Cardiovascular & Hemodynamics NCLEX Practice Questions

Digoxin (hold if HR <60, check potassium level), beta-blockers, ACE inhibitors, anticoagulants, antidysrhythmics, and nitroglycerin are heavily tested. Know the mechanism, key assessments before administration, therapeutic ranges, and priority adverse effects for each cardiac drug class.

NCLEX tests clinical manifestations (dyspnea, orthopnea, edema, crackles), distinguishing left vs right heart failure, priority nursing interventions (positioning — high Fowler's, fluid restriction, daily weights, medication management), and recognizing acute decompensation that requires immediate reporting.

Use the MONA mnemonic as a memory aid (Morphine, Oxygen, Nitroglycerin, Aspirin), though current AHA guidelines prioritize aspirin first and oxygen only if SpO2 <94%. Obtain a 12-lead ECG immediately, establish IV access, administer sublingual nitroglycerin (up to 3 doses, 5 min apart), and prepare for potential PCI or thrombolytic therapy. Monitor for dysrhythmias and hemodynamic changes continuously.

Ventricular fibrillation (V-fib): chaotic rhythm, no pulse — immediate defibrillation and CPR. Ventricular tachycardia (V-tach): wide QRS, may be pulseless — defibrillate if pulseless, cardiovert if pulse present. Asystole: flat line — CPR and epinephrine (do NOT defibrillate). Third-degree heart block: complete AV dissociation — may require temporary or permanent pacemaker. Always assess for a pulse first.

CVP (central venous pressure): normal 2–6 mmHg, reflects right heart preload. PAWP/wedge pressure: normal 8–12 mmHg, reflects left heart preload. MAP (mean arterial pressure): normal 70–105 mmHg, needed for organ perfusion. Cardiac output: normal 4–8 L/min. Elevated CVP/PAWP suggests fluid overload or heart failure; decreased values suggest hypovolemia.

Monitor the insertion site for bleeding or hematoma, assess distal pulses (dorsalis pedis or posterior tibial), check capillary refill, color, and temperature of the affected extremity, maintain bed rest with the affected limb extended (4–6 hours for femoral approach), encourage oral fluids to flush contrast dye, and monitor renal function (BUN/creatinine) — contrast can cause nephrotoxicity. Report signs of retroperitoneal bleeding: flank pain, hypotension, and tachycardia.