Cardiac Nursing Questions for the Prometric Exam 2026: 20 MCQs with Answers on Acute Coronary Syndrome, Heart Failure, Arrhythmias, Anticoagulation, Hypertension, Cardiac Catheterisation, Pacemakers, Valve Disease and Cardiac Rehabilitation

Cardiovascular nursing is the largest single topic inside the medical-surgical domain of the registered nurse paper, typically 10 to 15 questions, and cardiac units are among the biggest recruiters in the Gulf, where heart disease presents a decade earlier than in Western populations. The exam tests the chest pain pathway, heart failure and arrhythmia management, drug safety, and care around procedures. ECG recognition has its own set (ECG questions). This set covers the rest.

Acute coronary syndrome

Question 1

A 55-year-old man arrives with 40 minutes of crushing central chest pain radiating to the left arm, sweating and nausea. The nurse's first actions are:

1. Complete the admission paperwork, then call the doctor
2. A 12-lead ECG within 10 minutes of arrival and immediate review, continuous cardiac monitoring with a defibrillator nearby, intravenous access, oxygen only if saturations are below 90%, aspirin 300 mg chewed unless contraindicated, pain assessment and nitrates or opioid analgesia as prescribed, and bloods including troponin
3. Oxygen at 15 L/min for every patient
4. Walk the patient to the x-ray department

Answer: B. Routine high-flow oxygen in normoxic patients is no longer recommended; ST elevation triggers the primary PCI pathway with a door-to-balloon target of 90 minutes or less.

Question 2

Before giving sublingual glyceryl trinitrate to a patient with chest pain, the nurse must check:

1. The patient's weight
2. Systolic blood pressure (hold if below about 90 mmHg), heart rate, and whether the patient has taken a phosphodiesterase-5 inhibitor (sildenafil, tadalafil) in the last 24 to 48 hours, because the combination causes profound hypotension; also assess for right ventricular infarction
3. Blood glucose
4. Oxygen saturation only

Answer: B. Nitrates are given up to three doses five minutes apart with blood pressure between doses; headache is an expected side effect.

Question 3

A patient returns to the ward after primary PCI via the right femoral artery with a closure device. Which finding requires immediate action?

1. A small bruise at the puncture site
2. A rapidly expanding groin swelling, bleeding through the dressing, a cold pale pulseless right foot, severe back or flank pain with hypotension (suggesting retroperitoneal bleed), or new chest pain or ECG changes suggesting stent thrombosis
3. The patient asking for water
4. Mild discomfort at the site

Answer: B. Site checks and distal pulses are performed every 15 minutes initially; the patient keeps the leg straight and head of bed at the prescribed angle for the specified time. Radial access has fewer bleeding complications.

Question 4

Discharge teaching after a myocardial infarction with a drug-eluting stent must emphasise:

1. Stopping all medication once the chest pain has gone
2. Never stopping dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor such as clopidogrel or ticagrelor) without the cardiologist's instruction because of stent thrombosis risk, continuing the statin, beta blocker and ACE inhibitor, carrying GTN and knowing when to call emergency services, smoking cessation, cardiac rehabilitation enrolment, diet, activity and driving advice
3. Avoiding all physical activity for six months
4. Taking aspirin only when chest pain occurs

Answer: B. Dentists and surgeons must be told about the antiplatelet therapy before any procedure; premature discontinuation is a leading cause of stent thrombosis.

Heart failure

Question 5

A patient with heart failure has gained 2.5 kg in three days, has bibasal crackles, orthopnoea, raised jugular venous pressure and pitting oedema to the knees. The nurse's priority actions are:

1. Encourage oral fluids to improve kidney function
2. Sit the patient upright, give oxygen if hypoxic, administer intravenous loop diuretic as prescribed and monitor the response (urine output, weight, breathlessness), continuous monitoring, strict fluid balance, daily weights, fluid and sodium restriction as prescribed, and check electrolytes and renal function
3. Lie the patient flat with legs elevated
4. Give a fluid bolus

Answer: B. A weight gain of more than 2 kg in three days is the threshold patients are taught to report; daily weight is the most sensitive marker of fluid status.

Question 6

A patient on digoxin for heart failure and atrial fibrillation reports nausea, anorexia and seeing yellow-green halos around lights. Her heart rate is 48 and potassium 3.1 mmol/L. The nurse should:

1. Give the next digoxin dose as scheduled
2. Withhold digoxin, notify the prescriber, obtain a digoxin level, electrolytes and ECG, correct hypokalaemia as prescribed (which potentiates toxicity), and anticipate digoxin-specific antibody fragments for life-threatening toxicity
3. Give potassium-wasting diuretics
4. Encourage a high-calcium diet

Answer: B. The apical pulse is checked for a full minute before each dose and the drug withheld below 60 in adults; the therapeutic range is narrow (0.5 to 2 ng/mL, lower targets in heart failure).

Question 7

Which medication teaching is correct for a patient with heart failure started on an ACE inhibitor and spironolactone?

1. Use potassium-based salt substitutes freely
2. Report a persistent dry cough or any facial or lip swelling (angio-oedema) immediately, avoid potassium supplements and salt substitutes, have renal function and potassium checked within one to two weeks, rise slowly to avoid postural hypotension, and understand that these drugs improve survival and are continued even when feeling well
3. Stop the drugs when the swelling resolves
4. Double the dose if blood pressure is high

Answer: B. The four pillars of heart failure with reduced ejection fraction are ACE inhibitor/ARNI, beta blocker, mineralocorticoid receptor antagonist and SGLT2 inhibitor; NSAIDs are avoided because they cause fluid retention.

Question 8

A patient with heart failure asks why they must weigh themselves every morning. The nurse explains:

1. To track calorie intake
2. That fluid accumulates before breathlessness or swelling become obvious, so weighing at the same time each morning after voiding and before breakfast, and reporting a gain of about 1 kg overnight or 2 kg in three days (or as individually set), allows early diuretic adjustment and prevents hospital admission
3. It is not important once symptoms settle
4. Weight is only relevant for medication dosing

Answer: B. Self-care education, including fluid limits (often 1.5 to 2 litres), sodium under 2 g, and recognising deterioration, is the core of heart failure nursing.

Arrhythmias and anticoagulation

Question 9

A patient on the ward has a heart rate of 150, irregular, with a blood pressure of 85/50, chest pain and confusion. The monitor shows atrial fibrillation. The nurse anticipates:

1. Oral beta blocker and reassessment in four hours
2. Urgent synchronised electrical cardioversion under sedation because the patient is haemodynamically unstable, with oxygen, intravenous access and the resuscitation team called; rate control with drugs is for stable patients
3. Carotid sinus massage
4. Unsynchronised defibrillation

Answer: B. Unsynchronised shocks are only for pulseless VT and VF; synchronisation avoids delivering the shock on the T wave.

Question 10

A patient with atrial fibrillation on warfarin has an INR of 6.5 with no bleeding. The nurse should:

1. Give the usual warfarin dose
2. Withhold warfarin, notify the prescriber, anticipate oral vitamin K for INR above a threshold per protocol (often above 8, or lower with bleeding risk), assess for bleeding, review interacting drugs and diet changes, and arrange INR recheck; intravenous vitamin K and prothrombin complex concentrate are for major bleeding
3. Give aspirin as well
4. Double the next dose

Answer: B. Antibiotics, amiodarone, alcohol and reduced vitamin K intake raise the INR; the target for most indications is 2 to 3 (2.5 to 3.5 for some mechanical valves).

Question 11

Which teaching is correct for a patient started on a direct oral anticoagulant (apixaban or rivaroxaban) for atrial fibrillation?

1. Weekly INR tests are required
2. No routine INR monitoring, take at the same time daily (rivaroxaban with food), do not miss doses because the effect wears off within a day, report bleeding, carry an anticoagulant alert card, tell dentists and surgeons, avoid NSAIDs, and have renal function checked at least annually because dosing depends on kidney function
3. Stop the drug if bruising appears
4. Take double doses to catch up if a dose is missed

Answer: B. Specific reversal agents exist (idarucizumab for dabigatran, andexanet for factor Xa inhibitors); DOACs are not used for mechanical valves.

Question 12

A patient has a heart rate of 38 with dizziness, hypotension and a complete heart block on the monitor. The nurse's immediate actions are:

1. Encourage ambulation
2. Oxygen if hypoxic, intravenous access, atropine 0.5 mg as prescribed (often ineffective in complete heart block), prepare for transcutaneous pacing and call for help, with isoprenaline or adrenaline infusion as a bridge to temporary or permanent pacemaker insertion
3. Give a beta blocker
4. Carotid sinus massage

Answer: B. Beta blockers, calcium channel blockers and digoxin are reviewed as causes; transcutaneous pacing requires analgesia and sedation.

Question 13

After permanent pacemaker insertion, discharge teaching includes:

1. No restrictions at all
2. Keep the wound clean and dry and report redness, swelling or discharge, avoid raising the arm on the implant side above the shoulder and heavy lifting for about four to six weeks to prevent lead displacement, check the pulse daily and report a rate below the set rate or symptoms, carry the pacemaker card, keep mobile phones and magnets at least 15 cm from the device, inform staff before MRI (many modern devices are MRI-conditional), and attend device checks
3. Avoid microwave ovens permanently
4. Stop all cardiac medication

Answer: B. Hiccups, muscle twitching or syncope after insertion suggest lead problems and are reported; airport security is safe with the card shown.

Hypertension, valves and other conditions

Question 14

A patient has a blood pressure of 230/130 mmHg with severe headache, blurred vision, confusion and papilloedema. The nurse recognises and anticipates:

1. Hypertensive urgency; oral medication and outpatient follow-up
2. Hypertensive emergency with end-organ damage; ICU-level monitoring with an arterial line, intravenous antihypertensives (labetalol, nicardipine, GTN) titrated to reduce mean arterial pressure by no more than about 20 to 25% in the first hour, then towards 160/100 over the next hours, because precipitous drops cause stroke and ischaemia; neurological observations and assessment for stroke, aortic dissection and pulmonary oedema
3. Normal for an anxious patient
4. Sublingual nifedipine for rapid reduction

Answer: B. Sublingual nifedipine causes unpredictable precipitous falls and is not used; aortic dissection is the exception where rapid lowering to a systolic of 100 to 120 is targeted.

Question 15

A patient with a prosthetic heart valve needs a dental extraction. The nurse's teaching includes:

1. No special precautions are needed
2. Antibiotic prophylaxis before dental procedures involving gingival manipulation (amoxicillin 2 g one hour before, or clindamycin or azithromycin in penicillin allergy) because a prosthetic valve is a high-risk condition for infective endocarditis, meticulous oral hygiene, and informing the dentist about anticoagulation, with warfarin usually continued for simple extractions
3. Stopping warfarin a week before
4. Prophylaxis only for heart surgery

Answer: B. Other high-risk conditions are previous endocarditis, certain congenital heart diseases and cardiac transplant with valve disease; fever in a patient with a prosthetic valve prompts blood cultures before antibiotics.

Question 16

Three days after cardiac surgery, a patient becomes hypotensive and tachycardic with distended neck veins, muffled heart sounds and a falling urine output, and the chest drain output has suddenly stopped. The nurse recognises:

1. Hypovolaemia from over-diuresis
2. Cardiac tamponade (Beck's triad), a surgical emergency; call for immediate help, give oxygen and fluids as prescribed to maintain preload, check the drains for clots, and prepare for echocardiography and urgent pericardial drainage or return to theatre
3. Pneumonia; antibiotics
4. Expected post-operative recovery

Answer: B. Pulsus paradoxus and electrical alternans are additional signs; a drain that stops suddenly after steady output is the classic clue.

Question 17

A patient with peripheral arterial disease reports calf pain on walking 100 metres that resolves with rest. Which nursing advice is correct?

1. Elevate the legs above the heart and apply heat
2. Supervised exercise (walking to near-maximal pain, resting, repeating), smoking cessation, foot care and daily inspection, well-fitting footwear, keep legs dependent or level rather than elevated, avoid cold and constrictive clothing, control diabetes, blood pressure and lipids, and take antiplatelet and statin therapy as prescribed; report rest pain, ulcers or a cold pale foot urgently
3. Bed rest to protect the legs
4. Compression stockings for arterial disease

Answer: B. Compression is contraindicated in significant arterial disease (ankle-brachial index below 0.8); elevation worsens arterial perfusion. Venous disease, by contrast, is managed with elevation and compression.

Question 18

A patient with suspected deep vein thrombosis of the left leg is started on treatment-dose low-molecular-weight heparin. Which nursing intervention is correct?

1. Vigorous massage of the calf to disperse the clot
2. Administer the injection subcutaneously into the abdomen rotating sites without expelling the air bubble or rubbing the site, monitor for bleeding and signs of pulmonary embolism (sudden breathlessness, chest pain, tachycardia), check platelet count for heparin-induced thrombocytopenia, encourage mobilisation as tolerated once anticoagulated, and teach self-injection if going home on LMWH
3. Strict bed rest for two weeks
4. Apply heat and massage

Answer: B. Early ambulation with anticoagulation does not increase embolism and reduces post-thrombotic syndrome; DOACs are now first line for most DVTs.

Diagnostics and rehabilitation

Question 19

A patient is scheduled for elective coronary angiography tomorrow. Which pre-procedure checks are essential?

1. Only a signed consent form
2. Informed consent, allergy history especially to iodinated contrast and shellfish myths clarified, renal function (contrast nephropathy risk, with hydration and metformin held per protocol), anticoagulant and antiplatelet management per the cardiologist, fasting as instructed, baseline vital signs and peripheral pulses marked, pregnancy status where relevant, and preparation of the access site
3. Full anticoagulation reversal in every patient
4. A chest radiograph only

Answer: B. A previous contrast reaction warrants premedication with steroids and antihistamines; metformin is held around contrast in patients with reduced eGFR.

Question 20

Which statement about cardiac rehabilitation is correct?

1. It is only for patients under 60
2. Structured cardiac rehabilitation (supervised exercise, education, risk factor management and psychological support) after myocardial infarction, revascularisation or heart failure reduces mortality and readmission; the nurse refers every eligible patient, assesses readiness and addresses barriers such as transport, work and gender-appropriate facilities, which matter in Gulf settings
3. Exercise is dangerous after a heart attack
4. Rehabilitation replaces medication

Answer: B. Sexual activity can usually resume two to four weeks after an uncomplicated MI; depression screening after cardiac events is routine because it worsens outcomes.

How to practise

• Learn the pathways: chest pain to PCI, heart failure decompensation, unstable arrhythmia, bradycardia with pacing, hypertensive emergency.
• Know the drug safety: nitrates and PDE-5 inhibitors, digoxin and potassium, warfarin interactions and INR actions, DOAC teaching, dual antiplatelet therapy.
• Know the post-procedure checks for angiography, PCI, pacemakers and cardiac surgery.

Cardiovascular chapters with explanations are in the Registered Nurse bank; related sets are the ECG questions, critical care questions, medical-surgical questions and pharmacology questions. Cardiology specialists have their own set (cardiology questions).

Frequently asked questions

How many cardiac questions are in the Prometric nursing exam?

About 10 to 15 of 150, within the medical-surgical domain, plus ECG and critical care items elsewhere.

Which cardiac nursing topics come up most?

Acute coronary syndrome care and discharge teaching, heart failure management and self-care, digoxin and anticoagulant safety, unstable arrhythmias, and post-procedure care after angiography and pacemaker insertion.

Do I need to know drug doses?

Key emergency doses (aspirin 300 mg, atropine 0.5 mg, GTN dosing intervals) and therapeutic ranges (INR, digoxin) are tested; full prescribing detail is not.

Which guidelines does the exam follow?

Current ESC and AHA/ACC guidance on acute coronary syndromes, heart failure, atrial fibrillation and hypertension, as reflected in standard nursing textbooks.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.