1.

During a routine assessment, Nurse Aya finds that a patient has a serum
calcium level of 7.5 mg/dL. The patient is at risk for which of the following
complications?
A) Increased neuromuscular excitability leading to tetany.
B) Decreased risk of fracture due to strong bones.
C) Impaired renal function due to increased calcium.
D) Hyperparathyroidism.
2. Patient Ezra presents with metabolic alkalosis. Which of the following factors
could have contributed to his condition?
A) Diarrhea and dehydration.
B) Excessive vomiting and diuretic use.
C) Hypoventilation and anxiety.
D) Renal failure and fluid retention.
3. Nurse Doj is educating patient Tin with hypercalcemia about dietary changes.
Which food should nurse Doj recommend avoiding?
A) Leafy greens
B) Dairy products
C) Nuts
D) Fish
4. Nurse Darlene is assessing patient Mau with a history of renal disease. Which
finding would indicate possible hyperkalemia?
A) Dry skin
B) Positive Trousseau’s sign
C) Peaked T waves on ECG
D) Weight loss
5. Patient Niko presents with confusion, tremors, and a serum sodium level of
120 mEq/L. What is the best nursing action?
A) Administer hypertonic saline as ordered.
B) Encourage increased oral sodium intake.
C) Restrict fluid intake.
D) Monitor urine output closely.
6. Patient Bagarinee with chronic diarrhea is at risk for which acid-base
imbalance?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis
7. A patient with a history of excessive alcohol use presents with confusion and
tremors. A serum magnesium level reveals hypomagnesemia. What is the
priority nursing intervention?
A) Administer magnesium sulfate IV.
B) Encourage oral intake of magnesium-rich foods.
C) Assess for signs of hypocalcemia.
D) Administer calcium gluconate IV
8. A patient with hyperparathyroidism is experiencing hypercalcemia.
Which symptom should the nurse monitor for as a potential complication?
A) Muscle spasms
B) Dehydration
C) Bone fractures
D) Cardiac arrhythmias
9. A patient presents with severe diarrhea. The nurse anticipates which laboratory
finding indicative of metabolic acidosis?
A) Decreased HCO3
B) Increased PaCO2
C) Elevated pH
D) Decreased potassium
10. A patient with heart failure is prescribed a diuretic. What is the expected
effect of this medication on homeostasis?
A) Increased fluid retention
B) Decreased potassium loss
C) Decreased blood volume
D) Increased sodium levels
11. A patient with hyperaldosteronism is at risk for which
electrolyte imbalance?
A) Hyperkalemia
B) Hyponatremia
C) Hypercalcemia
D) Hypokalemia
12. A patient presents with a potassium level of 6.2 mEq/L. Which cardiac
rhythm might the nurse anticipate on the ECG?
A) Normal sinus rhythm
B) Ventricular tachycardia
C) Atrial fibrillation
D) Peaked T waves
13. A patient with a history of alcoholism presents with muscle spasms and
positive Chvostek's sign. What is the most appropriate intervention?
A) Administer intravenous calcium gluconate
B) Encourage dietary intake of magnesium
C) Increase fluid intake
D) Restrict protein intake
14. A patient receiving intravenous fluids develops signs of fluid overload,
including hypertension and edema. What is the best nursing intervention?
A) Increase the rate of fluid administration
B) Administer a diuretic as ordered
C) Restrict the patient's dietary sodium
D) Monitor daily weights and vital signs
15. A patient with atherosclerosis is being educated about exercise. Which
statement indicates the need for further teaching?
A) “I will start with light activities and gradually increase.”
B) “I should avoid exercise if I feel any chest pain.”
C) “I can walk 30 minutes a day as long as I feel okay.”
D) “I should only exercise when I have a personal trainer.”
Case 1. Mr. Ronell, a 65-year-old male with a significant medical history of
hypertension, coronary artery disease, and type 2 diabetes mellitus, is admitted to
the telemetry unit with worsening dyspnea, fatigue, and bilateral lower extremity
edema. He reports a 5-pound weight gain over the past week and states he can no
longer sleep lying flat due to shortness of breath. Upon examination, the nurse notes
bilateral crackles, a heart rate of 100 beats per minute, and a blood pressure of
135/88 mmHg. The patient's lab results show elevated B-type natriuretic peptide
(BNP) levels and normal renal function.

16. Considering Mr. Ronell's clinical presentation, which underlying mechanism is

primarily responsible for his symptoms of shortness of breath?
A) Increased left atrial pressure leading to pulmonary congestion
B) Decreased cardiac output resulting in reduced peripheral perfusion
C) Compensatory tachycardia in response to hypotension
D) Systemic vasodilation causing decreased blood volume
17. Given Mr. Ronell's history and current condition, which lab value is most
critical to monitor for signs of worsening heart failure?
A) Serum potassium
B) Serum creatinine
C) B-type natriuretic peptide (BNP)
D) Hemoglobin and hematocrit
18. In educating Mr. Ronell about his medications, which statement should
the nurse emphasize regarding the purpose of an ACE inhibitor?
A) "This medication will increase your heart rate to improve circulation.“
B) "This will help relax your blood vessels and lower your blood pressure."
C) "This medication will prevent blood clots in your veins."
D) "This will increase your heart’s pumping efficiency."
19. When assessing Mr. Ronell's nutritional status, which dietary component
should the nurse specifically monitor to prevent exacerbation of heart
failure?
A) Total caloric intake
B) Saturated fat content
C) Sodium intake
D) Fiber content
20. As part of Mr. Ronell's assessment, the nurse notes jugular vein distention.
What does this finding suggest?
A) Fluid overload and increased right atrial pressure
B) Effective compensation of the cardiovascular system
C) Dehydration and low blood volume
D) Normal cardiac function
21. In the context of myocardial infarction, which of the following is
considered a significant risk factor for the development of coronary artery
disease?
A) Hyperlipidemia
B) Occasional alcohol consumption
C) Low physical activity
D) All of the above
22. A patient recovering from myocardial infarction is prescribed a statin. What is
the primary mechanism by which statins provide cardiovascular protection?
A) Increase in high-density lipoprotein (HDL) levels
B) Decrease in low-density lipoprotein (LDL) levels
C) Antioxidant effects
D) Improvement of endothelial function
23. A patient with a myocardial infarction is being considered for thrombolytic
therapy. Which of the following contraindications would most significantly
impact the decision to administer this treatment?
A) History of smoking
B) Recent gastrointestinal bleeding
C) Elevated blood pressure
D) Age over 75 years
24. In the management of a patient with aortic stenosis, which surgical intervention
is considered definitive?
A) Balloon valvuloplasty
B) Aortic valve replacement
C) Medical management with diuretics
D) Transcatheter aortic valve implantation (TAVI)
25. A patient diagnosed with aortic regurgitation experiences acute shortness of
breath. Which of the following interventions should be prioritized in the
emergency department?
A) Administer intravenous fluids
B) Position the patient upright
C) Start anticoagulation therapy
D) Provide supplemental oxygen
26. In a patient with suspected mitral stenosis, which of the following clinical
features would most likely be present on physical examination?
A) Wide pulse pressure
B) A diastolic murmur
C) Systolic ejection click
D) Holosystolic murmur
27. During a physical examination, Nurse Lexyl hears a loud,
holosystolic murmur at the apex that radiates to the left axilla. This
finding is most consistent with which of the following conditions?
A) Aortic regurgitation
B) Mitral regurgitation
C) Tricuspid regurgitation
D) Mitral stenosis
28. In patients with rheumatic endocarditis, which of the
following cardiac manifestations is most commonly
observed?
A) Pericardial effusion
B) Myocardial infarction
C) Valve stenosis or regurgitation
D) Conduction abnormalities
29. Which of the following assessments should be prioritized in a patient
with rheumatic endocarditis?
A) Neurological assessment
B) Respiratory assessment
C) Cardiovascular assessment
D) Gastrointestinal assessment
30. A 30-year-old male presents with chest pain, shortness of breath, and
fatigue after a recent viral infection and has been diagnosed with
myocarditis. Which of the following findings would most likely be present
on an electrocardiogram (ECG)?
A) ST-segment elevation
B) T-wave inversions
C) Q waves
D) Atrial fibrillation
31. In a patient with myocarditis, which clinical finding would indicate the
potential for heart failure?
A) Bradycardia
B) Normal blood pressure
C) Elevated jugular venous pressure
D) Decreased heart rate variability
32. A 45-year-old male presents with sharp chest pain that worsens with
deep breathing and improves when sitting forward. Which of the following
findings is most characteristic of pericarditis?
A) A friction rub on auscultation
B) Diminished breath sounds
C) Bradycardia
D) Increased jugular venous pressure
33. In a patient with chronic pericarditis, which of the following
laboratory findings would you expect to see?
A) Elevated blood glucose
B) Increased platelet
C) Elevated cardiac enzymes
D) Elevated erythrocyte sedimentation rate (ESR)
34. The nurse is reviewing laboratory results for a patient with
coronary artery disease. Which of the following lipid levels
should be considered abnormal and contribute to
atherosclerosis? (Select all that apply)
1. LDL of 180 mg/dL
2. HDL of 65 mg/dL
3. Triglycerides of 220 mg/dL
4. Total cholesterol of 180 mg/dL
5. LDL of 90 mg/dL
a. 1-3-4
b. 1-3
c. 1-2-3
d. 1-2-3-4-5
e. 1-4
35. Which of the following interventions should be your first priority when
treating a patient experiencing chest pain while walking?
a) Get the patient drink water
b) Have the patient sit down
c) Obtain ECG
d) Administer sublingual nitrates
Case 2. A 26-year-old female athlete with a family history of sudden cardiac
death presents with a harsh systolic murmur and occasional palpitations
after intense exercise. An ECG shows left ventricular hypertrophy.

36. What is the primary pathophysiological mechanism behind hypertrophic

cardiomyopathy?
A) Inflammation of the myocardium leading to ventricular dilation
B) Abnormal thickening of the heart muscle, primarily the left ventricle
C) Stiffening of the myocardium causing restrictive filling
D) Excessive fluid buildup in the lungs due to heart failure
37. What diagnostic test is most definitive for diagnosing hypertrophic
cardiomyopathy?
A) ECG
B) Echocardiography
C) Chest Xray
D) Endomyocardial biopsy
38. Which of the following is an absolute contraindication for an
athlete with hypertrophic cardiomyopathy?
A) Competitive sports participation
B) Moderate aerobic exercise
C) Yoga or stretching exercises
D) Swimming in a controlled environment
39. Which of the following is an important consideration when prescribing
beta-blockers to a patient with hypertrophic cardiomyopathy?
A) Monitor for signs of fluid retention and edema.
B) Monitor for hypotension and bradycardia.
C) Increase the dose if the patient develops syncope.
D) Beta-blockers are contraindicated in hypertrophic cardiomyopathy.
40. Which of the following is a potential complication of untreated
hypertrophic cardiomyopathy?
A) Pulmonary embolism
B) Heart failure
C) Sarcoidosis
D) Deep vein thrombosis
Case 3. A 65-year-old woman with a history of diabetes mellitus,
hypertension, and hyperlipidemia presents to the clinic for follow-up care.
She complains of chest discomfort when walking briskly, which improves
with rest. She denies nausea, diaphoresis, or radiating pain.

41. Based on this patient's presentation, which type of angina is most likely?
A) Stable angina
B) Unstable angina
C) Prinzmetal's angina
D) Silent ischemia
42. What is the primary goal of treatment for a patient with this type of angina?
A) Prevent myocardial infarction
B) Relieve chest pain during episodes
C) Increase exercise tolerance
D) Improve long-term survival
Case 4. A 72-year-old male with a history of myocardial infarction (MI) 5
years ago presents to the ER with substernal chest pain radiating to the left
arm. The pain has lasted for 30 minutes and is not relieved by rest. He is
diaphoretic and anxious. An ECG shows ST-segment elevation.

43. What is the most likely diagnosis for this patient?

A) Unstable angina
B) Acute myocardial infarction (MI)
C) Stable angina
D) Pulmonary embolism
44. What is the first-line pharmacological treatment for a patient with such
condition?
A) Beta-blockers
B) Fibrinolytics
C) Calcium channel blockers
D) Morphine, oxygen, nitrates, and aspirin.
45. The attending physician ordered additional laboratory tests to rule out
the condition of the patient. Blood results showed elevated levels of
cardiac biomarkers. What does this suggest?
A) Ischemia
B) Infarction
C) Injury
D) Cardiac muscle damage
46. During cardiac catheterization, the patient is found to have a blockage in
the left anterior descending artery (LAD). What is the next most likely
intervention?
A) Administer anticoagulant to dissolve the clot
B) Prepare the patient for coronary artery bypass grafting (CABG)
C) Schedule the patient for a percutaneous coronary intervention (PCI)
D) Start the patient on long-term anticoagulation therapy
47. What is the most important diagnostic feature that a transthoracic
echocardiogram (TTE) can provide in a patient with suspected mitral valve
regurgitation?
A) Measurement of left ventricular ejection fraction
B) Visualization of the mitral valve leaflets and assessment of regurgitant flow
C) Evaluation of coronary artery patency
D) Detection of left atrial thrombus
48. What is the main goal of percutaneous coronary intervention (PCI) in this
patient?
A) To repair the mitral valve and relieve the regurgitation
B) To remove a clot from the coronary artery and restore blood flow
C) To determine the degree of aortic stenosis and plan for surgery
D) To assess the patient’s coronary artery bypass grafts (CABG)
49. What is the most important post-procedural nursing intervention for a
patient after PCI?
A) Encourage early ambulation to prevent venous stasis
B) Monitor for signs of bleeding, particularly at the catheter insertion site
C) Administer a high dose of aspirin to prevent re-thrombosis
D) Place the patient in Trendelenburg position to increase venous return
50. Which part of the conduction system is responsible for delaying the
electrical impulse before it enters the ventricles?
A) SA node
B) AV node
C) Bundle of His
D) Purkinje fibers