Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 28-year-old female reports sudden palpitations and
lightheadedness. Vital signs: HR 180 bpm, BP 110/70 mmHg, O₂
98% on room air. EKG text: "Rate ~180 bpm, regular narrow
QRS, absent P waves — SVT." What is the nurse’s best first
action?
A. Encourage the patient to perform a Valsalva maneuver
(bearing down).
B. Prepare to administer IV adenosine rapid bolus.
C. Prepare for immediate synchronized cardioversion.
D. Administer high-flow oxygen via nonrebreather.
Answer: A
Rationale:
• Why correct: Vagal maneuvers (e.g., Valsalva) are the
recommended initial, noninvasive intervention for stable SVT
and can terminate re-entrant SVT by increasing vagal tone and
slowing AV nodal conduction. Two to three attempts or coached
Valsalva under monitoring are appropriate before IV drugs.
• Distractor A: (correct) — N/A.
• Distractor B: Adenosine is appropriate if vagal maneuvers fail
but is not the first action for a stable patient.
• Distractor C: Synchronized cardioversion is reserved for
unstable patients (hypotension, ischemia, altered mental
status).
• Distractor D: High-flow oxygen is unnecessary when O₂
,saturation is normal and will not terminate SVT.
• Quick nursing action/priority: Coach and assist the patient
with a Valsalva maneuver while monitoring rhythm and vital
signs.
Difficulty: Easy
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 72-year-old male with atrial fibrillation reports
palpitations. Vitals: HR 140 bpm, BP 128/78 mmHg, O₂ 96%.
EKG text: "Irregularly irregular rhythm, absent discrete P waves,
ventricular rate ~140 bpm — A-fib with RVR." Which is the
nurse’s priority action?
A. Administer IV diltiazem per standing orders for rate control.
B. Start therapeutic heparin infusion immediately.
C. Prepare for immediate synchronized cardioversion.
D. Give IV adenosine to restore sinus rhythm.
Answer: A
Rationale:
• Why correct: For hemodynamically stable A-fib with rapid
ventricular response, rate control (eg, IV diltiazem) is prioritized
to reduce ventricular rate and improve symptoms while
planning anticoagulation and cardiology evaluation.
• Distractor A: (correct) — N/A.
• Distractor B: Anticoagulation is important but is not the
immediate priority for symptomatic rate control in a patient
,who is stable.
• Distractor C: Synchronized cardioversion is indicated for
unstable patients or when immediate rhythm control is
necessary; this patient is hemodynamically stable.
• Distractor D: Adenosine is ineffective for atrial fibrillation and
is used for re-entrant SVT.
• Quick nursing action/priority: Administer ordered IV diltiazem
and monitor blood pressure and rhythm continuously.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 60-year-old woman suddenly becomes unresponsive on
the telemetry unit. EKG text: "Wide QRS complexes, rate ~170
bpm — pulseless ventricular tachycardia." What must the nurse
do first?
A. Begin high-quality CPR and call a code; prepare for
immediate unsynchronized defibrillation.
B. Administer IV amiodarone and wait for rhythm response.
C. Attempt vagal maneuvers to terminate the rhythm.
D. Give a 6 mg IV bolus of adenosine.
Answer: A
Rationale:
• Why correct: Pulseless VT is a cardiac arrest rhythm —
immediate high-quality CPR and prompt unsynchronized
defibrillation (rapid shock) per ACLS algorithm are lifesaving and
, take priority.
• Distractor A: (correct) — N/A.
• Distractor B: Antiarrhythmics (eg, amiodarone) are used after
defibrillation/CPR; delaying CPR/shock increases mortality.
• Distractor C: Vagal maneuvers are ineffective and
inappropriate for ventricular arrhythmias.
• Distractor D: Adenosine is contraindicated for wide-complex
ventricular rhythms and will not treat VT.
• Quick nursing action/priority: Start CPR immediately, call the
code team, and deliver unsynchronized defibrillation as soon as
the defibrillator is ready.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 78-year-old male with syncope has EKG text: "P waves
and QRS complexes present but independent; ventricular rate
~30 bpm — complete (third-degree) AV block." He is
diaphoretic and hypotensive (BP 80/50 mmHg). What is the
nurse’s priority action?
A. Administer IV atropine and observe for response.
B. Prepare for immediate transcutaneous pacing (external
pacing).
C. Start oral beta-blocker therapy to control conduction.
D. Give a sublingual nitroglycerin tablet.
Answer: B
Undergraduate
Q1. A 28-year-old female reports sudden palpitations and
lightheadedness. Vital signs: HR 180 bpm, BP 110/70 mmHg, O₂
98% on room air. EKG text: "Rate ~180 bpm, regular narrow
QRS, absent P waves — SVT." What is the nurse’s best first
action?
A. Encourage the patient to perform a Valsalva maneuver
(bearing down).
B. Prepare to administer IV adenosine rapid bolus.
C. Prepare for immediate synchronized cardioversion.
D. Administer high-flow oxygen via nonrebreather.
Answer: A
Rationale:
• Why correct: Vagal maneuvers (e.g., Valsalva) are the
recommended initial, noninvasive intervention for stable SVT
and can terminate re-entrant SVT by increasing vagal tone and
slowing AV nodal conduction. Two to three attempts or coached
Valsalva under monitoring are appropriate before IV drugs.
• Distractor A: (correct) — N/A.
• Distractor B: Adenosine is appropriate if vagal maneuvers fail
but is not the first action for a stable patient.
• Distractor C: Synchronized cardioversion is reserved for
unstable patients (hypotension, ischemia, altered mental
status).
• Distractor D: High-flow oxygen is unnecessary when O₂
,saturation is normal and will not terminate SVT.
• Quick nursing action/priority: Coach and assist the patient
with a Valsalva maneuver while monitoring rhythm and vital
signs.
Difficulty: Easy
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 72-year-old male with atrial fibrillation reports
palpitations. Vitals: HR 140 bpm, BP 128/78 mmHg, O₂ 96%.
EKG text: "Irregularly irregular rhythm, absent discrete P waves,
ventricular rate ~140 bpm — A-fib with RVR." Which is the
nurse’s priority action?
A. Administer IV diltiazem per standing orders for rate control.
B. Start therapeutic heparin infusion immediately.
C. Prepare for immediate synchronized cardioversion.
D. Give IV adenosine to restore sinus rhythm.
Answer: A
Rationale:
• Why correct: For hemodynamically stable A-fib with rapid
ventricular response, rate control (eg, IV diltiazem) is prioritized
to reduce ventricular rate and improve symptoms while
planning anticoagulation and cardiology evaluation.
• Distractor A: (correct) — N/A.
• Distractor B: Anticoagulation is important but is not the
immediate priority for symptomatic rate control in a patient
,who is stable.
• Distractor C: Synchronized cardioversion is indicated for
unstable patients or when immediate rhythm control is
necessary; this patient is hemodynamically stable.
• Distractor D: Adenosine is ineffective for atrial fibrillation and
is used for re-entrant SVT.
• Quick nursing action/priority: Administer ordered IV diltiazem
and monitor blood pressure and rhythm continuously.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 60-year-old woman suddenly becomes unresponsive on
the telemetry unit. EKG text: "Wide QRS complexes, rate ~170
bpm — pulseless ventricular tachycardia." What must the nurse
do first?
A. Begin high-quality CPR and call a code; prepare for
immediate unsynchronized defibrillation.
B. Administer IV amiodarone and wait for rhythm response.
C. Attempt vagal maneuvers to terminate the rhythm.
D. Give a 6 mg IV bolus of adenosine.
Answer: A
Rationale:
• Why correct: Pulseless VT is a cardiac arrest rhythm —
immediate high-quality CPR and prompt unsynchronized
defibrillation (rapid shock) per ACLS algorithm are lifesaving and
, take priority.
• Distractor A: (correct) — N/A.
• Distractor B: Antiarrhythmics (eg, amiodarone) are used after
defibrillation/CPR; delaying CPR/shock increases mortality.
• Distractor C: Vagal maneuvers are ineffective and
inappropriate for ventricular arrhythmias.
• Distractor D: Adenosine is contraindicated for wide-complex
ventricular rhythms and will not treat VT.
• Quick nursing action/priority: Start CPR immediately, call the
code team, and deliver unsynchronized defibrillation as soon as
the defibrillator is ready.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 78-year-old male with syncope has EKG text: "P waves
and QRS complexes present but independent; ventricular rate
~30 bpm — complete (third-degree) AV block." He is
diaphoretic and hypotensive (BP 80/50 mmHg). What is the
nurse’s priority action?
A. Administer IV atropine and observe for response.
B. Prepare for immediate transcutaneous pacing (external
pacing).
C. Start oral beta-blocker therapy to control conduction.
D. Give a sublingual nitroglycerin tablet.
Answer: B
