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Nervous, Respiratory and Cardiovascular Systems

Cardiac Shock and Acute Coronary Syndrome Practice Questions

11 free Cardiac Shock and Acute Coronary Syndrome 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.

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Question 1 of 11 Medium

Which of the following is an indicator of cardiogenic shock in a patient with acute myocardial infarction?

  1. A Low urine output and cool clammy skin
  2. B High urine output and warm extremities
  3. C Elevated blood pressure and diaphoresis
  4. D Mottled skin and decreased respiratory rate

Correct answer: Low urine output and cool clammy skin

The combination of low urine output, cool clammy skin along with myocardial infarction suggests cardiogenic shock.

Question 2 of 11 Easy

In the context of ACS, what is the recommended timing to obtain a 12-lead ECG for rapid diagnosis?

  1. A Within 10 minutes of presentation
  2. B Within 30 minutes of presentation
  3. C After laboratory results return
  4. D After 1 hour of presentation

Correct answer: Within 10 minutes of presentation

Obtaining a 12-lead ECG within 10 minutes of presentation is critical for rapid diagnosis in ACS.

Question 3 of 11 Medium

What is the primary effect of an intra-aortic balloon pump (IABP) in a patient with cardiogenic shock?

  1. A Increased diastolic aortic pressure improving coronary blood flow
  2. B Increased left ventricular afterload during cardiac systole
  3. C Decreased coronary perfusion during the diastolic phase
  4. D An intentional reduction in overall cardiac output and stroke volume

Correct answer: Increased diastolic aortic pressure improving coronary blood flow

IABP inflates during diastole to improve aortic diastolic pressure and enhance coronary perfusion.

Question 4 of 11 Easy

Which diagnostic test is not typically utilized initially for suspected ACS?

  1. A D-dimer only (and no other tests)
  2. B Serial troponins
  3. C 12-lead ECG
  4. D Chest x-ray and basic metabolic panel

Correct answer: D-dimer only (and no other tests)

D-dimer is not a primary diagnostic test for ACS; troponins, ECG, and metabolic panel are more commonly used.

Question 5 of 11 Medium

What is the recommended primary intervention in a patient with cardiogenic shock and pulmonary edema?

  1. A Give a rapid intravenous fluid bolus of 500 mL crystalloid
  2. B Start diuretics with ventilatory support as needed
  3. C Delay oxygen therapy until blood culture results return
  4. D Provide only oral fluids and avoid intravenous medications

Correct answer: Start diuretics with ventilatory support as needed

In cardiogenic shock with pulmonary edema, diuretics and ventilatory support are critical for managing fluid overload.

Question 6 of 11 Medium

What coronary artery occlusion is suggested by ST elevation in leads V1–V4 on ECG?

  1. A Encourage early ambulation to reduce systemic fluid overload
  2. B Place in semi-Fowler's, monitor hemodynamics, ready advanced support
  3. C Discontinue cardiac monitoring and wait for a physician order
  4. D Administer pain medication only and defer all other interventions

Correct answer: Place in semi-Fowler's, monitor hemodynamics, ready advanced support

ST elevations in V1–V4 typically indicate occlusion of the left anterior descending (LAD) artery.

Question 7 of 11 Easy

What is the prominent nursing priority immediately upon identifying signs of cardiogenic shock in a patient?

  1. A Occlusion of the right coronary artery (RCA)
  2. B Occlusion of the left circumflex coronary artery
  3. C Occlusion of the left anterior descending artery
  4. D Occlusion of the posterior descending coronary artery

Correct answer: Occlusion of the left anterior descending artery

Promptly placing the patient in semi‐Fowler’s, monitoring vital signs, and preparing for support are key in managing cardiogenic shock.

Question 8 of 11 Easy

In what time frame does guidelines recommend performing PCI in a patient with acute STEMI?

  1. A 120 minutes
  2. B 90 minutes
  3. C 300 minutes
  4. D 45 minutes

Correct answer: 90 minutes

PCI should ideally be done within 90 minutes of hospital arrival to optimize outcomes in acute STEMI.

Question 9 of 11 Medium

What does rising lactate levels and metabolic acidosis indicate in a patient with cardiogenic shock?

  1. A Adequate tissue perfusion with normal cellular oxygen delivery
  2. B Poor tissue perfusion with anaerobic metabolism
  3. C A finding that is unrelated to the patient's shock state
  4. D An over-hydration state from excessive fluid administration

Correct answer: Poor tissue perfusion with anaerobic metabolism

Rising lactate and acidosis suggest poor tissue perfusion and anaerobic metabolism due to inadequate oxygenated blood flow.

Question 10 of 11 Medium

What diagnosis is suggested by T-wave inversions and elevated troponin without ST elevation on ECG?

  1. A STEMI
  2. B NSTEMI
  3. C Unstable angina
  4. D Pulmonary embolism

Correct answer: NSTEMI

T-wave inversions and elevated troponin without ST elevation often indicate NSTEMI without full-thickness infarct.

Question 11 of 11 Easy

What symptom combination on physical exam is indicative of poor perfusion in a patient with ACS?

  1. A Stable blood pressure with warm, well-perfused extremities
  2. B Cool clammy skin, narrow pulse pressure and tachycardia
  3. C Warm dry skin with strong, easily palpable peripheral pulses
  4. D A low heart rate accompanied by bounding peripheral pulses

Correct answer: Cool clammy skin, narrow pulse pressure and tachycardia

Cool, clammy skin, narrow pulse pressure, and tachycardia are early signs of poor perfusion in ACS.

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