Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 65-year-old patient with a history of heart failure is
admitted with worsening dyspnea. The telemetry monitor
shows a rhythm with an atrial rate of 300 bpm (flutter waves)
and a ventricular rate of 150 bpm. The QRS complex is narrow.
What is the nurse's correct interpretation of this rhythm?
A. Atrial fibrillation
B. Sinus tachycardia
C. Atrial flutter with 2:1 conduction
D. Ventricular tachycardia
Answer: C
Rationale:
• The correct answer is Atrial Flutter with 2:1 conduction
because the classic findings are a very rapid atrial rate (250-350
bpm) seen as flutter waves and a ventricular rate that is a
mathematical divisor of the atrial rate (e.g., 300 bpm atrial / 2 =
150 bpm ventricular).
• A is incorrect because atrial fibrillation has a chaotic atrial
activity with an irregularly irregular ventricular response.
• B is incorrect because sinus tachycardia has a 1:1 relationship
with visible P waves preceding each QRS at a rate typically less
than 150 bpm.
• D is incorrect because ventricular tachycardia produces a wide
QRS complex.
,The nurse's priority is to assess the patient's hemodynamic
stability and prepare for potential cardioversion or medication
administration to control the rate.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A patient with an acute ST-elevation myocardial infarction
(STEMI) is scheduled for emergent percutaneous coronary
intervention (PCI). The nurse should ensure which medication is
administered prior to the procedure, as ordered?
A. Metoprolol
B. Furosemide
C. Dual antiplatelet therapy (e.g., Aspirin and a P2Y12 inhibitor
like Clopidogrel)
D. Warfarin
Answer: C
Rationale:
• The correct answer is Dual antiplatelet therapy because it
inhibits platelet aggregation, which is crucial to prevent
thrombosis in the stent being placed during PCI and is a
standard pre-procedure medication.
• A is incorrect because while beta-blockers like metoprolol are
important in MI management, they are not the priority
medication required immediately before PCI.
• B is incorrect because furosemide is a diuretic used for fluid
,overload, not for pre-PCI preparation.
• D is incorrect because warfarin is an anticoagulant used for
long-term prevention of thromboembolism and is not standard
for acute PCI.
The nurse's priority is to administer the dual antiplatelet
therapy promptly to ensure its effectiveness during the
procedure.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A patient with acute decompensated heart failure has
bibasilar crackles, jugular venous distension, and +3 pitting
edema. The nurse anticipates an order for which intravenous
medication to reduce preload and provide afterload reduction?
A. Dobutamine
B. Nitroglycerin
C. Furosemide
D. Metoprolol
Answer: B
Rationale:
• The correct answer is Nitroglycerin because it is a venodilator
that reduces preload (by pooling blood in the periphery) and an
arteriodilator that reduces afterload, decreasing the heart's
workload and improving cardiac output in acute failure.
• A is incorrect because dobutamine is an inotrope that
, increases myocardial contractility and oxygen demand, which
may not be the first choice in a hypervolemic patient.
• C is incorrect because furosemide is a diuretic that reduces
fluid volume but does not provide direct afterload reduction like
nitroglycerin.
• D is incorrect because metoprolol is a beta-blocker that can
negatively inotropic and chronotropic effects, which could
worsen acute decompensated heart failure.
The nurse's priority is to monitor blood pressure closely during
nitroglycerin infusion to prevent hypotension.
Difficulty: Hard
Bloom’s level: Application
NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies: Cardiovascular
Q4. A patient's arterial line shows a blood pressure of 70/40
mm Hg. The nurse calculates the mean arterial pressure (MAP).
What is the correct calculation?
A. (70 + 40) / 2 = 55 mm Hg
B. (70 - 40) / 3 = 10 mm Hg
C. (70 + 40 + 40) / 3 = 50 mm Hg
D. (Systolic + 2*Diastolic) / 3 = (70 + 80) / 3 = = 50 mm
Hg
Answer: D
Rationale:
• The correct answer is D because the formula for MAP is
(Systolic BP + 2*Diastolic BP) / 3. The math is shown step-by-
Undergraduate
Q1. A 65-year-old patient with a history of heart failure is
admitted with worsening dyspnea. The telemetry monitor
shows a rhythm with an atrial rate of 300 bpm (flutter waves)
and a ventricular rate of 150 bpm. The QRS complex is narrow.
What is the nurse's correct interpretation of this rhythm?
A. Atrial fibrillation
B. Sinus tachycardia
C. Atrial flutter with 2:1 conduction
D. Ventricular tachycardia
Answer: C
Rationale:
• The correct answer is Atrial Flutter with 2:1 conduction
because the classic findings are a very rapid atrial rate (250-350
bpm) seen as flutter waves and a ventricular rate that is a
mathematical divisor of the atrial rate (e.g., 300 bpm atrial / 2 =
150 bpm ventricular).
• A is incorrect because atrial fibrillation has a chaotic atrial
activity with an irregularly irregular ventricular response.
• B is incorrect because sinus tachycardia has a 1:1 relationship
with visible P waves preceding each QRS at a rate typically less
than 150 bpm.
• D is incorrect because ventricular tachycardia produces a wide
QRS complex.
,The nurse's priority is to assess the patient's hemodynamic
stability and prepare for potential cardioversion or medication
administration to control the rate.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A patient with an acute ST-elevation myocardial infarction
(STEMI) is scheduled for emergent percutaneous coronary
intervention (PCI). The nurse should ensure which medication is
administered prior to the procedure, as ordered?
A. Metoprolol
B. Furosemide
C. Dual antiplatelet therapy (e.g., Aspirin and a P2Y12 inhibitor
like Clopidogrel)
D. Warfarin
Answer: C
Rationale:
• The correct answer is Dual antiplatelet therapy because it
inhibits platelet aggregation, which is crucial to prevent
thrombosis in the stent being placed during PCI and is a
standard pre-procedure medication.
• A is incorrect because while beta-blockers like metoprolol are
important in MI management, they are not the priority
medication required immediately before PCI.
• B is incorrect because furosemide is a diuretic used for fluid
,overload, not for pre-PCI preparation.
• D is incorrect because warfarin is an anticoagulant used for
long-term prevention of thromboembolism and is not standard
for acute PCI.
The nurse's priority is to administer the dual antiplatelet
therapy promptly to ensure its effectiveness during the
procedure.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A patient with acute decompensated heart failure has
bibasilar crackles, jugular venous distension, and +3 pitting
edema. The nurse anticipates an order for which intravenous
medication to reduce preload and provide afterload reduction?
A. Dobutamine
B. Nitroglycerin
C. Furosemide
D. Metoprolol
Answer: B
Rationale:
• The correct answer is Nitroglycerin because it is a venodilator
that reduces preload (by pooling blood in the periphery) and an
arteriodilator that reduces afterload, decreasing the heart's
workload and improving cardiac output in acute failure.
• A is incorrect because dobutamine is an inotrope that
, increases myocardial contractility and oxygen demand, which
may not be the first choice in a hypervolemic patient.
• C is incorrect because furosemide is a diuretic that reduces
fluid volume but does not provide direct afterload reduction like
nitroglycerin.
• D is incorrect because metoprolol is a beta-blocker that can
negatively inotropic and chronotropic effects, which could
worsen acute decompensated heart failure.
The nurse's priority is to monitor blood pressure closely during
nitroglycerin infusion to prevent hypotension.
Difficulty: Hard
Bloom’s level: Application
NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies: Cardiovascular
Q4. A patient's arterial line shows a blood pressure of 70/40
mm Hg. The nurse calculates the mean arterial pressure (MAP).
What is the correct calculation?
A. (70 + 40) / 2 = 55 mm Hg
B. (70 - 40) / 3 = 10 mm Hg
C. (70 + 40 + 40) / 3 = 50 mm Hg
D. (Systolic + 2*Diastolic) / 3 = (70 + 80) / 3 = = 50 mm
Hg
Answer: D
Rationale:
• The correct answer is D because the formula for MAP is
(Systolic BP + 2*Diastolic BP) / 3. The math is shown step-by-
