Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old patient with a history of hypertension is
admitted with palpitations. Vital signs: BP 148/90 mm Hg, HR
160 bpm, respirations 22/min, SpO2 96% on room air. The
cardiac monitor shows a regular rhythm with a narrow QRS
complex at a rate of ~150 bpm; P waves are not visible. What is
the nurse's priority action?
A. Administer intravenous metoprolol 5 mg.
B. Prepare for synchronized cardioversion.
C. Assess for vagal maneuvers like bearing down.
D. Administer a rapid intravenous normal saline bolus.
Answer: C
Rationale:
• Vagal maneuvers are a first-line, non-invasive intervention for
stable supraventricular tachycardia (SVT) to attempt restoration
of sinus rhythm. Assessing for their appropriateness and
attempting them is the initial priority.
• A is incorrect because IV beta-blockers, while a treatment for
SVT, are not the first action for a stable patient.
• B is incorrect because synchronized cardioversion is reserved
for unstable patients with signs of poor perfusion.
• D is incorrect because a fluid bolus is not a standard
treatment for this tachyarrhythmia.
• The nurse should first perform vagal maneuvers while
continuously monitoring the patient's rhythm and vital signs.
,Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q2. A 55-year-old patient complains of sudden, "tearing" back
pain. BP is 180/110 mm Hg in the right arm and 150/95 mm Hg
in the left arm. The nurse auscultates a diastolic murmur over
the sternal border. Which action should the nurse take first?
A. Administer prescribed sublingual nifedipine to lower the
blood pressure.
B. Prepare the patient for a STAT transesophageal
echocardiogram.
C. Initiate intravenous heparin infusion as prescribed.
D. Administer prescribed intravenous morphine sulfate for pain.
Answer: D
Rationale:
• The patient's symptoms are classic for an aortic dissection.
The immediate priority is to reduce pain and attenuate the
shear stress on the aortic wall by controlling heart rate and
blood pressure. Administering analgesia is a key initial step.
• A is incorrect because nifedipine can cause a rapid,
unpredictable drop in blood pressure, which is dangerous in this
scenario; blood pressure control should be achieved with
titratable IV medications.
• B is incorrect while preparing for diagnostics is important, the
nurse's first action is to manage the patient's immediate
,condition (pain, hypertension).
• C is incorrect because heparin is contraindicated as it could
promote bleeding into the dissected aorta.
• The nurse's priority is to administer analgesia and beta-
blockers as prescribed while preparing for emergent diagnostic
confirmation.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q3. A 72-year-old patient with heart failure is receiving a
furosemide infusion. One hour after the infusion ends, the
nurse notes the patient voided 50 mL of urine. The patient's
baseline creatinine is 1.2 mg/dL. Which finding is most critical
for the nurse to report?
A. Serum potassium level of 3.3 mEq/L.
B. Blood pressure decrease from 130/80 mm Hg to 110/70 mm
Hg.
C. Patient report of mild dizziness when standing.
D. A new order for a serum creatinine level.
Answer: A
Rationale:
• Hypokalemia is a serious, common adverse effect of loop
diuretics like furosemide and can precipitate life-threatening
cardiac dysrhythmias, especially in a patient with heart failure.
A potassium level of 3.3 mEq/L requires immediate
, intervention.
• B is incorrect because a BP of 110/70 is not critically low and
may be an expected outcome of diuresis.
• C is incorrect while dizziness should be monitored, it is often
expected with diuresis and orthostatic changes.
• D is incorrect as monitoring creatinine is appropriate but not
as immediately critical as the electrolyte abnormality.
• The nurse should report the hypokalemia immediately and
anticipate potassium replacement.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies: Adverse Effects/Contraindications
Q4. A patient with an inferior wall MI suddenly becomes
diaphoretic and anxious. Monitor shows a regular wide-
complex rhythm at a rate of 40 bpm. BP is 78/50 mm Hg. Which
action should the nurse take first?
A. Administer atropine 0.5 mg IV push.
B. Apply transcutaneous pacing pads.
C. Start a dopamine infusion.
D. Assess the patient's responsiveness.
Answer: B
Rationale:
• The scenario describes symptomatic bradycardia
(hypotension) likely due to heart block complicating an inferior
MI. Transcutaneous pacing is the first-line treatment for
Undergraduate
Q1. A 68-year-old patient with a history of hypertension is
admitted with palpitations. Vital signs: BP 148/90 mm Hg, HR
160 bpm, respirations 22/min, SpO2 96% on room air. The
cardiac monitor shows a regular rhythm with a narrow QRS
complex at a rate of ~150 bpm; P waves are not visible. What is
the nurse's priority action?
A. Administer intravenous metoprolol 5 mg.
B. Prepare for synchronized cardioversion.
C. Assess for vagal maneuvers like bearing down.
D. Administer a rapid intravenous normal saline bolus.
Answer: C
Rationale:
• Vagal maneuvers are a first-line, non-invasive intervention for
stable supraventricular tachycardia (SVT) to attempt restoration
of sinus rhythm. Assessing for their appropriateness and
attempting them is the initial priority.
• A is incorrect because IV beta-blockers, while a treatment for
SVT, are not the first action for a stable patient.
• B is incorrect because synchronized cardioversion is reserved
for unstable patients with signs of poor perfusion.
• D is incorrect because a fluid bolus is not a standard
treatment for this tachyarrhythmia.
• The nurse should first perform vagal maneuvers while
continuously monitoring the patient's rhythm and vital signs.
,Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q2. A 55-year-old patient complains of sudden, "tearing" back
pain. BP is 180/110 mm Hg in the right arm and 150/95 mm Hg
in the left arm. The nurse auscultates a diastolic murmur over
the sternal border. Which action should the nurse take first?
A. Administer prescribed sublingual nifedipine to lower the
blood pressure.
B. Prepare the patient for a STAT transesophageal
echocardiogram.
C. Initiate intravenous heparin infusion as prescribed.
D. Administer prescribed intravenous morphine sulfate for pain.
Answer: D
Rationale:
• The patient's symptoms are classic for an aortic dissection.
The immediate priority is to reduce pain and attenuate the
shear stress on the aortic wall by controlling heart rate and
blood pressure. Administering analgesia is a key initial step.
• A is incorrect because nifedipine can cause a rapid,
unpredictable drop in blood pressure, which is dangerous in this
scenario; blood pressure control should be achieved with
titratable IV medications.
• B is incorrect while preparing for diagnostics is important, the
nurse's first action is to manage the patient's immediate
,condition (pain, hypertension).
• C is incorrect because heparin is contraindicated as it could
promote bleeding into the dissected aorta.
• The nurse's priority is to administer analgesia and beta-
blockers as prescribed while preparing for emergent diagnostic
confirmation.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q3. A 72-year-old patient with heart failure is receiving a
furosemide infusion. One hour after the infusion ends, the
nurse notes the patient voided 50 mL of urine. The patient's
baseline creatinine is 1.2 mg/dL. Which finding is most critical
for the nurse to report?
A. Serum potassium level of 3.3 mEq/L.
B. Blood pressure decrease from 130/80 mm Hg to 110/70 mm
Hg.
C. Patient report of mild dizziness when standing.
D. A new order for a serum creatinine level.
Answer: A
Rationale:
• Hypokalemia is a serious, common adverse effect of loop
diuretics like furosemide and can precipitate life-threatening
cardiac dysrhythmias, especially in a patient with heart failure.
A potassium level of 3.3 mEq/L requires immediate
, intervention.
• B is incorrect because a BP of 110/70 is not critically low and
may be an expected outcome of diuresis.
• C is incorrect while dizziness should be monitored, it is often
expected with diuresis and orthostatic changes.
• D is incorrect as monitoring creatinine is appropriate but not
as immediately critical as the electrolyte abnormality.
• The nurse should report the hypokalemia immediately and
anticipate potassium replacement.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies: Adverse Effects/Contraindications
Q4. A patient with an inferior wall MI suddenly becomes
diaphoretic and anxious. Monitor shows a regular wide-
complex rhythm at a rate of 40 bpm. BP is 78/50 mm Hg. Which
action should the nurse take first?
A. Administer atropine 0.5 mg IV push.
B. Apply transcutaneous pacing pads.
C. Start a dopamine infusion.
D. Assess the patient's responsiveness.
Answer: B
Rationale:
• The scenario describes symptomatic bradycardia
(hypotension) likely due to heart block complicating an inferior
MI. Transcutaneous pacing is the first-line treatment for
