Acute Coronary Syndrome and MI Care Practice Questions
20 free Acute Coronary Syndrome and MI Care practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
What does ST elevation in leads V2-V4 indicate on an ECG?
- A Non-ST-elevation myocardial infarction (NSTEMI)
- B Unstable angina
- C ST-elevation myocardial infarction (STEMI)
- D Prinzmetal’s angina
Correct answer: ST-elevation myocardial infarction (STEMI)
ST elevation in contiguous leads (e.g., V2-V4) is characteristic of a STEMI, indicating a complete coronary occlusion.
What is the nurse's first priority intervention after stabilising the airway and breathing in the acute phase of MI?
- A Begin a high-dose statin before any other intervention
- B Give sublingual nitroglycerin and aspirin unless contraindicated
- C Start cardiac rehabilitation exercises at the bedside now
- D Delay all cardiac monitoring until after the cath lab visit
Correct answer: Give sublingual nitroglycerin and aspirin unless contraindicated
Early administration of aspirin and nitroglycerin (if not contraindicated) helps reduce mortality and relieve ischaemia in ACS.
What does "door-to-balloon time" refer to in STEMI care?
- A The time from hospital arrival to starting cardiac rehabilitation
- B The time from arrival to inflation of the angioplasty balloon
- C The time from arrival to administration of the first statin dose
- D The time from the patient's arrival to their hospital discharge
Correct answer: The time from arrival to inflation of the angioplasty balloon
Door-to-balloon time is a key quality indicator in STEMI care, defined as arrival to coronary intervention via balloon inflation.
What action should the nurse take if a patient with suspected ACS has a blood glucose of 45 mg/dL (hypoglycaemia)?
- A Ignore the glucose because it is unrelated to the myocardial infarction
- B Administer glucose and correct it before interpreting ECG or biomarkers
- C Wait until after the cath lab before correcting the low glucose
- D Immediately commence full activity despite the low blood glucose
Correct answer: Administer glucose and correct it before interpreting ECG or biomarkers
Hypoglycaemia should be corrected promptly to avoid misdiagnosis and ongoing tissue damage.
What nursing assessment indicates possible cardiogenic shock in patients with MI?
- A BP 120/70, warm extremities and normal urine output
- B BP 80/50, cool clammy skin, oliguria and elevated PCWP
- C HR 70 with a urine output of about 45 mL per hour
- D Normal mentation, no JVD and warm well-perfused skin
Correct answer: BP 80/50, cool clammy skin, oliguria and elevated PCWP
Cardiogenic shock is characterised by low blood pressure, poor perfusion, and elevated filling pressures like PCWP.
How does NSTEMI differ from STEMI?
- A NSTEMI always resolves spontaneously without any treatment
- B NSTEMI shows persistent ST-segment elevation on the ECG
- C NSTEMI is partial occlusion with raised biomarkers and no ST elevation
- D Thrombolysis is always the first-line treatment for NSTEMI
Correct answer: NSTEMI is partial occlusion with raised biomarkers and no ST elevation
NSTEMI involves partial occlusion, elevated biomarkers, but no persistent ST elevation on ECG, unlike STEMI.
Why is obtaining an ECG within 10 minutes critical upon arrival of a patient?
- A ECG findings are rarely useful in evaluating chest pain
- B Early ECG identifies STEMI and enables timely reperfusion
- C An ECG is only required if the pain persists beyond 24 hours
- D A CT scan replaces the ECG in evaluating myocardial infarction
Correct answer: Early ECG identifies STEMI and enables timely reperfusion
Rapid ECG within minutes is essential to identify STEMI and begin reperfusion therapy quickly, reducing myocardial damage.
Which nursing intervention helps reduce myocardial workload and oxygen demand post-acute MI?
- A Place the patient flat and supine in the bed continuously
- B Elevate head of bed, keep patient calm and give beta-blocker
- C Increase the patient's activity level immediately after the MI
- D Withhold supplemental oxygen even when saturation is normal
Correct answer: Elevate head of bed, keep patient calm and give beta-blocker
Reducing cardiac workload by semi-Fowler position, controlling heart rate, and ensuring oxygenation helps limit ischaemic damage.
What should the nocturnal nurse's next priority be if a post-MI patient has chest pain rated at 8/10 despite nitroglycerin and aspirin?
- A Document the pain and wait to act until the morning round
- B Call rapid response and assess for reinfarction or arrhythmia
- C Administer a cough suppressant to relieve the chest discomfort
- D Increase the patient's activity to distract them from the pain
Correct answer: Call rapid response and assess for reinfarction or arrhythmia
Persistent chest pain post-MI signals possible reinfarction or complication; immediate assessment and cardiology consultation are required.
Which is a core measure for MI care at discharge?
- A Stop all of the patient's medications at the time of discharge
- B Prescribe a statin and beta-blocker with smoking cessation counselling
- C Recommend no scheduled follow-up after the patient is discharged
- D Give only aspirin and provide no discharge education at all
Correct answer: Prescribe a statin and beta-blocker with smoking cessation counselling
Core quality measures at discharge include statin prescription, beta-blocker, and smoking cessation counselling.
What is the essential post-procedure nursing action in the cardiac catheterisation recovery area for a patient undergoing PCI?
- A Allow the patient to ambulate immediately with no monitoring
- B Monitor the access site for bleeding and check distal pulses
- C Defer vital sign checks until transfer to the inpatient floor
- D Remove the patient's intravenous access immediately after PCI
Correct answer: Monitor the access site for bleeding and check distal pulses
Post-PCI monitoring for access-site bleeding and distal perfusion is vital to prevent complications.
Which sign should the nurse recognise as a major complication for a patient receiving thrombolytic therapy post-MI?
- A Mild transient headache that resolves spontaneously
- B Slurred speech with a sudden drop in blood pressure
- C Stable vital signs with relief of ischaemic chest pain
- D Slight nausea that settles with antiemetics
Correct answer: Slurred speech with a sudden drop in blood pressure
Thrombolysis carries the risk of intracranial haemorrhage; sudden neuro change and hypotension must be treated as an emergency.
Why does the nurse monitor for dysrhythmias in the first 24 hours post-MI?
- A Dysrhythmias have no bearing on early MI outcomes
- B Reperfusion and ischaemia raise the risk of lethal arrhythmias
- C Significant arrhythmias only emerge several weeks after MI
- D Only sinus bradycardia is clinically relevant after MI
Correct answer: Reperfusion and ischaemia raise the risk of lethal arrhythmias
The early post-MI period carries a high risk of arrhythmias due to reperfusion injury and myocardial irritability.
What lifestyle changes should a nurse counsel a patient post-MI to adopt?
- A Resuming smoking is acceptable once symptoms improve
- B Adopt a heart-healthy diet, stop smoking, and control BP and cholesterol
- C Routine exercise is no longer necessary after an MI
- D Medication alone is sufficient without any lifestyle change
Correct answer: Adopt a heart-healthy diet, stop smoking, and control BP and cholesterol
Long-term outcomes improve when patients adopt healthy lifestyle changes post MI.
What is a key nursing monitoring parameter when administering sublingual nitroglycerin to an MI patient?
- A A reflex rise in heart rate without other changes
- B A drop in blood pressure, headache, and relief of chest pain
- C No appreciable change in vital signs or symptoms
- D An abrupt need to discontinue supplemental oxygen
Correct answer: A drop in blood pressure, headache, and relief of chest pain
Monitoring for blood pressure drop and pain relief is essential when administering nitroglycerin.
How may the presentation of MI in women differ from men?
- A Presentation is essentially identical to classic male chest pain
- B Often atypical, with jaw or neck pain, fatigue, and nausea
- C Limited to vague indigestion-like epigastric discomfort
- D Dyspnea and exertional fatigue are rarely reported
Correct answer: Often atypical, with jaw or neck pain, fatigue, and nausea
Women often present with non-classic symptoms during MI which can delay recognition and treatment.
Why is continuous oxygen therapy not recommended for all MI patients?
- A Oxygen plays no therapeutic role in acute MI care
- B It is indicated only when SpO2 <94% or the patient is dyspneic
- C It should be given in high, unlimited concentrations to all
- D It is absolutely contraindicated in any patient with MI
Correct answer: It is indicated only when SpO2 <94% or the patient is dyspneic
Supplemental oxygen is indicated in hypoxia or respiratory distress; unnecessary oxygen may cause harm.
Which nursing diagnosis is the immediate physiological priority for a patient in the acute phase post-MI?
- A Activity intolerance related to deconditioning
- B Acute pain related to myocardial ischemia
- C Fear related to perceived threat of death
- D Anxiety related to an unfamiliar care environment
Correct answer: Acute pain related to myocardial ischemia
In the acute phase, relieving ischaemic chest pain is the immediate physiological priority because ongoing pain reflects continuing ischaemia and increases myocardial oxygen demand. Psychosocial and activity diagnoses are addressed once the physiological threat is controlled.
What does an elevated troponin level along with non-ST elevation on ECG suggest?
- A STEMI
- B NSTEMI
- C Unstable angina
- D Pericarditis
Correct answer: NSTEMI
Elevated troponin with no ST elevation indicates NSTEMI rather than unstable angina or STEMI.
What is an important intervention before discharge for a patient post-MI entering the recovery phase?
- A Reassure the patient that medication teaching can be skipped
- B Teach cardiac rehab, medication adherence, lifestyle change, and follow-up
- C Advise an unrestricted diet with no scheduled follow-up
- D Concentrate solely on managing the access-site wound
Correct answer: Teach cardiac rehab, medication adherence, lifestyle change, and follow-up
Discharge education including rehab, adherence to medications, lifestyle changes, and follow-up improves long-term outcomes post MI.