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WorksheetsCAD & ACS – NCLEX
Total questions: 51
Worksheet time: 26mins
A patient with coronary artery disease develops myocardial ischemia when which imbalance occurs?
Oxygen supply exceeds myocardial demand
Oxygen demand exceeds oxygen supply
Cardiac output exceeds systemic vascular resistance
Stroke volume exceeds preload
What pathophysiologic event most directly differentiates acute coronary syndrome (ACS) from chronic stable angina?
Fixed narrowing of coronary arteries
Gradual progression of atherosclerosis
Sudden plaque rupture with thrombus formation
Coronary artery vasospasm during exertion
A patient reports chest pain that occurs with exertion, lasts 3–5 minutes, and is relieved by rest. Which finding best explains this presentation?
Complete coronary artery occlusion
Plaque rupture with thrombus
Fixed coronary artery narrowing limiting blood flow during exertion
Myocardial necrosis
Which assessment finding most strongly suggests unstable angina rather than chronic stable angina?
Chest pain relieved by nitroglycerin
Chest pain occurring at rest
Predictable pain pattern
Absence of ECG changes after pain resolves
A patient presents with chest pain at rest, ST-segment depression on ECG, and elevated troponin levels. How should the nurse interpret these findings?
Stable angina
Unstable angina
NSTEMI
STEMI
Which cardiac biomarker is most specific for myocardial injury?
Myoglobin
Creatine kinase (CK)
CK-MB
Troponin
A patient with suspected ACS is brought to the emergency department. What is the priority initial nursing action?
Administer morphine
Obtain cardiac biomarkers
Apply oxygen and obtain a 12-lead ECG
Prepare the patient for cardiac catheterization
Sublingual nitroglycerin relieves anginal chest pain primarily by which mechanism?
Increasing myocardial contractility
Preventing platelet aggregation
Reducing preload and myocardial oxygen demand
Dissolving coronary thrombi
Which ECG finding is most characteristic of a STEMI?
ST-segment depression
Inverted T waves
Normal ECG
ST-segment elevation
A patient with ACS is diagnosed with a STEMI. Which treatment is considered the gold standard?
Thrombolytic therapy only
Medical management with nitrates and beta blockers
Emergency cardiac catheterization with PCI
Stress testing prior to intervention
A patient with long-standing hypertension is diagnosed with coronary artery disease. Which mechanism most directly links hypertension to the development of CAD?
Decreased preload causing endothelial collapse
Increased afterload causing myocardial ischemia
Endothelial injury promoting atherosclerosis
Reduced cardiac output leading to hypoxia
Which characteristic makes a complicated atherosclerotic lesion the most dangerous?
Gradual narrowing of the arterial lumen
Increased arterial elasticity
Plaque instability leading to thrombus formation
Complete endothelial healing
A patient presents with chest pain lasting 15 minutes that began at rest. ECG shows ST-segment depression, but troponin levels are normal. How should the nurse interpret this presentation?
Chronic stable angina
Unstable angina
NSTEMI
STEMI
Which finding best differentiates NSTEMI from unstable angina?
ST-segment depression on ECG
Presence of chest pain at rest
Elevated cardiac biomarkers
Need for nitroglycerin therapy
A patient with suspected ACS reports nausea, weakness, and shortness of breath but denies chest pain. This presentation is most concerning in which population?
Young adults
Athletes
Older adults
Patients with hypertension
Which intervention has the highest priority in preserving myocardial tissue during an acute MI?
Administering high-dose statins
Rapid restoration of coronary blood flow
Controlling anxiety
Reducing serum cholesterol
A patient with STEMI is preparing for PCI. Which nursing action is most critical before transport?
Administer oral beta-blocker
Obtain informed consent for discharge
Maintain continuous ECG monitoring
Encourage ambulation
Which medication is routinely administered early in ACS to reduce platelet aggregation?
Nitroglycerin
Morphine
Aspirin
Metoprolol
A patient experiences chest pain unrelieved by nitroglycerin. Morphine is administered. What is the primary therapeutic effect of morphine in ACS?
Increases myocardial contractility
Decreases preload and anxiety
Prevents thrombus formation
Improves coronary artery patency
Following an MI, which complication places the patient at highest immediate risk of death?
Ventricular fibrillation
Acute pericarditis
Heart failure exacerbation
Ventricular aneurysm
A patient with chest pain has ST-segment elevation in leads II, III, and aVF. Which area of the heart is most likely affected?
Anterior wall
Lateral wall
Inferior wall
Septal wall
A patient with ACS has a normal ECG on arrival but reports ongoing chest pain. What is the nurse’s best next action?
Reassure the patient and monitor
Obtain serial cardiac biomarkers
Administer thrombolytics
Discharge if pain resolves
Which finding most strongly supports a diagnosis of chronic stable angina rather than ACS?
Chest pain lasting longer than 20 minutes
Chest pain at rest
Troponin elevation
Chest pain relieved by rest or nitroglycerin
A patient with CAD is prescribed a beta blocker. Which therapeutic effect is most important in reducing anginal episodes?
Increased preload
Increased myocardial oxygen demand
Decreased heart rate and contractility
Coronary artery dilation
Which assessment finding suggests progression from CAD to acute myocardial infarction?
Chest pain relieved by rest
ST-segment depression that resolves
Persistent chest pain with elevated troponin
Predictable exertional chest pain
In ACS, why is time to reperfusion critical?
It prevents dysrhythmias
It reduces platelet aggregation
It limits irreversible myocardial necrosis
It normalizes blood pressure
A patient with STEMI receives PCI with stent placement. Which medication is essential to prevent stent thrombosis?
Loop diuretic
Antiplatelet therapy
ACE inhibitor
Calcium channel blocker
Which symptom is most atypical but clinically significant for ACS in older adults?
Crushing chest pain
Diaphoresis
Shortness of breath
Acute confusion
A patient presents with chest pain, ST-segment depression, and elevated troponin. Which intervention is most appropriate?
Immediate thrombolytic therapy
Emergency PCI only
Which complication following MI requires continuous cardiac monitoring due to its high mortality risk?
Pleural effusion
Pericarditis
Dysrhythmias
Hypertensive urgency
A patient arrives with chest pain and ST-segment elevation. Why is PCI preferred over thrombolytic therapy when available?
It has fewer bleeding risks
It dissolves clots more slowly
It directly restores coronary blood flow
It eliminates the need for antiplatelet therapy
Which medication is given first in suspected ACS unless contraindicated?
Morphine
Nitroglycerin
Aspirin
Beta blocker
A patient with ACS is hypotensive and reports worsening chest pain after nitroglycerin. What is the nurse’s priority action?
Administer another dose of nitroglycerin
Place the patient supine and reassess blood pressure
Administer morphine
Prepare for discharge
Which assessment finding indicates ineffective myocardial perfusion following MI?
Heart rate of 88 bpm
Blood pressure of 130/84 mmHg
New onset dysrhythmia
Oxygen saturation of 96%
A patient with NSTEMI asks why emergency catheterization is not immediately performed. What is the best explanation?
NSTEMI causes no myocardial damage
NSTEMI usually resolves with rest
Blood flow is partially occluded, allowing medical stabilization
PCI increases mortality in NSTEMI
Which factor most significantly increases myocardial oxygen demand, worsening ischemia?
Decreased preload
Decreased heart rate
Increased afterload
Coronary vasodilation
A patient post-MI asks why beta blockers are prescribed long-term. Which explanation is most accurate?
“They dissolve existing plaques.”
“They reduce heart rate and oxygen demand.”
“They prevent platelet aggregation.”
“They increase myocardial contractility.”
Which nursing assessment finding requires immediate provider notification in a post-MI patient?
Mild chest soreness
Heart rate of 52 bpm
Frequent premature ventricular contractions
Blood pressure of 138/86 mmHg
A patient with CAD states, “Now that I have a stent, I don’t need to change my lifestyle.” How should the nurse respond?
“That’s correct—the stent fixes the disease.”
“Lifestyle changes are only needed before PCI.”
“CAD is a chronic disease and lifestyle changes remain essential.”
“Medication alone prevents further plaque buildup.”
Which outcome best indicates successful early treatment of ACS?
Absence of chest pain
Normal blood pressure
Rapid reperfusion limiting myocardial necrosis
Decreased anxiety
A patient with coronary artery disease experiences chest pain when climbing stairs that resolves with rest. What is the primary physiologic cause of this pain?
Complete coronary artery occlusion
Fixed atherosclerotic narrowing limiting blood flow during increased demand
Sudden plaque rupture with thrombus formation
Coronary artery spasm at rest
Which factor most directly contributes to endothelial injury, initiating atherosclerosis?
Increased preload
Decreased heart rate
Hypertension
Increased venous return
A patient presents with chest pain lasting 20 minutes, ST-segment depression on ECG, and normal troponin levels. How should the nurse interpret these findings?
Chronic stable angina
Unstable angina
NSTEMI
STEMI
Which finding best indicates progression from unstable angina to NSTEMI?
ST-segment depression
Chest pain at rest
Elevated troponin levels
Relief with nitroglycerin
A patient with ACS is placed on continuous ECG monitoring. What is the primary rationale for this intervention?
Detect early heart failure
Monitor for dysrhythmias
Assess preload status
Evaluate oxygen saturation
Which assessment finding is most concerning for myocardial infarction rather than angina?
Chest pain relieved by rest
Predictable pain pattern
Persistent chest pain unrelieved by nitroglycerin
Absence of ECG changes
Why are older adults more likely to present with atypical symptoms during an MI?
Reduced pain perception
Increased coronary collateral circulation
Altered physiologic response to ischemia
Lower incidence of CAD
Which medication reduces myocardial oxygen demand by decreasing heart rate and contractility?
Nitroglycerin
Aspirin
Beta blockers
Morphine
A patient with suspected ACS has chest pain and diaphoresis. Which intervention should the nurse perform first?
Administer morphine
Obtain cardiac biomarkers
Apply oxygen and obtain a 12-lead ECG
Prepare for cardiac catheterization
Which pathophysiologic event most commonly triggers acute coronary syndrome?
Progressive vessel narrowing
Increased myocardial workload
Plaque rupture with platelet aggregation
Coronary artery vasospasm
A patient diagnosed with STEMI is transferred for PCI. Which outcome best indicates successful reperfusion?
Resolution of anxiety
Decrease in blood pressure
Rapid reduction in chest pain with ECG improvement
Normalization of heart rate
