NCLEX ACS PRACTICE
EXAM Question 1: A nurse is caring for a client admitted with Acute Coronary Syndrome (ACS). Which assessment �nding is most indicative of a myocardial infarction (MI) rather than stable angina?
Choices:
1) Pain radiating to the left arm or jaw 2) Chest pain that occurs during physical exertion 3) Chest pain lasting longer than 30 minutes and unrelieved by rest or nitroglycerin 4) Transient ST-segment depression on the electrocardiogram (ECG) Correct Answer: Chest pain lasting longer than 30 minutes and unrelieved by rest or nitroglycerin Explanation: Pain from an MI typically lasts longer than 30 minutes and is not relieved by rest or nitroglycerin. Stable angina is usually relieved by rest or nitroglycerin and lasts less than 15 minutes.Page 1
Question 2: A client presents to the emergency department with severe, crushing
chest pain. The ECG shows ST-segment elevation. What is the priority nursing intervention?
Choices:
1) Administer a beta-blocker orally 2) Prepare the client for an immediate percutaneous coronary intervention (PCI) 3) Draw blood for a lipid panel 4) Administer a prophylactic dose of heparin Correct Answer: Prepare the client for an immediate percutaneous coronary intervention (PCI) Explanation: ST-segment elevation indicates a STEMI, requiring immediate reperfusion therapy.PCI is the treatment of choice and should be performed within 90 minutes of arrival.Question 3: Which medication should the nurse anticipate administering �rst to a client experiencing acute chest pain suggestive of an MI, according to the MONA protocol?
Choices:
1) Morphine 2) Oxygen 3) Nitroglycerin 4) Aspirin
Correct Answer: Oxygen
Explanation: While all are part of MONA, Oxygen is typically applied �rst if O2 saturation is below 90% or the patient is dyspneic, followed by Aspirin (to prevent further clotting), Nitroglycerin, and Morphine (if pain is unrelieved by nitro).Page 2
Question 4: A client is prescribed sublingual nitroglycerin for angina. Which
statement by the client indicates e�ective teaching?
Choices:
1) I should take a pill every 15 minutes until the pain stops.2) I will call 911 if my pain is not relieved 5 minutes after taking the �rst pill.3) I should swallow the pill with a full glass of water.4) I can store the medication in a clear plastic bag in my pocket.Correct Answer: I will call 911 if my pain is not relieved 5 minutes after taking the �rst pill.Explanation: Current guidelines state that if chest pain is unrelieved 5 minutes after taking one sublingual nitroglycerin tablet, the client should call EMS and can take a second tablet while waiting.Question 5: Which cardiac biomarker is the most speci�c indicator of myocardial damage in a client with suspected ACS?
Choices:
1) Creatine kinase (CK-MB) 2) Myoglobin 3) Troponin I 4) C-reactive protein (CRP)
Correct Answer: Troponin I
Explanation: Troponin T and Troponin I are highly speci�c to cardiac muscle damage and remain elevated for up to two weeks, making them the gold standard for diagnosing an MI.Page 3