Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 62-year-old post-MI patient on telemetry becomes
suddenly tachycardic: "Rate ~180 bpm, regular, narrow QRS,
absent visible P waves" on monitor; patient is pale but alert and
reports palpitations. What is the nurse's best initial action?
A. Prepare synchronized cardioversion.
B. Attempt vagal maneuvers (carotid sinus massage or Valsalva).
C. Administer IV amiodarone bolus.
D. Start immediate CPR.
Answer: B
Rationale:
• Why correct: The rhythm description is consistent with
supraventricular tachycardia (SVT, rate ~180, regular narrow
QRS, absent P waves); in a stable, alert patient the first-line
immediate action is to attempt vagal maneuvers to terminate
SVT. Vagal maneuvers can transiently increase AV nodal
refractoriness and restore sinus rhythm.
• Why A is incorrect: Synchronized cardioversion is indicated if
the patient is unstable (hypotension, altered mental status,
ischemia) — this patient is alert and relatively stable.
• Why C is incorrect: IV antiarrhythmics like amiodarone are not
first-line immediate measures for narrow-complex SVT in a
stable patient; vagal maneuvers or adenosine are preferred next
steps.
• Why D is incorrect: CPR is only indicated for pulseless cardiac
,arrest; this patient has a pulse and is breathing.
• Quick nursing action/priority: Coach and assist the patient to
perform a Valsalva maneuver and call for rapid-response if it
fails.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 78-year-old with chronic atrial fibrillation has irregularly
irregular rhythm at "ventricular rate ~140 bpm" and systolic BP
90 mm Hg, dyspnea, and confusion. What is the nurse’s
priority?
A. Administer oral metoprolol as scheduled.
B. Prepare for immediate synchronized cardioversion.
C. Obtain a 12-lead ECG and continue to monitor.
D. Give IV digoxin bolus now.
Answer: B
Rationale:
• Why correct: Rapid ventricular response with hypotension
(systolic BP 90), altered mental status, and dyspnea indicates
hemodynamic instability from AF with RVR; synchronized
cardioversion is the priority to restore adequate perfusion.
• Why A is incorrect: Oral metoprolol is too slow and unreliable
in an unstable patient and may worsen hypotension while
taking effect.
• Why C is incorrect: While ECG is useful, delaying immediate
,cardioversion risks further deterioration in an unstable patient.
• Why D is incorrect: IV digoxin is not appropriate for
immediate rate control in an unstable, hypotensive patient
needing urgent cardioversion.
• Quick nursing action/priority: Notify the provider and prepare
the patient for synchronized cardioversion (consent, NPO,
sedation per protocol).
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. Telemetry shows "wide QRS complexes, rate 160 bpm,
regular; patient is hypotensive and confused." The nurse
identifies monomorphic ventricular tachycardia. Which action is
highest priority?
A. Give IV lidocaine.
B. Prepare for immediate synchronized cardioversion.
C. Obtain arterial blood gas.
D. Administer high-flow oxygen and observe.
Answer: B
Rationale:
• Why correct: Wide-complex tachycardia with hypotension and
confusion indicates unstable VT — immediate synchronized
cardioversion is the priority to rapidly restore perfusion.
• Why A is incorrect: IV antiarrhythmics may be used for stable
VT; they are not first-line for unstable VT when immediate
, cardioversion is indicated.
• Why C is incorrect: ABG does not address the immediate
threat to hemodynamics and wastes critical time.
• Why D is incorrect: Oxygen and observation are supportive
but insufficient when the patient is hemodynamically unstable
from VT.
• Quick nursing action/priority: Call for help and prepare/assist
with synchronized cardioversion per protocol.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 55-year-old complains of dizziness; monitor reads
"regular rhythm, PR interval progressively lengthening, then a
dropped QRS." Which description fits and what is the nurse’s
next step?
A. Second-degree AV block Mobitz I (Wenckebach); observe and
notify provider.
B. Second-degree AV block Mobitz II; anticipate pacemaker
insertion.
C. Complete heart block; start CPR.
D. Sinus bradycardia; give atropine immediately.
Answer: A
Rationale:
• Why correct: Progressive PR lengthening followed by a
dropped QRS is classic Mobitz I (Wenckebach); if patient is
Undergraduate
Q1. A 62-year-old post-MI patient on telemetry becomes
suddenly tachycardic: "Rate ~180 bpm, regular, narrow QRS,
absent visible P waves" on monitor; patient is pale but alert and
reports palpitations. What is the nurse's best initial action?
A. Prepare synchronized cardioversion.
B. Attempt vagal maneuvers (carotid sinus massage or Valsalva).
C. Administer IV amiodarone bolus.
D. Start immediate CPR.
Answer: B
Rationale:
• Why correct: The rhythm description is consistent with
supraventricular tachycardia (SVT, rate ~180, regular narrow
QRS, absent P waves); in a stable, alert patient the first-line
immediate action is to attempt vagal maneuvers to terminate
SVT. Vagal maneuvers can transiently increase AV nodal
refractoriness and restore sinus rhythm.
• Why A is incorrect: Synchronized cardioversion is indicated if
the patient is unstable (hypotension, altered mental status,
ischemia) — this patient is alert and relatively stable.
• Why C is incorrect: IV antiarrhythmics like amiodarone are not
first-line immediate measures for narrow-complex SVT in a
stable patient; vagal maneuvers or adenosine are preferred next
steps.
• Why D is incorrect: CPR is only indicated for pulseless cardiac
,arrest; this patient has a pulse and is breathing.
• Quick nursing action/priority: Coach and assist the patient to
perform a Valsalva maneuver and call for rapid-response if it
fails.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 78-year-old with chronic atrial fibrillation has irregularly
irregular rhythm at "ventricular rate ~140 bpm" and systolic BP
90 mm Hg, dyspnea, and confusion. What is the nurse’s
priority?
A. Administer oral metoprolol as scheduled.
B. Prepare for immediate synchronized cardioversion.
C. Obtain a 12-lead ECG and continue to monitor.
D. Give IV digoxin bolus now.
Answer: B
Rationale:
• Why correct: Rapid ventricular response with hypotension
(systolic BP 90), altered mental status, and dyspnea indicates
hemodynamic instability from AF with RVR; synchronized
cardioversion is the priority to restore adequate perfusion.
• Why A is incorrect: Oral metoprolol is too slow and unreliable
in an unstable patient and may worsen hypotension while
taking effect.
• Why C is incorrect: While ECG is useful, delaying immediate
,cardioversion risks further deterioration in an unstable patient.
• Why D is incorrect: IV digoxin is not appropriate for
immediate rate control in an unstable, hypotensive patient
needing urgent cardioversion.
• Quick nursing action/priority: Notify the provider and prepare
the patient for synchronized cardioversion (consent, NPO,
sedation per protocol).
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. Telemetry shows "wide QRS complexes, rate 160 bpm,
regular; patient is hypotensive and confused." The nurse
identifies monomorphic ventricular tachycardia. Which action is
highest priority?
A. Give IV lidocaine.
B. Prepare for immediate synchronized cardioversion.
C. Obtain arterial blood gas.
D. Administer high-flow oxygen and observe.
Answer: B
Rationale:
• Why correct: Wide-complex tachycardia with hypotension and
confusion indicates unstable VT — immediate synchronized
cardioversion is the priority to rapidly restore perfusion.
• Why A is incorrect: IV antiarrhythmics may be used for stable
VT; they are not first-line for unstable VT when immediate
, cardioversion is indicated.
• Why C is incorrect: ABG does not address the immediate
threat to hemodynamics and wastes critical time.
• Why D is incorrect: Oxygen and observation are supportive
but insufficient when the patient is hemodynamically unstable
from VT.
• Quick nursing action/priority: Call for help and prepare/assist
with synchronized cardioversion per protocol.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 55-year-old complains of dizziness; monitor reads
"regular rhythm, PR interval progressively lengthening, then a
dropped QRS." Which description fits and what is the nurse’s
next step?
A. Second-degree AV block Mobitz I (Wenckebach); observe and
notify provider.
B. Second-degree AV block Mobitz II; anticipate pacemaker
insertion.
C. Complete heart block; start CPR.
D. Sinus bradycardia; give atropine immediately.
Answer: A
Rationale:
• Why correct: Progressive PR lengthening followed by a
dropped QRS is classic Mobitz I (Wenckebach); if patient is
