Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old male telemetry patient complains of sudden
palpitations. EKG description: Rate ~160 bpm, regular narrow
QRS, absent visible P waves. BP 110/70 mm Hg, O2 sat 96% on
room air. What is the most appropriate immediate nursing
action?
A. Administer IV amiodarone per standing order.
B. Prepare for synchronized cardioversion.
C. Vagal maneuvers (e.g., carotid sinus massage) and attempt to
obtain 12-lead EKG.
D. Give oral metoprolol and observe.
Answer: C
Rationale:
• Why correct: The EKG description is consistent with
supraventricular tachycardia (SVT, rate ~160 bpm, regular
narrow QRS, absent P waves), and in a hemodynamically stable
patient (BP 110/70, O2 96%), initial noninvasive measures such
as vagal maneuvers and obtaining a 12-lead EKG are
appropriate first actions.
• Why A incorrect: IV amiodarone is not first-line for stable SVT
and is typically reserved for ventricular or refractory
arrhythmias.
• Why B incorrect: Synchronized cardioversion is indicated for
unstable patients (hypotension, altered mental status, ischemia,
shock), which this patient does not have.
,• Why D incorrect: Oral metoprolol onset is slower and not the
immediate first-line bedside maneuver for acute stable SVT.
• Quick nursing action: Coach patient through a Valsalva
maneuver or perform vagal maneuver while preparing to
monitor rhythm and obtain a 12-lead EKG.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary — Dysrhythmia recognition and
initial management
Q2. A 54-year-old woman with a history of COPD has an EKG:
irregularly irregular rhythm, rate ~90 bpm, variable PR intervals,
absent distinct P waves replaced by fibrillatory waves. BP
132/78 mm Hg. Which is the best long-term nursing teaching
point?
A. Encourage daily caffeine intake to control heart rate.
B. Emphasize anticoagulation discussion due to stroke risk.
C. Teach that cardioversion is routinely performed weekly to
maintain sinus rhythm.
D. Tell patient anticoagulation is unnecessary because rate is
<100 bpm.
Answer: B
Rationale:
• Why correct: The EKG description is atrial fibrillation;
independent of ventricular rate, AF increases thromboembolic
stroke risk and patients should be assessed for anticoagulation
,(e.g., CHA₂DS₂-VASc) and educated about stroke prevention.
• Why A incorrect: Caffeine may precipitate arrhythmias and is
not recommended to control AF.
• Why C incorrect: Routine weekly cardioversion is not standard
practice; cardioversion is used selectively, not repeatedly as
routine.
• Why D incorrect: Atrial fibrillation stroke risk is not
determined solely by rate; anticoagulation decisions are based
on stroke risk scores, not just ventricular rate.
• Quick nursing action: Arrange patient education and notify
provider to evaluate anticoagulation eligibility and explain
risks/benefits.
Difficulty: Easy
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary — Dysrhythmia management
Q3. Telemetry alarm shows a rhythm described as: wide QRS
complexes at a rate of 40 bpm, P waves absent, QRS
morphology consistent with ventricular escape rhythm. The
patient is lightheaded and diaphoretic. What should the nurse
do first?
A. Begin TCP (transcutaneous pacing) preparations and apply
pads.
B. Give oral atropine and reassess in 30 minutes.
C. Increase the oxygen flow and wait for cardiology.
D. Start IV amiodarone bolus.
, Answer: A
Rationale:
• Why correct: Wide QRS ventricular escape at bradycardic rate
with symptomatic hypotension or lightheadedness indicates
symptomatic ventricular bradycardia; immediate preparation
for transcutaneous pacing is a priority to stabilize perfusion.
• Why B incorrect: Oral atropine is not appropriate (atropine for
symptomatic bradycardia should be IV, and waiting 30 minutes
is unsafe).
• Why C incorrect: While oxygen may be helpful, it is not the
priority; immediate pacing/advanced measures are needed for
symptomatic ventricular bradycardia.
• Why D incorrect: Amiodarone treats tachyarrhythmias; it is
not indicated for symptomatic ventricular escape rhythm
causing bradycardia.
• Quick nursing action: Activate emergency response, apply
transcutaneous pacing pads, and prepare for immediate pacing
per protocol.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary — Dysrhythmia emergency
management
Q4. Interpret this EKG scenario: Rate ~150 bpm, regular, narrow
QRS complexes, P waves not discernible; carotid massage
converts rhythm to sinus at 80 bpm with visible P waves. Which
Undergraduate
Q1. A 68-year-old male telemetry patient complains of sudden
palpitations. EKG description: Rate ~160 bpm, regular narrow
QRS, absent visible P waves. BP 110/70 mm Hg, O2 sat 96% on
room air. What is the most appropriate immediate nursing
action?
A. Administer IV amiodarone per standing order.
B. Prepare for synchronized cardioversion.
C. Vagal maneuvers (e.g., carotid sinus massage) and attempt to
obtain 12-lead EKG.
D. Give oral metoprolol and observe.
Answer: C
Rationale:
• Why correct: The EKG description is consistent with
supraventricular tachycardia (SVT, rate ~160 bpm, regular
narrow QRS, absent P waves), and in a hemodynamically stable
patient (BP 110/70, O2 96%), initial noninvasive measures such
as vagal maneuvers and obtaining a 12-lead EKG are
appropriate first actions.
• Why A incorrect: IV amiodarone is not first-line for stable SVT
and is typically reserved for ventricular or refractory
arrhythmias.
• Why B incorrect: Synchronized cardioversion is indicated for
unstable patients (hypotension, altered mental status, ischemia,
shock), which this patient does not have.
,• Why D incorrect: Oral metoprolol onset is slower and not the
immediate first-line bedside maneuver for acute stable SVT.
• Quick nursing action: Coach patient through a Valsalva
maneuver or perform vagal maneuver while preparing to
monitor rhythm and obtain a 12-lead EKG.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary — Dysrhythmia recognition and
initial management
Q2. A 54-year-old woman with a history of COPD has an EKG:
irregularly irregular rhythm, rate ~90 bpm, variable PR intervals,
absent distinct P waves replaced by fibrillatory waves. BP
132/78 mm Hg. Which is the best long-term nursing teaching
point?
A. Encourage daily caffeine intake to control heart rate.
B. Emphasize anticoagulation discussion due to stroke risk.
C. Teach that cardioversion is routinely performed weekly to
maintain sinus rhythm.
D. Tell patient anticoagulation is unnecessary because rate is
<100 bpm.
Answer: B
Rationale:
• Why correct: The EKG description is atrial fibrillation;
independent of ventricular rate, AF increases thromboembolic
stroke risk and patients should be assessed for anticoagulation
,(e.g., CHA₂DS₂-VASc) and educated about stroke prevention.
• Why A incorrect: Caffeine may precipitate arrhythmias and is
not recommended to control AF.
• Why C incorrect: Routine weekly cardioversion is not standard
practice; cardioversion is used selectively, not repeatedly as
routine.
• Why D incorrect: Atrial fibrillation stroke risk is not
determined solely by rate; anticoagulation decisions are based
on stroke risk scores, not just ventricular rate.
• Quick nursing action: Arrange patient education and notify
provider to evaluate anticoagulation eligibility and explain
risks/benefits.
Difficulty: Easy
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary — Dysrhythmia management
Q3. Telemetry alarm shows a rhythm described as: wide QRS
complexes at a rate of 40 bpm, P waves absent, QRS
morphology consistent with ventricular escape rhythm. The
patient is lightheaded and diaphoretic. What should the nurse
do first?
A. Begin TCP (transcutaneous pacing) preparations and apply
pads.
B. Give oral atropine and reassess in 30 minutes.
C. Increase the oxygen flow and wait for cardiology.
D. Start IV amiodarone bolus.
, Answer: A
Rationale:
• Why correct: Wide QRS ventricular escape at bradycardic rate
with symptomatic hypotension or lightheadedness indicates
symptomatic ventricular bradycardia; immediate preparation
for transcutaneous pacing is a priority to stabilize perfusion.
• Why B incorrect: Oral atropine is not appropriate (atropine for
symptomatic bradycardia should be IV, and waiting 30 minutes
is unsafe).
• Why C incorrect: While oxygen may be helpful, it is not the
priority; immediate pacing/advanced measures are needed for
symptomatic ventricular bradycardia.
• Why D incorrect: Amiodarone treats tachyarrhythmias; it is
not indicated for symptomatic ventricular escape rhythm
causing bradycardia.
• Quick nursing action: Activate emergency response, apply
transcutaneous pacing pads, and prepare for immediate pacing
per protocol.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary — Dysrhythmia emergency
management
Q4. Interpret this EKG scenario: Rate ~150 bpm, regular, narrow
QRS complexes, P waves not discernible; carotid massage
converts rhythm to sinus at 80 bpm with visible P waves. Which
