Heart Failure, Infarction and Angina Practice Questions
20 free Heart Failure, Infarction and Angina 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.
Which condition is most likely presented by a patient with acute chest pressure, diaphoresis, and shortness of breath along with ST-segment elevation in leads II, III and aVF?
- A Unstable angina without infarction
- B Non-ST-elevation MI (NSTEMI)
- C STEMI of the inferior wall
- D Stable exertional angina
Correct answer: STEMI of the inferior wall
ST-elevation in leads II, III and aVF suggests an inferior wall STEMI, which is indicative of a full-thickness myocardial infarction. This presentation is inconsistent with unstable angina or NSTEMI.
In patients with chronic heart failure with reduced ejection fraction (HFrEF), which class of medication has been shown to reduce mortality?
- A Short-acting oral nitrates
- B Beta-blockers (e.g., carvedilol)
- C High-dose NSAIDs such as ibuprofen
- D Routine oral calcium supplementation
Correct answer: Beta-blockers (e.g., carvedilol)
Beta-blockers improve outcomes and reduce mortality in stable HFrEF by reducing sympathetic drive and myocardial oxygen demand.
In a patient with stable angina, what is the correct action regarding sublingual nitroglycerin administration?
- A Take nitroglycerin but ignore persisting pain
- B Lie down; take one dose, repeat q5min; if pain persists after 3 doses, seek emergency care.
- C Delay nitroglycerin until the pain becomes severe
- D Take nitroglycerin only after physical exertion
Correct answer: Lie down; take one dose, repeat q5min; if pain persists after 3 doses, seek emergency care.
Standard teaching for angina includes taking nitroglycerin promptly, monitoring response, and seeking emergency care if pain is unrelieved after three doses or persists beyond the usual pattern.
What is a key nursing priority when an acute MI patient arrives in the emergency department?
- A Wait for cardiac enzyme results before treating
- B Give aspirin and obtain a 12-lead ECG within 10 minutes
- C Begin cardiac physical therapy immediately
- D Focus only on documenting the patient’s diet
Correct answer: Give aspirin and obtain a 12-lead ECG within 10 minutes
Rapid recognition and treatment of MI is essential; obtaining ECG quickly and giving aspirin reduces myocardial damage and improves outcomes.
In acute decompensated heart failure, what finding is most characteristic?
- A Clear lung fields with a low respiratory rate
- B Pulmonary crackles, orthopnoea, and elevated JVP
- C Isolated ankle swelling without respiratory signs
- D Bradycardia and hypotension without any edema
Correct answer: Pulmonary crackles, orthopnoea, and elevated JVP
Decompensated heart failure typically presents with fluid overload signs including pulmonary congestion (crackles), orthopnoea, and elevated jugular venous pressure.
How does unstable angina, not relieved by rest or nitroglycerin, differ from stable angina?
- A It reliably resolves with one nitroglycerin dose
- B It indicates a higher risk of imminent myocardial infarction
- C It is provoked only by physical exertion
- D It seldom requires hospital admission
Correct answer: It indicates a higher risk of imminent myocardial infarction
Unstable angina is unpredictable, occurs at rest or with minimal exertion, and indicates an acute coronary syndrome with a higher risk of MI.
Which laboratory marker is most specific for detecting myocardial necrosis?
- A Creatine kinase only
- B Troponin I or T
- C Total cholesterol
- D Pro-BNP
Correct answer: Troponin I or T
Cardiac troponins (I or T) are highly specific for myocardial injury and are key in diagnosing MI.
A nurse caring for a post-MI patient notes a new loud murmur and acute pulmonary edema. What complication is the patient at risk for?
- A Pericarditis with a friction rub
- B Papillary muscle rupture causing acute mitral regurgitation and shock
- C Benign sinus bradycardia
- D Musculoskeletal leg cramps
Correct answer: Papillary muscle rupture causing acute mitral regurgitation and shock
A sudden murmur plus pulmonary edema post-MI suggests a mechanical complication such as papillary muscle rupture leading to acute mitral regurgitation and cardiogenic shock.
Which lifestyle change is foundational in preventing recurrent angina and MI?
- A Continue smoking while exercising more often
- B Smoking cessation, heart-healthy diet, exercise, and stress management
- C Avoid all physical exercise going forward
- D Rely on medication alone and ignore lifestyle factors
Correct answer: Smoking cessation, heart-healthy diet, exercise, and stress management
Comprehensive risk-factor modification (smoking cessation, diet, exercise, stress) is essential to reduce recurrence of angina/MI and improve outcomes.
What is the significance of daily weight monitoring in heart failure management?
- A It provides little useful clinical information
- B It detects early fluid retention and worsening failure
- C It is relevant mainly in chronic liver disease
- D It can replace all other forms of monitoring
Correct answer: It detects early fluid retention and worsening failure
Daily weights allow early detection of fluid retention in heart failure, prompting timely intervention before overt decompensation.
A patient complains of chest pain radiating to the jaw, relieved by rest. What condition is this likely to be?
- A Variant (Prinzmetal’s) angina at rest
- B Stable (typical) angina on exertion
- C Acute myocarditis
- D Acute pulmonary embolism
Correct answer: Stable (typical) angina on exertion
Stable angina is characterised by predictable chest pain on exertion or stress that is relieved by rest or nitroglycerin.
After an MI, what sign is most suggestive of left ventricular failure?
- A Dry cough with a low heart rate
- B Bibasilar crackles, dyspnoea, and an S3 heart sound
- C Isolated large-joint pain
- D Persistently high urine output
Correct answer: Bibasilar crackles, dyspnoea, and an S3 heart sound
Left-ventricular failure leads to pulmonary congestion: rales, S3, shortness of breath are characteristic.
A patient with heart failure is prescribed an ACE inhibitor. What side effect should the patient watch for?
- A Persistent dry cough, hyperkalemia, and angioedema
- B Increased scalp and body hair growth
- C A measurable gain in skeletal muscle strength
- D Noticeably improved hearing acuity
Correct answer: Persistent dry cough, hyperkalemia, and angioedema
ACE inhibitors commonly cause cough, may increase potassium, and in rare cases angioedema—patients should be informed.
Which assessment finding indicates a patient with angina is at higher risk for progression to MI?
- A Pain only during vigorous physical exercise
- B New-onset angina at rest or with minimal exertion
- C Pain consistently relieved within one minute
- D An unchanged anginal pattern over several years
Correct answer: New-onset angina at rest or with minimal exertion
Angina that occurs at rest or minimal exertion (unstable pattern) signifies a higher risk of MI and requires aggressive management.
A nurse is teaching a post-MI patient about medications. The patient asks why they are prescribed a high-dose statin. What is the nurse's explanation?
- A It is prescribed mainly to lower your blood sugar.
- B It lowers cholesterol and stabilises plaque, cutting further coronary events.
- C It removes your need for nitroglycerin tablets.
- D It reduces the fluid swelling in your legs.
Correct answer: It lowers cholesterol and stabilises plaque, cutting further coronary events.
High-intensity statins reduce LDL cholesterol and stabilise atherosclerotic plaques, preventing further coronary events post-MI.
During an angina episode, how does nitroglycerin primarily work?
- A Increasing the heart rate and contractility
- B Dilating coronary and peripheral vessels, lowering oxygen demand
- C Promoting renal fluid and sodium retention
- D Blocking conduction through the AV node
Correct answer: Dilating coronary and peripheral vessels, lowering oxygen demand
Nitroglycerin dilates coronary and systemic veins/arteries, decreasing preload and myocardial oxygen demand, relieving angina.
In chronic heart failure with preserved ejection fraction (HFpEF), what characteristic is observed?
- A A markedly reduced ejection fraction
- B Normal ejection fraction with impaired ventricular relaxation and filling
- C Predominant primary valvular heart disease
- D A history of prior acute myocardial infarction
Correct answer: Normal ejection fraction with impaired ventricular relaxation and filling
HFpEF involves stiff ventricles that cannot fill properly despite normal ejection fraction, leading to heart failure symptoms.
A patient is being discharged after an MI. What teaching point should the nurse include for home care?
- A Stop your medications once you start feeling better
- B Report chest pain over 5 minutes, arm/jaw radiation, nausea, or sweating—call EMS
- C Plan to return to the clinic only after one year
- D Assume no lifestyle changes will be necessary
Correct answer: Report chest pain over 5 minutes, arm/jaw radiation, nausea, or sweating—call EMS
Recognising recurrent MI symptoms and seeking immediate care is vital; patients should be taught warning signs and to call EMS promptly.
What hemodynamic change is typical of advanced left-sided heart failure?
- A A fall in pulmonary venous pressure
- B Elevated pulmonary capillary wedge pressure with congestion
- C An increase in peripheral tissue perfusion
- D An automatic reduction in heart rate
Correct answer: Elevated pulmonary capillary wedge pressure with congestion
Left-sided failure leads to increased left atrial/pulmonary venous pressure causing pulmonary oedema and congestion.
A patient with angina has taken sublingual nitroglycerin three times without relief. What is the next appropriate nursing action?
- A Wait another hour before contacting the provider
- B Activate emergency response/call 911—possible MI
- C Increase the nitroglycerin dose independently
- D Discontinue all of the patient’s medications
Correct answer: Activate emergency response/call 911—possible MI
Failure to relieve angina after three nitro doses may indicate evolving MI and requires emergency activation—waiting is inappropriate.