NCLEX Med-Surg: Cardiac & Respiratory Practice Questions
NCLEX med-surg practice questions on heart failure, MI, COPD, and respiratory distress, with rationales explaining the correct priority action.
Cardiac and respiratory content dominates Physiological Integrity because these systems account for the majority of acute, life-threatening changes in condition. Here's a sample from our full cardiac/respiratory set.
Practice questions
1. A client reports crushing substernal chest pain radiating to the left arm. What is the nurse's first action?
- A. Obtain a 12-lead ECG
- B. Administer sublingual nitroglycerin
- C. Call the client's family
- D. Assess the client's pain scale rating
Show answer & rationale
Correct answer: A
Obtaining a 12-lead ECG immediately is priority to identify STEMI changes and guide time-sensitive treatment; 'time is muscle' in suspected MI, so rapid diagnosis drives every next step.
2. Which finding in a client with heart failure indicates the need for immediate intervention?
- A. Weight gain of 3 lbs in 24 hours
- B. Trace pedal edema
- C. Oxygen saturation of 96%
- D. Mild fatigue with exertion
Show answer & rationale
Correct answer: A
A rapid weight gain of 2–3 lbs in 24 hours (or 5 lbs in a week) indicates fluid retention and worsening heart failure requiring prompt evaluation.
3. A client with COPD has an oxygen saturation of 89% on room air. What oxygen delivery method is most appropriate initially?
- A. Non-rebreather mask at 15 L/min
- B. Low-flow nasal cannula at 1–2 L/min
- C. No supplemental oxygen needed
- D. High-flow oxygen titrated to 100% saturation
Show answer & rationale
Correct answer: B
Clients with chronic COPD rely on a hypoxic drive to breathe; oxygen should be started at low flow (1–2 L/min) and titrated carefully to avoid suppressing respiratory drive.
4. Which lab value would the nurse expect to be elevated in a client having an acute myocardial infarction?
- A. Troponin
- B. Hemoglobin A1c
- C. Serum albumin
- D. Platelet count
Show answer & rationale
Correct answer: A
Troponin is the most sensitive and specific cardiac biomarker for myocardial injury, rising within hours of an MI and remaining elevated for days.
5. A client post-cardiac catheterization via the femoral approach must maintain which position?
- A. High Fowler's with legs crossed
- B. Supine with the affected leg straight for the prescribed time
- C. Left lateral position
- D. Ambulate immediately after the procedure
Show answer & rationale
Correct answer: B
The affected leg must remain straight and the client supine (per facility protocol, often 2–6 hours) to prevent bleeding or hematoma at the femoral access site.
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Work through the full NCLEX-RN question bank with detailed rationales for every answer.
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Frequently asked questions
What's the number one cardiac emergency tested on the NCLEX?
Acute MI and its recognition (chest pain, ECG changes, troponin) is the highest-yield cardiac emergency, closely followed by heart failure exacerbation.
What's the key COPD oxygen safety concept?
Start low and titrate slowly — COPD clients can lose their respiratory drive with too much supplemental oxygen, which is one of the NCLEX's favorite 'trick' concepts.