Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old patient with a history of heart failure is on a
continuous lidocaine infusion at 2 mg/min. The pharmacy
supplies lidocaine 2 g in 500 mL D5W. What is the infusion rate
in mL/hr?
A. 15 mL/hr
B. 30 mL/hr
C. 60 mL/hr
D. 120 mL/hr
Answer: B
Rationale:
• The correct answer is calculated by first determining the
concentration of the solution: 2 g/500 mL = 2000 mg/500 mL =
4 mg/mL. The ordered dose is 2 mg/min. To find the mL/min
rate: (2 mg/min) / (4 mg/mL) = 0.5 mL/min. Converting to
mL/hr: 0.5 mL/min * 60 min/hr = 30 mL/hr.
• A is incorrect; 15 mL/hr would deliver half the required dose.
• C is incorrect; 60 mL/hr would deliver double the required
dose.
• D is incorrect; 120 mL/hr would deliver four times the
required dose.
• The nurse should verify the calculation with a second nurse
and use an infusion pump.
Difficulty: Moderate
Bloom’s level: Application
,NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies: Dosage Calculation
Q2. A patient's telemetry strip shows a regular rhythm at a rate
of 36 bpm. The P waves are upright and uniform, each followed
by a QRS complex. The PR interval is 0.24 seconds and constant.
The QRS duration is 0.10 seconds. Which rhythm does the nurse
identify?
A. Sinus bradycardia
B. First-degree AV block
C. Junctional rhythm
D. Third-degree AV block
Answer: A
Rationale:
• The correct answer is sinus bradycardia because the rhythm is
regular with a rate less than 60 bpm, and there is a normal P
wave before each QRS complex with a constant, albeit slightly
prolonged, PR interval.
• B is incorrect; first-degree AV block is a finding within a
rhythm (prolonged PR interval), not a rhythm diagnosis itself.
The underlying rhythm here is sinus bradycardia.
• C is incorrect; a junctional rhythm typically has no P waves or
inverted P waves, not upright P waves.
• D is incorrect; in third-degree AV block, P waves and QRS
complexes are independent (no relationship), which is not the
case here.
,• The nurse should assess the patient for symptoms of low
cardiac output, such as dizziness or hypotension.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Alterations in Body Systems
Q3. A 55-year-old male arrives at the ED reporting severe,
crushing substernal chest pain radiating to his jaw that started
30 minutes ago. Vital signs are BP 168/100, HR 112, RR 24,
SpO2 94% on room air. The nurse attaches the cardiac monitor
and obtains IV access. What is the nurse's priority action?
A. Administer sublingual nitroglycerin.
B. Obtain a 12-lead EKG.
C. Administer morphine sulfate IV.
D. Draw blood for cardiac enzymes.
Answer: B
Rationale:
• The correct answer is to obtain a 12-lead EKG because the
patient's symptoms are classic for acute coronary syndrome
(ACS). Guidelines mandate an EKG be obtained within 10
minutes of presentation to diagnose ST-elevation MI (STEMI)
and expedite reperfusion therapy.
• A is incorrect; nitroglycerin may be given after the EKG
confirms the diagnosis and if the patient's blood pressure is
adequate.
• C is incorrect; morphine can be given for pain unrelieved by
, nitroglycerin, but it is not the immediate priority.
• D is incorrect; while important, drawing labs does not take
precedence over the immediate need for EKG interpretation.
• The priority is rapid diagnosis to determine if the patient is a
candidate for emergent percutaneous coronary intervention
(PCI).
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q4. A patient with an acute anterior MI suddenly becomes
diaphoretic and tachycardic. The nurse assesses jugular venous
distension and crackles in the lung bases. Which finding would
the nurse anticipate?
A. Increased cardiac output
B. Elevated pulmonary artery wedge pressure (PAWP)
C. Decreased systemic vascular resistance (SVR)
D. Widened pulse pressure
Answer: B
Rationale:
• The correct answer is elevated PAWP because the clinical
presentation (JVD, crackles) indicates left ventricular failure and
pulmonary congestion. PAWP reflects left atrial pressure and is
a key indicator of left ventricular preload.
• A is incorrect; cardiac output would likely be decreased due to
impaired ventricular function.
Undergraduate
Q1. A 68-year-old patient with a history of heart failure is on a
continuous lidocaine infusion at 2 mg/min. The pharmacy
supplies lidocaine 2 g in 500 mL D5W. What is the infusion rate
in mL/hr?
A. 15 mL/hr
B. 30 mL/hr
C. 60 mL/hr
D. 120 mL/hr
Answer: B
Rationale:
• The correct answer is calculated by first determining the
concentration of the solution: 2 g/500 mL = 2000 mg/500 mL =
4 mg/mL. The ordered dose is 2 mg/min. To find the mL/min
rate: (2 mg/min) / (4 mg/mL) = 0.5 mL/min. Converting to
mL/hr: 0.5 mL/min * 60 min/hr = 30 mL/hr.
• A is incorrect; 15 mL/hr would deliver half the required dose.
• C is incorrect; 60 mL/hr would deliver double the required
dose.
• D is incorrect; 120 mL/hr would deliver four times the
required dose.
• The nurse should verify the calculation with a second nurse
and use an infusion pump.
Difficulty: Moderate
Bloom’s level: Application
,NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies: Dosage Calculation
Q2. A patient's telemetry strip shows a regular rhythm at a rate
of 36 bpm. The P waves are upright and uniform, each followed
by a QRS complex. The PR interval is 0.24 seconds and constant.
The QRS duration is 0.10 seconds. Which rhythm does the nurse
identify?
A. Sinus bradycardia
B. First-degree AV block
C. Junctional rhythm
D. Third-degree AV block
Answer: A
Rationale:
• The correct answer is sinus bradycardia because the rhythm is
regular with a rate less than 60 bpm, and there is a normal P
wave before each QRS complex with a constant, albeit slightly
prolonged, PR interval.
• B is incorrect; first-degree AV block is a finding within a
rhythm (prolonged PR interval), not a rhythm diagnosis itself.
The underlying rhythm here is sinus bradycardia.
• C is incorrect; a junctional rhythm typically has no P waves or
inverted P waves, not upright P waves.
• D is incorrect; in third-degree AV block, P waves and QRS
complexes are independent (no relationship), which is not the
case here.
,• The nurse should assess the patient for symptoms of low
cardiac output, such as dizziness or hypotension.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Alterations in Body Systems
Q3. A 55-year-old male arrives at the ED reporting severe,
crushing substernal chest pain radiating to his jaw that started
30 minutes ago. Vital signs are BP 168/100, HR 112, RR 24,
SpO2 94% on room air. The nurse attaches the cardiac monitor
and obtains IV access. What is the nurse's priority action?
A. Administer sublingual nitroglycerin.
B. Obtain a 12-lead EKG.
C. Administer morphine sulfate IV.
D. Draw blood for cardiac enzymes.
Answer: B
Rationale:
• The correct answer is to obtain a 12-lead EKG because the
patient's symptoms are classic for acute coronary syndrome
(ACS). Guidelines mandate an EKG be obtained within 10
minutes of presentation to diagnose ST-elevation MI (STEMI)
and expedite reperfusion therapy.
• A is incorrect; nitroglycerin may be given after the EKG
confirms the diagnosis and if the patient's blood pressure is
adequate.
• C is incorrect; morphine can be given for pain unrelieved by
, nitroglycerin, but it is not the immediate priority.
• D is incorrect; while important, drawing labs does not take
precedence over the immediate need for EKG interpretation.
• The priority is rapid diagnosis to determine if the patient is a
candidate for emergent percutaneous coronary intervention
(PCI).
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q4. A patient with an acute anterior MI suddenly becomes
diaphoretic and tachycardic. The nurse assesses jugular venous
distension and crackles in the lung bases. Which finding would
the nurse anticipate?
A. Increased cardiac output
B. Elevated pulmonary artery wedge pressure (PAWP)
C. Decreased systemic vascular resistance (SVR)
D. Widened pulse pressure
Answer: B
Rationale:
• The correct answer is elevated PAWP because the clinical
presentation (JVD, crackles) indicates left ventricular failure and
pulmonary congestion. PAWP reflects left atrial pressure and is
a key indicator of left ventricular preload.
• A is incorrect; cardiac output would likely be decreased due to
impaired ventricular function.
