A patient two hours after thrombolysis for MI develops a frequent irregular wide-complex rhythm, then on the monitor a rapid regular wide-complex rhythm with no pulse. The nurse's immediate action is to:

Check the serum potassium first

Take a 12-lead ECG before acting

A patient with community-acquired pneumonia is ordered sputum culture and the first intravenous antibiotic. The nurse should:

Collect the sputum sample before the first dose

Give the antibiotic and collect sputum next day

Send saliva if sputum is scanty

Skip the culture if fever is present

Cardiac, vascular and respiratory nursing

70 Staff nurse recruitment practice questions on Cardiac, vascular and respiratory nursing, 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 · Hard
A patient two hours after thrombolysis for MI develops a frequent irregular wide-complex rhythm, then on the monitor a rapid regular wide-complex rhythm with no pulse. The nurse's immediate action is to:
1. ACheck the serum potassium first
2. BGive a dose of oral aspirin
3. CStart CPR and defibrillate
4. DTake a 12-lead ECG before acting
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Answer: C · Start CPR and defibrillate
Pulseless ventricular tachycardia is a shockable cardiac arrest rhythm. High-quality CPR is started at once and the patient is defibrillated as soon as the defibrillator arrives. Adrenaline and amiodarone follow per ACLS. Reperfusion arrhythmias are common after thrombolysis.
- A: Potassium checks come later, not before CPR.
- B: Aspirin plays no part in treating cardiac arrest.
- D: A 12-lead ECG delays life-saving shock.
Question 2 · Medium
A patient admitted with an inferior wall MI suddenly develops a heart rate of 38 per minute and feels faint. The artery most often involved in this infarct also supplies the:
1. ALeft anterior wall only
2. BAortic valve leaflets
3. CApex of the left ventricle
4. DSA and AV nodes in most people
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Answer: D · SA and AV nodes in most people
The right coronary artery supplies the inferior wall and, in most people, the SA and AV nodes. Inferior MI therefore often causes sinus bradycardia and heart block. Atropine is the first drug for symptomatic bradycardia. Pacing may be needed if it fails.
- A: The anterior wall is supplied by the left anterior descending artery.
- B: Valve leaflets have no coronary supply of this kind.
- C: The apex is supplied mainly by the left anterior descending artery.
Question 3 · Medium
A patient with suspected MI is ordered morphine, oxygen, nitrate and aspirin. Oxygen is indicated in this patient if the SpO2 is below:
1. A95% at any time
2. B100%
3. C90%
4. D98%
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Answer: C · 90%
Current AHA guidance gives oxygen in acute coronary syndrome only when SpO2 is below 90% or the patient is breathless. Routine oxygen in a normally saturated patient gives no benefit and may increase infarct size. Saturation is watched continuously. Pain relief and reperfusion remain the priorities.
- A: 95% is the old routine target, now replaced.
- B: Aiming for 100% causes hyperoxia.
- D: 98% is a normal saturation and needs no oxygen.
Question 4 · Medium
A patient with community-acquired pneumonia is ordered sputum culture and the first intravenous antibiotic. The nurse should:
1. AGive the antibiotic and collect sputum next day
2. BSend saliva if sputum is scanty
3. CCollect the sputum sample before the first dose
4. DSkip the culture if fever is present
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Answer: C · Collect the sputum sample before the first dose
Cultures are taken before antibiotics, since even one dose can stop growth and hide the organism. The sample is an early-morning deep cough specimen, not saliva. The antibiotic should still not be delayed for long. Sepsis guidance aims for antibiotics within one hour when septic.
- A: A sample after antibiotics may grow nothing.
- B: Saliva is not a valid sputum sample.
- D: Fever is a reason to culture, not to skip it.
Question 5 · Medium
An anxious patient breathing rapidly has ABG values of pH 7.50, PaCO2 30 mmHg and HCO3 24 mmol/L. This is:
1. AMetabolic alkalosis
2. BRespiratory alkalosis
3. CMetabolic acidosis
4. DRespiratory acidosis
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Answer: B · Respiratory alkalosis
The pH above 7.45 shows alkalosis. The PaCO2 is low, which matches an alkaline pH, so the cause is respiratory: hyperventilation blowing off CO2. The bicarbonate is normal, so there is no compensation yet. The nurse calms the patient and coaches slow breathing.
- A: Metabolic alkalosis would show a raised bicarbonate.
- C: Metabolic acidosis has a low pH and a low bicarbonate.
- D: Respiratory acidosis has a low pH and a high PaCO2.
Question 6 · Medium
A patient on TB treatment complains of tingling and burning in both feet. The drug most likely responsible, and the vitamin that prevents it, are:
1. APyrazinamide and folic acid
2. BEthambutol and thiamine
3. CRifampicin and vitamin K
4. DIsoniazid and pyridoxine
Answer and explanation in LearnFree account
Question 7 · Easy
A patient in acute pulmonary oedema is best placed in which position?
1. AFlat supine
2. BUpright with legs dangling
3. CTrendelenburg
4. DLeft lateral with legs raised
Answer and explanation in LearnFree account
Question 8 · Hard
A patient with a chest drain after trauma becomes very breathless, the trachea shifts to the opposite side and BP falls. The tubing is found clamped. The nurse's first action is to:
1. ARaise the bottle above the chest
2. BRemove the drain
3. CAdd another clamp
4. DUnclamp the tubing at once
Answer and explanation in LearnFree account
Question 9 · Hard
A 60 kg patient with a massive pulmonary embolism is ordered unfractionated heparin 80 units/kg as an IV bolus. The bolus dose is:
1. A1300 units
2. B4800 units
3. C8000 units
4. D6000 units
Answer and explanation in LearnFree account
Question 10 · Hard
A patient after a large anterior MI has BP 82/50 mmHg, pulse 118, cold clammy skin, crackles to mid-zones and urine 15 mL in the last hour. The most likely condition is:
1. AAnaphylactic shock
2. BCardiogenic shock
3. CSeptic shock
4. DHypovolaemic shock
Answer and explanation in LearnFree account
Question 11 · Easy
A patient starting rifampicin should be told that the drug may colour the urine, sweat and tears:
1. ABluish
2. BDark green
3. CBlack
4. DOrange-red
Answer and explanation in LearnFree account
Question 12 · Hard
A patient with a chest drain for a haemothorax only (no air leak was present) is comfortable with normal SpO2, but the water-seal chamber now bubbles continuously. The nurse should first:
1. AClamp the drain for one hour and observe
2. BAdd more water to stop the bubbling
3. CRaise the drainage unit above chest level
4. DCheck the tubing and connections for a leak
Answer and explanation in LearnFree account
Question 13 · Medium
A patient on long-term amlodipine for hypertension most commonly complains of:
1. AHyperkalaemia
2. BAnkle swelling
3. CDry cough
4. DSlow pulse
Answer and explanation in LearnFree account
Question 14 · Medium
A patient with COPD has ABG values: pH 7.32, PaCO2 58 mmHg, HCO3 34 mmol/L. This is interpreted as:
1. ARespiratory alkalosis, compensated
2. BMetabolic alkalosis, uncompensated
3. CMetabolic acidosis, fully compensated
4. DRespiratory acidosis, partly compensated
Answer and explanation in LearnFree account
Question 15 · Medium
A patient two days after hip surgery suddenly develops chest pain, breathlessness, tachycardia and anxiety. The nurse should first suspect:
1. AAsthma attack
2. BAngina from anxiety
3. CPulmonary embolism
4. DPneumothorax from the anaesthetic
Answer and explanation in LearnFree account
Question 16 · Hard
A patient one day after MI has a pulse of 54, BP 100/64 mmHg and complains of a sharp chest pain worse on lying flat, eased by leaning forward, with a scratchy sound at the left sternal edge. The likely cause is:
1. APericarditis
2. BRe-infarction
3. CPulmonary embolism
4. DAortic dissection
Answer and explanation in LearnFree account
Question 17 · Medium
A patient receiving intravenous heparin for DVT has an aPTT result of 30 seconds against a control of 30 seconds. This shows that the heparin dose is:
1. AToo low to be therapeutic
2. BIn the therapeutic range
3. CNot relevant to aPTT
4. DDangerously high
Answer and explanation in LearnFree account
Question 18 · Easy
The typical sputum of pulmonary oedema from left heart failure is:
1. APink and frothy
2. BThick and white in the morning only
3. CGreen and foul-smelling
4. DRusty coloured
Answer and explanation in LearnFree account
Question 19 · Easy
The normal cardiac output of an adult at rest is about:
1. A10-15 L/min
2. B20-25 L/min
3. C1-2 L/min
4. D4-8 L/min
Answer and explanation in LearnFree account
Question 20 · Medium
After a pneumonectomy, the nurse should position the patient:
1. AOn the back or on the operated side
2. BFully on the unoperated side
3. CFlat with the legs raised
4. DProne with the head lowered
Answer and explanation in LearnFree account
Question 21 · Easy
Hypertensive crisis needing urgent care is defined as a blood pressure above:
1. A180/120 mmHg
2. B160/100 mmHg
3. C130/80 mmHg
4. D140/90 mmHg
Answer and explanation in LearnFree account
Question 22 · Medium
When suctioning an adult tracheostomy, the nurse applies suction for each pass for no longer than:
1. A30-45 seconds
2. B10-15 seconds
3. C1 minute
4. D2 minutes
Answer and explanation in LearnFree account
Question 23 · Hard
A patient with heart failure is ordered 500 mL of normal saline over 6 hours using a microdrip set (60 drops/mL). The drip rate should be about:
1. A139 drops/min
2. B83 drops/min
3. C21 drops/min
4. D50 drops/min
Answer and explanation in LearnFree account
Question 24 · Medium
A patient with stable angina is taught how to use sublingual GTN tablets during an attack. The correct teaching is to:
1. ASit down and repeat every 5 minutes, up to three
2. BSwallow the tablet whole with a glass of water
3. CKeep the tablets in a clear bottle in sunlight
4. DWait an hour of pain before taking any tablet
Answer and explanation in LearnFree account
Question 25 · Medium
A patient with pneumonia is short of breath. To improve ventilation, the nurse positions the patient with a right-sided pneumonia:
1. AFlat supine
2. BLying on the right side
3. CProne with head down
4. DLying on the left side, good lung down
Answer and explanation in LearnFree account

45 more Cardiac, vascular and respiratory nursing questions

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Cardiac, vascular and respiratory nursing

A patient two hours after thrombolysis for MI develops a frequent irregular wide-complex rhythm, then on the monitor a rapid regular wide-complex rhythm with no pulse. The nurse's immediate action is to:

A patient admitted with an inferior wall MI suddenly develops a heart rate of 38 per minute and feels faint. The artery most often involved in this infarct also supplies the:

A patient with suspected MI is ordered morphine, oxygen, nitrate and aspirin. Oxygen is indicated in this patient if the SpO2 is below:

A patient with community-acquired pneumonia is ordered sputum culture and the first intravenous antibiotic. The nurse should:

An anxious patient breathing rapidly has ABG values of pH 7.50, PaCO2 30 mmHg and HCO3 24 mmol/L. This is:

A patient on TB treatment complains of tingling and burning in both feet. The drug most likely responsible, and the vitamin that prevents it, are:

A patient in acute pulmonary oedema is best placed in which position?

A patient with a chest drain after trauma becomes very breathless, the trachea shifts to the opposite side and BP falls. The tubing is found clamped. The nurse's first action is to:

A 60 kg patient with a massive pulmonary embolism is ordered unfractionated heparin 80 units/kg as an IV bolus. The bolus dose is:

A patient after a large anterior MI has BP 82/50 mmHg, pulse 118, cold clammy skin, crackles to mid-zones and urine 15 mL in the last hour. The most likely condition is:

A patient starting rifampicin should be told that the drug may colour the urine, sweat and tears:

A patient with a chest drain for a haemothorax only (no air leak was present) is comfortable with normal SpO2, but the water-seal chamber now bubbles continuously. The nurse should first:

A patient on long-term amlodipine for hypertension most commonly complains of:

A patient with COPD has ABG values: pH 7.32, PaCO2 58 mmHg, HCO3 34 mmol/L. This is interpreted as:

A patient two days after hip surgery suddenly develops chest pain, breathlessness, tachycardia and anxiety. The nurse should first suspect:

A patient one day after MI has a pulse of 54, BP 100/64 mmHg and complains of a sharp chest pain worse on lying flat, eased by leaning forward, with a scratchy sound at the left sternal edge. The likely cause is:

A patient receiving intravenous heparin for DVT has an aPTT result of 30 seconds against a control of 30 seconds. This shows that the heparin dose is:

The typical sputum of pulmonary oedema from left heart failure is:

The normal cardiac output of an adult at rest is about:

After a pneumonectomy, the nurse should position the patient:

Hypertensive crisis needing urgent care is defined as a blood pressure above:

When suctioning an adult tracheostomy, the nurse applies suction for each pass for no longer than:

A patient with heart failure is ordered 500 mL of normal saline over 6 hours using a microdrip set (60 drops/mL). The drip rate should be about:

A patient with stable angina is taught how to use sublingual GTN tablets during an attack. The correct teaching is to:

A patient with pneumonia is short of breath. To improve ventilation, the nurse positions the patient with a right-sided pneumonia: