NCLEX-RN Certification Test Prep: Cardiac and Respiratory Systems Focus

Introduction to Cardiac and Respiratory Systems for NCLEX-RN

The cardiac and respiratory systems represent some of the most critical and frequently tested content areas on the NCLEX-RN examination, consistently appearing across multiple client needs categories within the test plan. These interconnected body systems are fundamental to nursing practice because they directly impact oxygenation and circulation, two of the most essential physiological processes for sustaining life. NCLEX-RN questions in this domain test your ability to recognize early signs of cardiovascular and respiratory compromise, implement appropriate nursing interventions, and prioritize care for patients with acute and chronic conditions. Common cardiac conditions tested include heart failure, myocardial infarction, arrhythmias, and hypertension, while respiratory focus areas encompass chronic obstructive pulmonary disease (COPD), asthma, pneumonia, and respiratory failure. The examination emphasizes practical skills such as EKG interpretation, arterial blood gas (ABG) analysis, oxygen therapy management, and chest tube care. Understanding the pathophysiology of these systems allows nurses to anticipate complications, recognize deteriorating patient conditions, and implement life-saving interventions. Questions often present complex scenarios requiring clinical judgment about medication administration, patient positioning, activity restrictions, and patient education. The integration of cardiac and respiratory assessment skills with therapeutic interventions makes this content area particularly high-yield for NCLEX success. Mastery of these concepts ensures that new graduate nurses can provide safe, effective care to patients with cardiovascular and pulmonary conditions across all healthcare settings.

Practice Questions: Cardiac and Respiratory Systems

Question 1: A patient with heart failure is prescribed furosemide (Lasix). Which laboratory value should the nurse monitor most closely?
A) Blood glucose
B) Serum potassium
C) White blood cell count
D) Hemoglobin level

Question 2: A patient presents with chest pain, diaphoresis, and nausea. The EKG shows ST-segment elevation. What is the nurse’s priority action?
A) Administer sublingual nitroglycerin
B) Obtain a complete medical history
C) Notify the physician immediately
D) Start an IV line

Question 3: Which arterial blood gas (ABG) result indicates respiratory acidosis?
A) pH 7.48, PaCO2 32, HCO3 24
B) pH 7.32, PaCO2 50, HCO3 24
C) pH 7.40, PaCO2 40, HCO3 24
D) pH 7.50, PaCO2 40, HCO3 30

Question 4: A patient with COPD should be positioned in which way to facilitate breathing?
A) Supine with legs elevated
B) Trendelenburg position
C) High Fowler’s position
D) Left lateral position

Question 5: Which oxygen delivery method provides the highest concentration of oxygen?
A) Nasal cannula at 6 L/min
B) Simple face mask at 8 L/min
C) Non-rebreather mask at 15 L/min
D) Venturi mask at 10 L/min

Question 6: A patient with atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory test should be monitored regularly?
A) Partial thromboplastin time (PTT)
B) International normalized ratio (INR)
C) Platelet count
D) Fibrinogen level

Question 7: Which finding indicates that a patient with pneumonia is responding positively to treatment?
A) Increased sputum production
B) Decreased oxygen saturation
C) Clear breath sounds
D) Elevated white blood cell count

Question 8: A patient has a chest tube connected to a water-seal drainage system. Which observation requires immediate nursing intervention?
A) Gentle bubbling in the suction chamber
B) Fluctuation in the water-seal chamber with breathing
C) 50 mL of serosanguineous drainage in 8 hours
D) Continuous vigorous bubbling in the water-seal chamber

Question 9: Which medication is considered first-line treatment for acute myocardial infarction?
A) Morphine sulfate
B) Aspirin
C) Nitroglycerin
D) Metoprolol

Question 10: A patient with asthma is using a metered-dose inhaler (MDI). What should the nurse teach the patient?
A) Inhale rapidly and deeply
B) Hold breath for 2-3 seconds after inhalation
C) Exhale completely before using the inhaler
D) Use the inhaler every hour as needed

Question 11: Which sign indicates left-sided heart failure?
A) Peripheral edema
B) Jugular vein distention
C) Crackles in lung bases
D) Hepatomegaly

Question 12: A patient with COPD has an oxygen saturation of 88%. What is the appropriate oxygen flow rate via nasal cannula?
A) 1-2 L/min
B) 4-6 L/min
C) 8-10 L/min
D) 12-15 L/min

Question 13: Which EKG change is most characteristic of hyperkalemia?
A) Prolonged QT interval
B) Tall, peaked T waves
C) ST-segment depression
D) Shortened PR interval

Question 14: A patient is experiencing a hypertensive crisis with a blood pressure of 220/120 mmHg. What is the nurse’s priority assessment?
A) Peripheral pulses
B) Neurological status
C) Urinary output
D) Skin temperature

Question 15: Which instruction should the nurse give to a patient using an incentive spirometer?
A) Use it once every 8 hours
B) Exhale into the device
C) Breathe in slowly and deeply
D) Hold the device horizontally

Answer Key and Explanations

Answer 1: B – Furosemide is a loop diuretic that can cause significant potassium loss, requiring close monitoring of serum potassium levels.

Answer 2: C – ST-segment elevation indicates acute myocardial infarction requiring immediate physician notification for emergency intervention.

Answer 3: B – pH below 7.35 with elevated PaCO2 (above 45) indicates respiratory acidosis from CO2 retention.

Answer 4: C – High Fowler’s position (sitting upright) uses gravity to facilitate diaphragmatic excursion and ease breathing.

Answer 5: C – Non-rebreather masks can deliver up to 90-95% oxygen concentration, the highest among these options.

Answer 6: B – INR monitoring is essential for warfarin therapy to ensure therapeutic anticoagulation levels (target 2.0-3.0).

Answer 7: C – Clear breath sounds indicate resolution of lung consolidation and effective treatment of pneumonia.

Answer 8: D – Continuous vigorous bubbling in the water-seal chamber indicates an air leak requiring immediate intervention.

Answer 9: B – Aspirin is first-line treatment for MI due to its immediate antiplatelet effects reducing clot formation.

Answer 10: C – Complete exhalation before inhalation ensures maximum medication delivery to the airways.

Answer 11: C – Crackles in lung bases indicate pulmonary congestion, a classic sign of left-sided heart failure.

Answer 12: A – COPD patients should receive low-flow oxygen (1-2 L/min) to prevent suppression of hypoxic respiratory drive.

Answer 13: B – Tall, peaked T waves are the classic EKG finding associated with elevated serum potassium levels.

Answer 14: B – Neurological assessment is priority in hypertensive crisis due to risk of stroke and increased intracranial pressure.

Answer 15: C – Incentive spirometry requires slow, deep inspiration to expand alveoli and prevent pneumonia.