Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old patient with a history of heart failure is on a
cardiac monitor. The rhythm shows a regular ventricular rate of
38 bpm, a constant PR interval of 0.28 seconds, and a normal
QRS complex. The patient is awake but reports feeling dizzy.
Which rhythm does the nurse identify?
A. First-degree atrioventricular (AV) block
B. Second-degree AV block, Type I (Wenckebach)
C. Second-degree AV block, Type II
D. Third-degree AV block
Answer: D
Rationale:
• Third-degree AV block is characterized by complete
dissociation between atrial and ventricular activity, often
resulting in a slow, regular ventricular escape rhythm (as seen
with the rate of 38 bpm) and a constant PR interval is not
present; the P waves march through independently.
• A: First-degree AV block has a prolonged PR interval but every
P wave is followed by a QRS complex, which is not the case
here.
• B: Second-degree AV block, Type I, shows a progressively
lengthening PR interval until a QRS is dropped, which is not
described.
• C: Second-degree AV block, Type II, has intermittent non-
conducted P waves with constant PR intervals in the conducted
,beats, but the ventricular rate is usually not this slow or regular.
• Quick nursing action: Prepare for transcutaneous pacing and
notify the provider immediately due to symptomatic
bradycardia.
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 mmHg, HR 112 bpm, RR 24, SpO2 94% on room air. The
nurse attaches the cardiac monitor and sees ST-segment
elevation in leads II, III, and aVF. What is the nurse's priority
action?
A. Administer sublingual nitroglycerin every 5 minutes as
needed for pain.
B. Obtain a full set of vital signs and a detailed patient history.
C. Prepare the patient for emergent percutaneous coronary
intervention (PCI).
D. Administer morphine sulfate 4 mg IV push for pain control.
Answer: C
Rationale:
• The patient's symptoms and EKG findings (inferior wall ST-
elevation MI) indicate a time-sensitive condition where the goal
is to open the occluded artery as quickly as possible; primary
PCI is the preferred reperfusion strategy.
,• A: Nitroglycerin may be administered, but it is not the priority
over activating the catheterization lab.
• B: While history is important, it should not delay emergent
reperfusion therapy.
• D: Morphine can be used for pain unrelieved by nitroglycerin,
but it is not the immediate priority.
• Quick nursing action: Activate the STEMI protocol
immediately to minimize door-to-balloon time.
Difficulty: Hard
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q3. A client with acute decompensated heart failure has
bibasilar crackles, jugular venous distension, and +3 pitting
edema. The provider orders IV furosemide 40 mg. Which
assessment is most critical for the nurse to perform within one
hour of administration?
A. Check for pedal edema.
B. Auscultate bowel sounds.
C. Measure urine output.
D. Palpate the apical pulse.
Answer: C
Rationale:
• The primary goal of IV diuretic therapy in heart failure is to
promote diuresis and reduce fluid overload; monitoring urine
output is the most direct way to evaluate the effectiveness of
, the medication.
• A: Pedal edema will not change significantly within one hour.
• B: Bowel sounds are not directly related to the action or
common side effects of furosemide.
• D: While furosemide can affect electrolytes which may
influence cardiac rhythm, urine output is the priority
assessment for therapeutic effect.
• Quick nursing action: Initiate accurate intake and output
measurement and assess for signs of hypovolemia.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies: Diuretics
Q4. A patient in hypovolemic shock following a major trauma
has a central venous pressure (CVP) reading of 2 mmHg. What is
the nurse's interpretation of this finding?
A. It indicates fluid volume overload.
B. It is an expected normal value.
C. It suggests increased preload.
D. It reflects decreased preload.
Answer: D
Rationale:
• CVP reflects right atrial pressure and preload. A low CVP
(normal range ~2-8 mmHg) in the context of hypovolemic shock
indicates decreased intravascular volume and reduced preload.
• A: Fluid overload would cause an elevated CVP.
Undergraduate
Q1. A 68-year-old patient with a history of heart failure is on a
cardiac monitor. The rhythm shows a regular ventricular rate of
38 bpm, a constant PR interval of 0.28 seconds, and a normal
QRS complex. The patient is awake but reports feeling dizzy.
Which rhythm does the nurse identify?
A. First-degree atrioventricular (AV) block
B. Second-degree AV block, Type I (Wenckebach)
C. Second-degree AV block, Type II
D. Third-degree AV block
Answer: D
Rationale:
• Third-degree AV block is characterized by complete
dissociation between atrial and ventricular activity, often
resulting in a slow, regular ventricular escape rhythm (as seen
with the rate of 38 bpm) and a constant PR interval is not
present; the P waves march through independently.
• A: First-degree AV block has a prolonged PR interval but every
P wave is followed by a QRS complex, which is not the case
here.
• B: Second-degree AV block, Type I, shows a progressively
lengthening PR interval until a QRS is dropped, which is not
described.
• C: Second-degree AV block, Type II, has intermittent non-
conducted P waves with constant PR intervals in the conducted
,beats, but the ventricular rate is usually not this slow or regular.
• Quick nursing action: Prepare for transcutaneous pacing and
notify the provider immediately due to symptomatic
bradycardia.
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 mmHg, HR 112 bpm, RR 24, SpO2 94% on room air. The
nurse attaches the cardiac monitor and sees ST-segment
elevation in leads II, III, and aVF. What is the nurse's priority
action?
A. Administer sublingual nitroglycerin every 5 minutes as
needed for pain.
B. Obtain a full set of vital signs and a detailed patient history.
C. Prepare the patient for emergent percutaneous coronary
intervention (PCI).
D. Administer morphine sulfate 4 mg IV push for pain control.
Answer: C
Rationale:
• The patient's symptoms and EKG findings (inferior wall ST-
elevation MI) indicate a time-sensitive condition where the goal
is to open the occluded artery as quickly as possible; primary
PCI is the preferred reperfusion strategy.
,• A: Nitroglycerin may be administered, but it is not the priority
over activating the catheterization lab.
• B: While history is important, it should not delay emergent
reperfusion therapy.
• D: Morphine can be used for pain unrelieved by nitroglycerin,
but it is not the immediate priority.
• Quick nursing action: Activate the STEMI protocol
immediately to minimize door-to-balloon time.
Difficulty: Hard
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q3. A client with acute decompensated heart failure has
bibasilar crackles, jugular venous distension, and +3 pitting
edema. The provider orders IV furosemide 40 mg. Which
assessment is most critical for the nurse to perform within one
hour of administration?
A. Check for pedal edema.
B. Auscultate bowel sounds.
C. Measure urine output.
D. Palpate the apical pulse.
Answer: C
Rationale:
• The primary goal of IV diuretic therapy in heart failure is to
promote diuresis and reduce fluid overload; monitoring urine
output is the most direct way to evaluate the effectiveness of
, the medication.
• A: Pedal edema will not change significantly within one hour.
• B: Bowel sounds are not directly related to the action or
common side effects of furosemide.
• D: While furosemide can affect electrolytes which may
influence cardiac rhythm, urine output is the priority
assessment for therapeutic effect.
• Quick nursing action: Initiate accurate intake and output
measurement and assess for signs of hypovolemia.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies: Diuretics
Q4. A patient in hypovolemic shock following a major trauma
has a central venous pressure (CVP) reading of 2 mmHg. What is
the nurse's interpretation of this finding?
A. It indicates fluid volume overload.
B. It is an expected normal value.
C. It suggests increased preload.
D. It reflects decreased preload.
Answer: D
Rationale:
• CVP reflects right atrial pressure and preload. A low CVP
(normal range ~2-8 mmHg) in the context of hypovolemic shock
indicates decreased intravascular volume and reduced preload.
• A: Fluid overload would cause an elevated CVP.
