ACS & Dysrhythmias – NCLEX Scenario Questions (Extracted)

Early ACS Recognition: Mr. Lewis, 58, presents with substernal chest pressure radiating to his jaw and diaphoresis. Which question should the nurse ask first?

• Have you taken any nitroglycerin?

• Have you eaten recently?

• Do you have diabetes?

• How long have you had hypertension?

Triage Priority: A 64-year-old with chest pain rates pain 9/10. ECG shows ST elevation in V1–V4. Which order is priority?

• Start IV nitroglycerin.

• Obtain troponin levels.

• Activate the cath lab team.

• Apply transcutaneous pacing.

Chest Pain Reassessment: A patient on nitroglycerin reports headache and BP 90/58 mm Hg. What should the nurse do?

• Continue the infusion.

• Stop nitro and notify the provider.

• Give acetaminophen.

• Elevate the legs.

Fibrinolytic Therapy: A patient with STEMI is 1 hour from onset. Which order requires clarification?

• Alteplase 15 mg IV bolus.

• Aspirin 325 mg chewable.

• Heparin IV drip.

• IM injection for pain control.

Post-MI Monitoring: Twelve hours after PCI, the nurse notes new ST elevation and chest pain. Which action first?

• Increase nitroglycerin rate.

• Obtain 12-lead ECG.

• Administer morphine.

• Check potassium.

Mr. Rivera, post-MI, HR 52 bpm and BP 100/60 mm Hg. Before giving metoprolol, the nurse should:

• Hold the dose and notify provider.

• Give as ordered.

• Increase IV fluids.

• Administer atropine.

Why is morphine given during an acute MI?

• To increase preload

• To decrease oxygen demand and anxiety

• To increase heart rate

• To dilate cerebral vessels

A patient asks why dual antiplatelet therapy is necessary after stent placement.

• It prevents infection.

• It prevents clots in the stent.

• It lowers cholesterol.

• It dissolves existing plaque.

48 hours post-MI, patient develops murmur and pulmonary edema. The nurse suspects:

• Ventricular septal rupture

• Pericarditis

• Right-sided HF

• Mitral stenosis

Which patient statement indicates understanding?

• I should exercise until I feel mild chest pain.

• Cardiac rehab will help me return to activity safely.

• I’ll double my nitro before exercise.

• I can stop beta-blocker during rehab.