NCLEX-Style Myocardial Infarction Questions
Question 1: A 58-year-old patient arrives at the emergency department with severe crushing chest pain radiating to the left arm and jaw. The nurse suspects myocardial infarction (MI). Which lab marker is most specific for confirming myocardial cell damage?
- A. Creatine kinase (CK)
- B. Troponin I
- C. Myoglobin
- D. Lactate dehydrogenase (LDH)
Explanation: Troponin I is highly specific for myocardial injury and remains elevated for 7–10 days, making it the preferred marker for diagnosing MI.
Question 2: A patient with ST-segment elevation myocardial infarction (STEMI) is scheduled for percutaneous coronary intervention (PCI). What is the nurse’s priority before the procedure?
- A. Administer antihypertensive medications
- B. Obtain informed consent and ensure IV access
- C. Provide high-calorie diet
- D. Schedule echocardiography for later
Explanation: Ensuring informed consent and establishing IV access are critical before PCI to facilitate emergency medications and rapid intervention if complications occur.
Question 3: A patient experiencing MI reports severe chest pain unrelieved by rest. Which intervention should the nurse implement first?
- A. Encourage deep breathing exercises
- B. Administer prescribed nitroglycerin and oxygen
- C. Apply cold compress to the chest
- D. Prepare for immediate defibrillation
Explanation: Nitroglycerin reduces myocardial oxygen demand, and supplemental oxygen improves oxygenation; both are first-line interventions for acute MI pain.
Question 4: A 65-year-old patient with MI develops sudden shortness of breath and crackles in both lungs. Which complication should the nurse suspect?
- A. Pulmonary embolism
- B. Left-sided heart failure
- C. Right-sided heart failure
- D. Pneumothorax
Explanation: Crackles and dyspnea indicate pulmonary congestion caused by left-sided heart failure, a common complication of myocardial infarction.
Question 5: During assessment, a patient with an inferior wall MI presents with hypotension and bradycardia. What is the priority nursing action?
- A. Administer intravenous fluids cautiously and monitor vitals
- B. Start immediate cardioversion
- C. Encourage ambulation
- D. Apply topical nitroglycerin
Explanation: Inferior wall MI can affect the right ventricle, leading to hypotension and bradycardia. Careful IV fluid administration helps maintain cardiac output without overloading the heart.
Question 6: A patient recovering from MI is prescribed beta blockers. What is the primary nursing consideration before administration?
- A. Assess heart rate and blood pressure
- B. Monitor for hypoglycemia
- C. Ensure adequate fluid intake
- D. Encourage patient to exercise vigorously
Explanation: Beta blockers reduce heart rate and contractility; monitoring vitals is essential to prevent hypotension or bradycardia before administration.
Question 7: A nurse educates a post-MI patient about lifestyle modifications. Which statement indicates correct understanding?
- A. “I can stop taking my medications once I feel better.”
- B. “I should quit smoking, control my diet, and exercise as recommended.”
- C. “I should avoid all physical activity forever.”
- D. “Diet and exercise are not important since I had the procedure.”
Explanation: Lifestyle modifications, including smoking cessation, healthy diet, and appropriate exercise, are essential to prevent recurrence and promote cardiac recovery.
Question 8: A 70-year-old diabetic patient with MI reports no chest pain but presents with shortness of breath and fatigue. What should the nurse recognize about this presentation?
- A. The patient is experiencing anxiety, not MI
- B. Diabetic patients may have silent MI with atypical symptoms
- C. MI always presents with severe chest pain
- D. This is likely unrelated to cardiac events
Explanation: Diabetic neuropathy can mask classic chest pain, leading to silent myocardial infarction; atypical symptoms like fatigue or dyspnea are common.
Question 9: A patient with acute MI has an ECG showing ST-segment elevation in leads V1–V4. Which type of MI does this indicate?
- A. Inferior wall MI
- B. Anterior wall MI
- C. Lateral wall MI
- D. Posterior wall MI
Explanation: ST-segment elevation in V1–V4 corresponds to the anterior wall of the left ventricle, indicating anterior wall myocardial infarction.
Question 10: A patient with MI is scheduled to receive thrombolytic therapy. Which nursing action is most important before administration?
- A. Assess for contraindications such as recent surgery or bleeding
- B. Encourage patient to walk around
- C. Administer high-protein snacks
- D. Apply continuous cold compress
Explanation: Thrombolytics carry a high risk of bleeding; assessing for contraindications such as recent surgery, trauma, or hemorrhagic disorders is critical to ensure patient safety.
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