Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old patient with a history of heart failure is
admitted with dizziness. The cardiac monitor shows a regular
rhythm at a rate of 38 bpm. The P waves are present and
normal in configuration, but there is no consistent relationship
between P waves and QRS complexes. Which rhythm does the
nurse identify?
A. Sinus bradycardia
B. First-degree AV block
C. Third-degree AV block
D. Atrial fibrillation with slow ventricular response
Answer: C
Rationale:
• Third-degree AV block is characterized by complete
dissociation between atrial activity (P waves) and ventricular
activity (QRS complexes), resulting in a slow ventricular escape
rhythm, which matches the description.
• A. Sinus bradycardia would have a 1:1 relationship between P
waves and QRS complexes.
• B. First-degree AV block has a prolonged PR interval but a
consistent P wave to QRS relationship.
• D. Atrial fibrillation is irregularly irregular with no discernible P
waves.
• The nurse's priority is to prepare for potential transcutaneous
pacing as this rhythm can be unstable.
,Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 55-year-old male presents to the ED with crushing
substernal chest pain radiating to his left arm. Vital signs are BP
148/92, HR 110, RR 24, SpO2 94%. The nurse attaches the ECG
monitor. Which finding is the nurse most concerned about?
A. Sinus tachycardia at 110 bpm
B. ST-segment elevation in leads II, III, and aVF
C. Occasional premature atrial contractions (PACs)
D. Peaked T waves in the anterior leads
Answer: B
Rationale:
• ST-segment elevation in the inferior leads (II, III, aVF) is
indicative of acute myocardial injury and is the hallmark ECG
finding for an ST-elevation myocardial infarction (STEMI),
requiring immediate reperfusion therapy.
• A. Sinus tachycardia is a common compensatory response to
pain and anxiety but is not the primary concern.
• C. PACs are common and often benign dysrhythmias.
• D. Peaked T waves can be an early sign of hyperkalemia or
ischemia, but ST-elevation is the more acute indicator of MI.
• The nurse's priority is to notify the provider immediately and
prepare for possible cardiac catheterization.
,Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A patient with acute decompensated heart failure is
dyspneic, anxious, and producing pink, frothy sputum. Breath
sounds reveal bilateral crackles. What is the nurse's priority
action?
A. Administer IV furosemide 40 mg as ordered.
B. Position the patient in high-Fowler's position.
C. Obtain a stat chest x-ray.
D. Provide reassurance to decrease anxiety.
Answer: B
Rationale:
• Positioning the patient in high-Fowler's position decreases
venous return to the heart (preload) and improves lung
expansion, which is the immediate, independent nursing action
to alleviate respiratory distress in pulmonary edema.
• A. Administering diuretics is important but requires a provider
order and takes time to work.
• C. Obtaining a chest x-ray is diagnostic but does not address
the immediate respiratory crisis.
• D. Reassurance is supportive but not the priority when the
patient's airway and breathing are compromised.
• The nurse's immediate action is to position the patient to
facilitate breathing.
, Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A patient in hypovolemic shock has a BP of 88/50 mm Hg
and HR of 124 bpm. The nurse is ordered to calculate the Mean
Arterial Pressure (MAP). Using the formula MAP = [SBP +
2(DBP)] / 3, what is the patient's MAP?
A. 63 mm Hg
B. 69 mm Hg
C. 74 mm Hg
D. 79 mm Hg
Answer: A
Rationale:
• The correct calculation is: MAP = [88 + 2(50)] / 3 = (88 + 100) /
3 = = 62.66 mm Hg, which rounds to 63 mm Hg.
• B. 69 mm Hg is incorrect; this would be the result of a
calculation error, such as using SBP x 2.
• C. 74 mm Hg is incorrect; this is closer to the average of SBP
and DBP, not the correct formula.
• D. 79 mm Hg is incorrect; this is not supported by the correct
arithmetic.
• A MAP of less than 65 mm Hg indicates inadequate perfusion
to vital organs, and the nurse's priority is to initiate fluid
resuscitation as ordered.
Undergraduate
Q1. A 68-year-old patient with a history of heart failure is
admitted with dizziness. The cardiac monitor shows a regular
rhythm at a rate of 38 bpm. The P waves are present and
normal in configuration, but there is no consistent relationship
between P waves and QRS complexes. Which rhythm does the
nurse identify?
A. Sinus bradycardia
B. First-degree AV block
C. Third-degree AV block
D. Atrial fibrillation with slow ventricular response
Answer: C
Rationale:
• Third-degree AV block is characterized by complete
dissociation between atrial activity (P waves) and ventricular
activity (QRS complexes), resulting in a slow ventricular escape
rhythm, which matches the description.
• A. Sinus bradycardia would have a 1:1 relationship between P
waves and QRS complexes.
• B. First-degree AV block has a prolonged PR interval but a
consistent P wave to QRS relationship.
• D. Atrial fibrillation is irregularly irregular with no discernible P
waves.
• The nurse's priority is to prepare for potential transcutaneous
pacing as this rhythm can be unstable.
,Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 55-year-old male presents to the ED with crushing
substernal chest pain radiating to his left arm. Vital signs are BP
148/92, HR 110, RR 24, SpO2 94%. The nurse attaches the ECG
monitor. Which finding is the nurse most concerned about?
A. Sinus tachycardia at 110 bpm
B. ST-segment elevation in leads II, III, and aVF
C. Occasional premature atrial contractions (PACs)
D. Peaked T waves in the anterior leads
Answer: B
Rationale:
• ST-segment elevation in the inferior leads (II, III, aVF) is
indicative of acute myocardial injury and is the hallmark ECG
finding for an ST-elevation myocardial infarction (STEMI),
requiring immediate reperfusion therapy.
• A. Sinus tachycardia is a common compensatory response to
pain and anxiety but is not the primary concern.
• C. PACs are common and often benign dysrhythmias.
• D. Peaked T waves can be an early sign of hyperkalemia or
ischemia, but ST-elevation is the more acute indicator of MI.
• The nurse's priority is to notify the provider immediately and
prepare for possible cardiac catheterization.
,Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A patient with acute decompensated heart failure is
dyspneic, anxious, and producing pink, frothy sputum. Breath
sounds reveal bilateral crackles. What is the nurse's priority
action?
A. Administer IV furosemide 40 mg as ordered.
B. Position the patient in high-Fowler's position.
C. Obtain a stat chest x-ray.
D. Provide reassurance to decrease anxiety.
Answer: B
Rationale:
• Positioning the patient in high-Fowler's position decreases
venous return to the heart (preload) and improves lung
expansion, which is the immediate, independent nursing action
to alleviate respiratory distress in pulmonary edema.
• A. Administering diuretics is important but requires a provider
order and takes time to work.
• C. Obtaining a chest x-ray is diagnostic but does not address
the immediate respiratory crisis.
• D. Reassurance is supportive but not the priority when the
patient's airway and breathing are compromised.
• The nurse's immediate action is to position the patient to
facilitate breathing.
, Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A patient in hypovolemic shock has a BP of 88/50 mm Hg
and HR of 124 bpm. The nurse is ordered to calculate the Mean
Arterial Pressure (MAP). Using the formula MAP = [SBP +
2(DBP)] / 3, what is the patient's MAP?
A. 63 mm Hg
B. 69 mm Hg
C. 74 mm Hg
D. 79 mm Hg
Answer: A
Rationale:
• The correct calculation is: MAP = [88 + 2(50)] / 3 = (88 + 100) /
3 = = 62.66 mm Hg, which rounds to 63 mm Hg.
• B. 69 mm Hg is incorrect; this would be the result of a
calculation error, such as using SBP x 2.
• C. 74 mm Hg is incorrect; this is closer to the average of SBP
and DBP, not the correct formula.
• D. 79 mm Hg is incorrect; this is not supported by the correct
arithmetic.
• A MAP of less than 65 mm Hg indicates inadequate perfusion
to vital organs, and the nurse's priority is to initiate fluid
resuscitation as ordered.
