
Answer and explanation in LearnFree account
Question 22 · Hard
A patient with an inferior MI is dizzy and grey. BP 80/48 mmHg. The monitor shows P waves at 84/min and narrow QRS complexes at 40/min with no fixed relationship between them. Atropine 1 mg has been given three times, without effect. What is the next step?
1. AGive amiodarone 150 mg over 10 minutes
2. BStart transcutaneous pacing
3. CGive a fourth 1 mg dose of atropine
4. DGive adenosine 6 mg rapid IV push
Answer and explanation in LearnFree account
Question 23 · Medium
A patient with heart failure takes spironolactone and lisinopril. Which of today's results should the nurse report most urgently?
1. APotassium 6.2 mmol/L (reference 3.5-5.0)
2. BCreatinine 88 µmol/L (1.0 mg/dL)
3. CSodium 136 mmol/L (reference 135-145)
4. DFasting glucose 6.8 mmol/L (122 mg/dL)
Answer and explanation in LearnFree account
Question 24 · Hard
A 49-year-old man arrives at a hospital without a cath lab 1 hour after chest pain began. His ECG shows ST elevation in V1-V4, and he has no contraindications to fibrinolysis. Transfer to the nearest PCI centre would take about 150 minutes. Which plan is most appropriate?
1. ATransfer for primary PCI despite the delay
2. BFibrinolysis within 30 minutes of arrival
3. CHeparin alone until troponin results return
4. DRepeat the ECG in 6 hours before deciding
Answer and explanation in LearnFree account
Question 25 · Medium
Which patient is most likely to have an acute myocardial infarction without typical crushing chest pain?
1. AA 45-year-old man who smokes 20 cigarettes a day
2. BA 50-year-old man with untreated hyperlipidaemia
3. CA 38-year-old man with a strong family history
4. DA 68-year-old woman with long-standing diabetes
Answer and explanation in LearnFree account

25 more Cardiac care, ECG and haemodynamics questions

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Cardiac care, ECG and haemodynamics

A patient with heart failure is comfortable at rest but becomes breathless while dressing or walking a short distance on level ground. Which New York Heart Association (NYHA) class is this?

For high-quality CPR on an adult, the AHA recommends a chest compression depth of:

Beck's triad, the classic sign of acute cardiac tamponade, consists of:

During synchronised cardioversion of a sedated patient with unstable atrial fibrillation, the first shock converts the rhythm to ventricular fibrillation and the patient has no pulse. What should the nurse do next?

A patient 2 days after an anterior MI is cold and clammy, with crackles to the mid-lung fields. BP 90/60 mmHg, pulse 112/min, PAWP 26 mmHg (reference 6-12) and cardiac index 1.8 L/min/m2 (reference 2.5-4.0). Which new prescription should the nurse question?

A patient with heart failure (ejection fraction 25%) has new atrial fibrillation at 142/min, BP 116/72 mmHg and crackles at both lung bases. Which new prescription should the nurse question?

A patient with type 2 diabetes is booked for coronary angiography with iodinated contrast. Which of his medicines should the nurse confirm with the cardiologist about withholding?

A 6-second rhythm strip from a patient with atrial fibrillation contains 13 QRS complexes. What is the approximate ventricular rate?

A patient with unstable angina is prescribed an IV glyceryl trinitrate (nitroglycerin) infusion of 50 mg in 250 mL of 5% dextrose, starting at 10 mcg/min. At what rate should the pump be set?

After PCI through the right radial artery, a compression band is on the patient's wrist. Which finding needs the nurse's immediate action?

A patient's blood pressure is 200/124 mmHg. Which additional finding makes this a hypertensive emergency rather than an urgency?

Before a radial arterial line is inserted, which bedside test checks that the ulnar artery can supply the hand?

Prominent U waves on the ECG are a classic sign of:

Four hours after major abdominal surgery, a patient has BP 86/52 mmHg, pulse 124/min and urine output 15 mL/h. Readings: CVP 1 mmHg (reference 2-8), PAWP 4 mmHg (reference 6-12), cardiac index 1.9 L/min/m2 (reference 2.5-4.0) and raised SVR. Which prescription should the nurse expect first?

When giving chest compressions to an adult in cardiac arrest, the rescuer places the heel of the hand:

Dobutamine 500 mg in 250 mL of 5% dextrose is prescribed at 5 mcg/kg/min for an 80 kg patient. At what rate should the pump be set?

The specific reversal agent for the direct thrombin inhibitor dabigatran is:

A patient's cardiac monitor suddenly shows a chaotic, irregular waveform with no recognisable QRS complexes. At the bedside the nurse finds him sitting up, talking and brushing his teeth. What should the nurse do first?

A patient is found unresponsive with no pulse, but the monitor shows organised sinus rhythm at 70/min. After starting CPR, which drug should be given first?

For a patient with suspected acute coronary syndrome and no contraindication, aspirin is given as:

A 55-year-old man walks into the emergency department with 20 minutes of central chest tightness and sweating. What should the triage nurse do first?

A patient with an inferior MI is dizzy and grey. BP 80/48 mmHg. The monitor shows P waves at 84/min and narrow QRS complexes at 40/min with no fixed relationship between them. Atropine 1 mg has been given three times, without effect. What is the next step?

A patient with heart failure takes spironolactone and lisinopril. Which of today's results should the nurse report most urgently?

A 49-year-old man arrives at a hospital without a cath lab 1 hour after chest pain began. His ECG shows ST elevation in V1-V4, and he has no contraindications to fibrinolysis. Transfer to the nearest PCI centre would take about 150 minutes. Which plan is most appropriate?

Which patient is most likely to have an acute myocardial infarction without typical crushing chest pain?