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Quizzes > Health & Medicine

NCLEX Questions on Perfusion: Build Confident Cardiac Care

Quick, free NCLEX perfusion practice. Instant results.

Editorial: Review CompletedCreated By: Ayoub LamUpdated Aug 27, 2025
Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
paper art heart with arrow and ECG waves, alongside NCLEX perfusion quiz text on sky blue background

This quiz helps you practice cardiac perfusion for the NCLEX and build clinical judgment. Work through realistic questions, see instant results, and spot weak areas before test day. To go broader or deeper, try NCLEX cardiovascular questions, reinforce key concepts with heart failure NCLEX questions, or review vessels and flow in the peripheral artery disease quiz.

What term describes the process of delivering oxygenated blood to body tissues?
Diffusion
Osmosis
Perfusion
Respiration
Perfusion refers to the flow of oxygenated blood through the circulatory system to the tissues. It is essential for cellular metabolism and organ function. Inadequate perfusion can lead to tissue hypoxia and organ failure. .
A normal left ventricular ejection fraction (EF) is considered to be:
75 - 90%
55 - 70%
30 - 40%
40 - 50%
Ejection fraction measures the percentage of blood ejected from the left ventricle with each contraction. A normal EF ranges from 55% to 70%. Values below this indicate systolic dysfunction. .
Capillary refill time greater than 3 seconds most likely indicates:
Poor peripheral perfusion
Stable hemodynamics
Adequate oxygenation
Normal hydration status
Delayed capillary refill time (>3 seconds) is a clinical sign of poor peripheral perfusion and may indicate shock or hypovolemia. It is a quick bedside assessment of circulatory status. Prompt intervention may be required to restore tissue perfusion. .
Mean arterial pressure (MAP) below which organ perfusion is usually compromised:
65 mmHg
100 mmHg
45 mmHg
90 mmHg
MAP is calculated as diastolic pressure plus one-third of pulse pressure. A MAP below 65 mmHg often indicates insufficient organ perfusion and risk for ischemia. Targets may vary by patient but 65 mmHg is widely accepted. .
Central venous pressure (CVP) primarily reflects which parameter?
Right atrial pressure
Systemic vascular resistance
Pulmonary artery pressure
Left atrial pressure
CVP measures the pressure in the thoracic vena cava near the right atrium. It reflects right ventricular preload and circulating blood volume. It is used to guide fluid resuscitation. .
Cardiac output is calculated as which of the following formulas?
Heart rate ÷ Stroke volume
Stroke volume × Heart rate
MAP ÷ Cardiac index
Systemic vascular resistance × MAP
Cardiac output is the volume of blood pumped by the heart per minute, calculated by multiplying stroke volume by heart rate. It indicates overall cardiac performance and tissue perfusion. .
Urine output less than 30 mL/hour in a hospitalized patient is most concerning for:
Adequate hydration
Poor renal perfusion
Liver dysfunction
Cardiac tamponade
Oliguria (<0.5 mL/kg/hr or <30 mL/hr) suggests decreased renal perfusion, which may be due to hypovolemia, shock, or heart failure. Immediate evaluation and intervention are required. .
Mottled, cool extremities in a patient are indicative of:
Generalized hyperperfusion
Peripheral vasoconstriction due to poor perfusion
Hypoglycemia
Hypertension
Mottling and cool extremities are signs of peripheral vasoconstriction, a compensatory response to maintain core organ perfusion during shock or hypoperfusion. This finding warrants urgent hemodynamic assessment. .
Cardiac preload is best defined as:
Volume of blood in ventricles at end-diastole
Pressure in the pulmonary artery
Pressure against which the heart pumps
Amount of blood ejected per beat
Preload refers to the ventricular end-diastolic volume and stretch of myocardial fibers prior to contraction. It influences stroke volume via the Frank-Starling mechanism. Monitoring preload guides fluid management. .
Which medication lowers afterload and improves cardiac perfusion by vasodilation?
Phenylephrine
Nitroprusside
Vasopressin
Norepinephrine
Nitroprusside is a potent arterial and venous vasodilator, reducing both afterload and preload, improving cardiac output and perfusion. It is used in hypertensive crises and heart failure. .
Nitrates relieve myocardial ischemia primarily by:
Constriction of coronary arteries
Increasing heart rate
Reducing preload through venodilation
Increasing afterload
Nitrates cause venodilation, reducing venous return (preload) and myocardial oxygen demand. They also dilate coronary arteries, improving blood flow to ischemic myocardium. .
The first-line intervention in hypovolemic shock is:
Inotropic support
Vasopressors
Diuretic therapy
Fluid resuscitation
Hypovolemic shock results from inadequate circulating volume. Rapid crystalloid or blood product infusion restores intravascular volume, improving preload and cardiac output. Vasopressors are added if fluids alone are insufficient. .
Normal mixed venous oxygen saturation (SvO2) ranges from:
80 - 90%
20 - 30%
30 - 50%
60 - 80%
SvO2 reflects the balance between oxygen delivery and consumption. Values between 60% and 80% suggest adequate perfusion. Low SvO2 indicates increased extraction or decreased delivery. .
A transfusion threshold of hemoglobin below which most critically ill patients require blood products is:
<10 g/dL
<5 g/dL
<12 g/dL
<7 g/dL
Current guidelines recommend a restrictive transfusion strategy with a hemoglobin threshold of <7 g/dL for stable critically ill patients. This reduces transfusion-related risks without compromising outcomes. .
An intra-aortic balloon pump (IABP) primarily improves myocardial perfusion by:
Reducing systemic vascular resistance only
Increasing heart rate
Increasing diastolic coronary perfusion
Raising preload
The IABP inflates during diastole, augmenting coronary perfusion pressure, and deflates before systole, reducing afterload and myocardial oxygen demand. It is used as mechanical circulatory support. .
Therapeutic serum range for digoxin to support cardiac output is:
3.0 - 5.0 ng/mL
0.5 - 2.0 ng/mL
5.0 - 8.0 ng/mL
2.0 - 4.0 ng/mL
Digoxin enhances cardiac contractility and can improve output in heart failure. Levels between 0.5 and 2.0 ng/mL are considered therapeutic; higher levels risk toxicity. .
An elevated pulmonary capillary wedge pressure (PCWP) is most indicative of:
Septic shock
Left ventricular failure
Right ventricular failure
Hypovolemia
PCWP approximates left atrial pressure and reflects left ventricular preload. An elevated PCWP (>18 mmHg) suggests left ventricular failure or fluid overload. It helps differentiate cardiogenic from noncardiogenic pulmonary edema. .
A patient has a PaO? of 60 mmHg with normal hemoglobin and cardiac output. This primarily indicates:
Septic shock
Hypovolemic shock
Cardiogenic shock
Respiratory failure
A low arterial oxygen partial pressure (PaO?) with normal perfusion parameters indicates a gas exchange problem in the lungs. This defines respiratory failure. Hemodynamic support would not correct this hypoxemia. .
Pulsus paradoxus (a drop in systolic BP >10 mmHg during inspiration) is classically seen in:
Septic shock
Cardiac tamponade
Hypovolemia
Aortic stenosis
Pulsus paradoxus occurs when fluid in the pericardial sac limits ventricular filling during inspiration. It is a hallmark of cardiac tamponade. It may also be seen in severe asthma or COPD. .
On a ventricular pressure-volume loop, increased afterload manifests as:
No change in loop dimensions
Increased loop height only
Increased end-systolic volume and decreased stroke volume
Decreased end-systolic volume and increased stroke volume
Higher afterload requires the ventricle to generate greater pressure, reducing ejection fraction and stroke volume. This leads to increased end-systolic volume on the PV loop. .
The phase of shock characterized by lactic acidosis and organ ischemia despite support is:
Irreversible
Compensatory
Progressive
Initial
Irreversible shock is the final stage where cellular and organ damage become permanent, with refractory hypotension and metabolic acidosis. Interventions no longer restore adequate perfusion. .
Cardiac index is calculated by dividing cardiac output by:
Mean arterial pressure
Stroke volume
Body surface area
Heart rate
Cardiac index standardizes cardiac output for body size by dividing CO by body surface area (BSA). Normal CI ranges from 2.5 to 4.0 L/min/m². It more accurately reflects perfusion status. .
Vasopressin improves blood pressure in septic shock primarily through:
Beta-1 adrenergic stimulation
V1 receptor - mediated vasoconstriction
Diuretic effect
Alpha-1 antagonism
Vasopressin acts on V1 receptors in vascular smooth muscle causing potent vasoconstriction, which raises systemic vascular resistance and blood pressure in vasodilatory shock. .
A pressure-volume loop showing reduced preload would demonstrate which change?
Increased end-diastolic volume
No loop change
Increased stroke volume
Decreased end-diastolic volume and decreased stroke volume
Reduced preload lowers the end-diastolic volume, leading to a smaller loop width (stroke volume) on the PV diagram. This reflects diminished ventricular filling. .
In acute respiratory distress syndrome (ARDS), a normal pulmonary capillary wedge pressure (<18 mmHg) alongside pulmonary edema suggests:
Cardiogenic pulmonary edema
Left ventricular overload
Noncardiogenic pulmonary edema
Hypovolemic shock
In ARDS, pulmonary edema occurs due to increased capillary permeability rather than elevated left-sided pressures. A normal PCWP (<18 mmHg) differentiates it from cardiogenic causes. .
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Study Outcomes

  1. Understand Cardiac Perfusion Physiology -

    Grasp the fundamental concepts of cardiac output, vascular resistance, and oxygen delivery to identify key factors affecting perfusion.

  2. Analyze Hemodynamic Data -

    Interpret blood pressure, central venous pressure, and other assessment metrics to determine perfusion status in clinical scenarios.

  3. Apply Assessment Techniques -

    Perform targeted nursing assessments for perfusion, including pulse checks and capillary refill, to recognize early signs of compromise.

  4. Interpret Signs and Symptoms -

    Identify manifestations of impaired perfusion such as chest pain, edema, and altered mental status to guide timely interventions.

  5. Evaluate Evidence-Based Interventions -

    Recommend appropriate nursing actions and treatments that optimize perfusion, drawing from current practice guidelines.

  6. Strengthen Critical Thinking for NCLEX Perfusion Questions -

    Hone clinical reasoning skills to confidently tackle nursing perfusion quiz items and excel on your fundamentals of nursing NCLEX exam.

Cheat Sheet

  1. Cardiac Output and the Frank-Starling Law -

    Cardiac output (CO) equals heart rate × stroke volume (CO=HR×SV), reflecting how effectively the heart pumps (American Heart Association). According to the Frank-Starling principle, increased preload (end-diastolic volume) stretches myocardial fibers, enhancing contractility and CO. When tackling nclex perfusion questions, visualize a rubber band - greater stretch means a stronger snap.

  2. Preload, Afterload, Contractility, Output (PACO Mnemonic) -

    Preload is ventricular stretch at diastole, afterload is the resistance the ventricle must overcome, and contractility is myocardial squeeze strength. Use the mnemonic "PACO" (Preload, Afterload, Contractility, Output) to recall relationships and guide hemodynamic care (Fundamentals of Nursing NCLEX test plan). Pinpoint these in nclex practice questions by comparing fluid overload vs. hypertension scenarios.

  3. Hemodynamic Monitoring Parameters -

    Know normal ranges for CVP (2 - 8 mmHg), PAOP (8 - 12 mmHg), SVR (800 - 1200 dyn·s/cm5), and PVR (100 - 200 dyn·s/cm5) to assess perfusion status (UpToDate). When answering nursing perfusion quiz items, compare patient values to these norms to identify hypo- or hyperdynamic states. Visualizing a traffic map - higher resistance equals a traffic jam - can help recall vascular resistance concepts.

  4. Classification and Clinical Signs of Shock -

    Differentiate hypovolemic, cardiogenic, distributive, and obstructive shock by key signs: cool/clammy skin in hypovolemic vs. warm/flushed in early distributive (Sepsis Alliance). Use the mnemonic "DisCO" (Distributive, Cardiogenic, Hypovolemic, Obstructive) to organize shock types efficiently. Review case-based nclex perfusion questions featuring vital signs and hemodynamics to master shock management reasoning.

  5. Pharmacologic Interventions for Perfusion -

    Familiarize with inotropes (dobutamine ↑ contractility), vasopressors (norepinephrine ↑ SVR), and vasodilators (nitroprusside ↓ afterload) per American College of Cardiology guidelines. When facing fundamentals of nursing NCLEX pharmacology questions, categorize drugs by mechanism and hemodynamic effect. A quick tip: "DIP" - **D**o Inotropes, **I**ncrease Pressors, **P**refer Vasodilators - helps recall drug classes by perfusion impact.

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