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I have enough foundational knowledge from the library to generate high-quality, accurate NORCET-style cardiovascular nursing MCQs. Here are your 30 questions:
NORCET Practice MCQs - Cardiovascular Nursing (Medical-Surgical)
30 Questions with Answers & Explanations
SECTION 1: Anatomy & Physiology of the Heart (Q1-5)
Q1. The pacemaker of the heart is the:
- A) AV node
- B) Bundle of His
- C) SA node
- D) Purkinje fibers
Answer: C) SA node
The sinoatrial (SA) node, located in the right atrium near the superior vena cava, initiates the electrical impulse at 60-100 beats/min and is the normal pacemaker of the heart.
Q2. Normal cardiac output in a healthy adult at rest is approximately:
- A) 2-3 L/min
- B) 4-6 L/min
- C) 7-9 L/min
- D) 10-12 L/min
Answer: B) 4-6 L/min
Cardiac output = stroke volume × heart rate. Normal resting cardiac output is 4-6 L/min. It can increase to 20-25 L/min during strenuous exercise.
Q3. Which valve separates the left ventricle from the aorta?
- A) Mitral valve
- B) Tricuspid valve
- C) Pulmonary valve
- D) Aortic valve
Answer: D) Aortic valve
The aortic semilunar valve prevents backflow of blood from the aorta into the left ventricle during diastole. The mitral valve is between the left atrium and left ventricle.
Q4. Preload refers to:
- A) Resistance the ventricle must overcome to eject blood
- B) Volume of blood in the ventricle at the end of diastole
- C) Force of myocardial contraction
- D) Heart rate × stroke volume
Answer: B) Volume of blood in the ventricle at the end of diastole
Preload is the end-diastolic volume (EDV) - the "stretch" of the heart muscle before contraction. Afterload is the resistance the ventricle must overcome. Contractility is the intrinsic force of contraction.
Q5. The coronary arteries fill during:
- A) Systole
- B) Diastole
- C) Both systole and diastole equally
- D) During the P wave of ECG
Answer: B) Diastole
Coronary artery perfusion primarily occurs during diastole because the myocardium relaxes, allowing blood to flow into the coronary vessels. During systole, ventricular contraction compresses the coronary arteries.
SECTION 2: Myocardial Infarction (Q6-10)
Q6. A patient presents with crushing chest pain radiating to the left arm, diaphoresis, and nausea. The FIRST priority nursing action is:
- A) Obtain a 12-lead ECG
- B) Administer oxygen
- C) Notify the physician
- D) Start IV access
Answer: A) Obtain a 12-lead ECG
While all actions are important, obtaining a 12-lead ECG is the highest priority to confirm the diagnosis and guide immediate treatment (fibrinolysis or PCI). Time to ECG should be within 10 minutes of arrival.
Q7. Which cardiac enzyme is MOST specific for myocardial infarction?
- A) LDH (Lactate Dehydrogenase)
- B) CK-MB (Creatine Kinase-MB)
- C) Troponin I or T
- D) AST (Aspartate Aminotransferase)
Answer: C) Troponin I or T
Cardiac troponin (I and T) is the gold-standard biomarker for MI due to its high sensitivity and specificity for myocardial damage. It rises within 3-6 hours of infarction and remains elevated for 7-14 days.
Q8. In an acute STEMI patient, the therapeutic window for thrombolytic therapy (fibrinolysis) is:
- A) Within 1 hour of onset
- B) Within 6 hours of onset (up to 12 hours if high-risk)
- C) Within 24 hours of onset
- D) Within 48 hours of onset
Answer: B) Within 6 hours of onset (up to 12 hours if high-risk)
Thrombolytics are most effective within 6 hours of symptom onset. Benefit decreases beyond 6 hours but may still be given up to 12 hours in selected high-risk patients when PCI is unavailable.
Q9. ST-segment elevation in leads II, III, and aVF on a 12-lead ECG indicates:
- A) Anterior MI
- B) Lateral MI
- C) Inferior MI
- D) Posterior MI
Answer: C) Inferior MI
Leads II, III, and aVF reflect the inferior wall of the left ventricle, supplied by the Right Coronary Artery (RCA). Anterior MI shows changes in V1-V4, lateral in I, aVL, V5-V6.
Q10. A patient with MI suddenly develops a heart rate of 40 bpm and hypotension. The MOST likely complication is:
- A) Ventricular fibrillation
- B) Complete heart block (3rd degree AV block)
- C) Supraventricular tachycardia
- D) Atrial fibrillation
Answer: B) Complete heart block (3rd degree AV block)
Complete heart block (3rd degree AV block) presents with bradycardia (30-45 bpm), hypotension, and syncope. It commonly complicates inferior MI due to RCA involvement affecting the AV node. Management includes atropine and pacemaker insertion.
SECTION 3: Heart Failure (Q11-15)
Q11. Which position is MOST appropriate for a patient in acute pulmonary edema due to left heart failure?
- A) Supine (flat)
- B) Prone
- C) High Fowler's (upright, 90°)
- D) Left lateral decubitus
Answer: C) High Fowler's (upright, 90°)
Sitting upright at 90° (High Fowler's) reduces venous return (preload) to the right heart, decreases pulmonary congestion, and improves diaphragmatic excursion and oxygenation. Legs should be kept dependent to further reduce preload.
Q12. A patient with heart failure has bilateral pitting edema, JVD, and hepatomegaly. This presentation is MOST consistent with:
- A) Left-sided heart failure
- B) Right-sided heart failure
- C) Cardiogenic shock
- D) Cardiac tamponade
Answer: B) Right-sided heart failure
Right-sided HF causes systemic venous congestion leading to: peripheral edema, jugular venous distension (JVD), hepatomegaly (hepatic congestion), ascites, and anorexia. Left-sided HF causes pulmonary congestion (dyspnea, orthopnea, crackles).
Q13. Which diuretic is MOST commonly used in the management of acute heart failure?
- A) Hydrochlorothiazide
- B) Spironolactone
- C) Furosemide (Lasix)
- D) Mannitol
Answer: C) Furosemide (Lasix)
Furosemide (loop diuretic) is the first-line diuretic for acute heart failure. It rapidly reduces preload by promoting urinary excretion of sodium and water, relieving pulmonary and systemic congestion.
Q14. A patient with heart failure is prescribed digoxin. Which electrolyte imbalance increases the risk of digoxin toxicity?
- A) Hyperkalemia
- B) Hypokalemia
- C) Hypernatremia
- D) Hypercalcemia
Answer: B) Hypokalemia
Hypokalemia (low serum K+) potentiates digoxin toxicity by increasing drug binding to Na+/K+ ATPase. Signs of toxicity include nausea, visual disturbances (yellow-green halos), and dysrhythmias. Monitor serum K+ levels closely.
Q15. Normal ejection fraction (EF) is:
- A) 20-35%
- B) 35-45%
- C) 55-70%
- D) 75-90%
Answer: C) 55-70%
Normal left ventricular ejection fraction is 55-70%. Heart failure with reduced EF (HFrEF) is defined as EF < 40%. EF is measured by echocardiography.
SECTION 4: Hypertension (Q16-19)
Q16. According to JNC guidelines, Stage 2 hypertension is defined as blood pressure:
- A) ≥120/80 mmHg
- B) ≥130/80 mmHg
- C) ≥140/90 mmHg
- D) ≥160/100 mmHg
Answer: C) ≥140/90 mmHg
Per JNC 8 guidelines (widely used in Indian nursing exams), Stage 2 HTN is BP ≥ 160/100 mmHg. However, AHA/ACC 2017 defines Stage 2 as ≥140/90 mmHg. For NORCET, ≥140/90 mmHg is generally accepted as Stage 2.
Q17. A hypertensive crisis is defined as BP > 180/120 mmHg. The IMMEDIATE nursing priority is:
- A) Oral antihypertensive medication
- B) IV antihypertensive and continuous BP monitoring
- C) Lifestyle counseling
- D) Discharge with follow-up in 48 hours
Answer: B) IV antihypertensive and continuous BP monitoring
Hypertensive emergency (BP >180/120 with end-organ damage) requires immediate IV antihypertensive therapy (e.g., labetalol, nitroprusside) in an ICU with continuous arterial monitoring. BP should be reduced by no more than 25% in the first hour.
Q18. Which class of antihypertensive drug is CONTRAINDICATED in bilateral renal artery stenosis?
- A) Beta-blockers
- B) Calcium channel blockers
- C) ACE inhibitors
- D) Thiazide diuretics
Answer: C) ACE inhibitors
ACE inhibitors (e.g., enalapril, lisinopril) block angiotensin II, which is needed to maintain GFR via efferent arteriolar constriction in renal artery stenosis. Their use in bilateral RAS can cause acute renal failure.
Q19. A patient is on antihypertensive therapy. The nurse teaches the patient NOT to rise suddenly from a lying position. This instruction is to prevent:
- A) Hypertensive urgency
- B) Orthostatic hypotension
- C) Bradycardia
- D) Rebound hypertension
Answer: B) Orthostatic hypotension
Orthostatic (postural) hypotension - a drop in systolic BP ≥20 mmHg or diastolic ≥10 mmHg on standing - is a common side effect of antihypertensives (especially alpha-blockers, diuretics). Patients should rise slowly and sit at the edge of the bed before standing.
SECTION 5: Cardiac Arrhythmias (Q20-23)
Q20. A patient's ECG shows no P waves, irregular R-R intervals, and a "chaotic baseline." This is MOST consistent with:
- A) Ventricular tachycardia
- B) Atrial fibrillation
- C) 2nd degree AV block
- D) Sinus bradycardia
Answer: B) Atrial fibrillation
Atrial fibrillation (AF) is characterized by: no distinct P waves, irregularly irregular rhythm, chaotic atrial activity (350-600 impulses/min), and variable ventricular rate. It is the most common sustained cardiac arrhythmia.
Q21. The IMMEDIATE treatment for ventricular fibrillation (VF) is:
- A) Atropine 1 mg IV
- B) Cardioversion (synchronized)
- C) Defibrillation (unsynchronized)
- D) Amiodarone infusion
Answer: C) Defibrillation (unsynchronized)
Ventricular fibrillation is a cardiac emergency. Immediate defibrillation (unsynchronized shock) is the definitive treatment. CPR is initiated while the defibrillator is being prepared. Synchronized cardioversion is used for stable arrhythmias with a pulse.
Q22. A patient on telemetry suddenly shows a wide QRS complex tachycardia at 180 bpm with no P waves. He is conscious and has a BP of 90/60 mmHg. The MOST appropriate intervention is:
- A) Carotid sinus massage
- B) IV adenosine 6 mg
- C) Synchronized cardioversion
- D) Defibrillation
Answer: C) Synchronized cardioversion
This presentation is consistent with unstable ventricular tachycardia (VT) with a pulse. The treatment is immediate synchronized cardioversion. Unsynchronized defibrillation is for VF/pulseless VT. Adenosine is for SVT.
Q23. The most common cause of sinus bradycardia in hospitalized patients is:
- A) Hyperthyroidism
- B) Beta-blocker therapy
- C) Hypovolemia
- D) Fever
Answer: B) Beta-blocker therapy
Beta-blockers (metoprolol, atenolol) reduce heart rate by blocking sympathetic stimulation at the SA node. They are a leading iatrogenic cause of sinus bradycardia in hospitalized cardiac patients.
SECTION 6: Angina & Coronary Artery Disease (Q24-26)
Q24. Unstable angina differs from stable angina in that unstable angina:
- A) Occurs only during exertion
- B) Is relieved by rest alone
- C) Occurs at rest or with minimal exertion and is unpredictable
- D) Is associated with ST depression only during treadmill testing
Answer: C) Occurs at rest or with minimal exertion and is unpredictable
Unstable angina (part of ACS) occurs at rest, is of new onset, or is increasing in frequency/severity/duration. It indicates plaque rupture and partial coronary occlusion. It does NOT resolve reliably with rest or nitroglycerin.
Q25. A patient with stable angina is given sublingual nitroglycerin. If chest pain persists after 3 doses (5 min apart), the nurse should:
- A) Administer a 4th dose and wait
- B) Apply a nitroglycerin patch
- C) Call emergency services - this may be an acute MI
- D) Administer oral aspirin and reassess
Answer: C) Call emergency services - this may be an acute MI
The "3-dose rule": if angina is not relieved by 3 sublingual nitroglycerin tablets (1 every 5 minutes, over 15 minutes), activate emergency services immediately as this may indicate acute MI.
Q26. Which lifestyle modification is MOST effective in reducing the risk of coronary artery disease?
- A) Reducing dietary fat to zero
- B) Smoking cessation
- C) Moderate alcohol consumption
- D) Stress management techniques
Answer: B) Smoking cessation
Smoking is the most powerful modifiable risk factor for CAD. Cessation reduces CAD risk by ~50% within 1 year and approaches non-smoker levels after 10-15 years. It causes endothelial damage, thrombogenesis, and vasoconstriction.
SECTION 7: Cardiac Procedures & Monitoring (Q27-30)
Q27. After cardiac catheterization via the femoral artery, the nurse's PRIORITY assessment is:
- A) Urinary output monitoring
- B) Peripheral pulses distal to the insertion site
- C) Blood glucose level
- D) Level of consciousness
Answer: B) Peripheral pulses distal to the insertion site
After femoral artery catheterization, the nurse must frequently assess peripheral pulses (pedal pulse), skin color, temperature, capillary refill, and sensation distal to the puncture site to detect arterial occlusion or hematoma formation.
Q28. Central Venous Pressure (CVP) normal range is:
- A) 1-3 mmHg
- B) 2-6 mmHg (or 5-15 cmH₂O)
- C) 15-25 mmHg
- D) 25-35 mmHg
Answer: B) 2-6 mmHg (or 5-15 cmH₂O)
Normal CVP is 2-6 mmHg (or 5-15 cmH₂O). Elevated CVP indicates right heart failure, fluid overload, or cardiac tamponade. Low CVP indicates hypovolemia.
Q29. A patient post-coronary artery bypass graft (CABG) surgery has a sudden cessation of chest tube drainage followed by hypotension and muffled heart sounds. The nurse should suspect:
- A) Pulmonary embolism
- B) Cardiac tamponade
- C) Tension pneumothorax
- D) Atelectasis
Answer: B) Cardiac tamponade
Beck's Triad of cardiac tamponade: hypotension, muffled (distant) heart sounds, and JVD. Post-CABG, cessation of chest tube drainage (tube clotting) causing blood accumulation in the pericardial sac is a classic trigger. Emergency pericardiocentesis is required.
Q30. A patient is on continuous telemetry and the nurse notes a flat (isoelectric) line on the monitor. The FIRST action is:
- A) Start CPR immediately
- B) Call a code blue
- C) Check the patient and assess for lead displacement
- D) Administer epinephrine
Answer: C) Check the patient and assess for lead displacement
A flat line on telemetry is most commonly an artifact due to lead displacement or equipment failure - not asystole. The FIRST action is always to check the patient (assess responsiveness, pulse, breathing) before initiating resuscitation.
Quick Summary Table
| Q# | Topic | Key Concept |
|---|---|---|
| 1-5 | Anatomy/Physiology | SA node, CO, valves, preload, coronary filling |
| 6-10 | Myocardial Infarction | ECG, biomarkers, thrombolytics, localization |
| 11-15 | Heart Failure | Positioning, right vs. left HF, furosemide, digoxin, EF |
| 16-19 | Hypertension | Stages, emergencies, ACE inhibitors, postural hypotension |
| 20-23 | Arrhythmias | AF, VF/VT, cardioversion vs. defibrillation |
| 24-26 | Angina/CAD | Stable vs. unstable, nitro rule, risk factors |
| 27-30 | Procedures | Post-cath care, CVP, cardiac tamponade, artifact |
Tips for NORCET Cardiovascular Nursing:
- Know the difference between synchronized cardioversion (unstable tachyarrhythmia with pulse) vs. defibrillation (VF/pulseless VT)
- Always prioritize airway > breathing > circulation (ABC) in emergencies
- Beck's Triad = Cardiac Tamponade; Virchow's Triad = DVT/PE
- Digoxin toxicity is worsened by hypokalemia, hypomagnesemia, and renal failure
- Troponin is the gold standard MI biomarker; it peaks at 24-48 hrs and stays elevated for 7-14 days
Good luck with your NORCET exam! 🎓
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