Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 28-year-old male in triage reports sudden palpitations
and mild lightheadedness. Vitals: HR ~180 bpm, BP 124/78, O₂
98% RA. EKG description: "Rate ~180 bpm, regular, narrow QRS
complexes, P waves not apparent — consistent with SVT." What
is the nurse’s priority action?
A. Immediately attempt modified Valsalva maneuver.
B. Administer IV adenosine 6 mg rapid push now.
C. Prepare for immediate synchronized cardioversion.
D. Give oral propranolol and observe.
Answer: A
Rationale:
• Why correct: In a hemodynamically stable patient with
narrow-complex SVT, vagal maneuvers (modified Valsalva) are
the recommended first-line, noninvasive attempt to terminate
the arrhythmia.
• Why B is incorrect: IV adenosine is appropriate if vagal
maneuvers fail but should not be the immediate first action in a
stable patient.
• Why C is incorrect: Synchronized cardioversion is indicated for
unstable patients (hypotension, chest pain, altered mental
status); this patient is stable.
• Why D is incorrect: Oral beta-blocker is too slow and not an
immediate termination strategy.
,• Quick nursing action/priority: Coach and assist the patient to
perform the modified Valsalva (e.g., blow into a 10-mL syringe
for 10–15 seconds) while monitoring rhythm continuously.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 66-year-old female with known atrial fibrillation presents
with palpitations and light dyspnea. Vitals: HR 140, BP 112/68.
EKG description: "Irregularly irregular rhythm, absent discrete P
waves, ventricular rate 140 bpm" (AF with RVR). Best next
action?
A. Immediate synchronized cardioversion.
B. Administer IV diltiazem bolus and infusion for rate control.
C. Start subcutaneous enoxaparin before rate control.
D. Give oral digoxin and discharge.
Answer: B
Rationale:
• Why correct: For symptomatic AF with rapid ventricular
response in a hemodynamically stable patient, IV diltiazem (a
rate-controlling calcium channel blocker) is an effective initial
choice to slow AV nodal conduction.
• Why A is incorrect: Cardioversion is reserved for unstable
patients or those who fail medical rate/rhythm control; this
patient is stable.
• Why C is incorrect: Anticoagulation is important for stroke
,prevention but does not acutely control ventricular rate and
should not delay symptomatic rate control.
• Why D is incorrect: Oral digoxin acts slowly and is not
appropriate as immediate inpatient therapy for symptomatic
RVR; discharge is inappropriate.
• Quick nursing action/priority: Prepare and administer IV
diltiazem per protocol and monitor BP and rhythm
continuously.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 70-year-old man on telemetry suddenly becomes pale,
diaphoretic, and hypotensive. Vitals: HR 160, BP 78/46, O₂ 90%.
EKG description: "Regular wide QRS complexes, rate ~160 bpm"
(monomorphic VT). What should the nurse do first?
A. Deliver unsynchronized high-energy defibrillation.
B. Prepare for synchronized cardioversion immediately.
C. Start IV amiodarone and observe rhythm.
D. Give sublingual nitroglycerin for chest pain.
Answer: B
Rationale:
• Why correct: The patient is unstable (hypotension, hypoxia)
with monomorphic ventricular tachycardia and a pulse;
immediate synchronized cardioversion is indicated to restore
perfusing rhythm.
, • Why A is incorrect: Unsynchronized defibrillation is for
pulseless VT/fibrillation, not for a pulsed unstable VT.
• Why C is incorrect: Antiarrhythmic infusion may be used if
cardioversion is delayed or if stable, but immediate
cardioversion is priority in unstable VT.
• Why D is incorrect: Nitroglycerin is inappropriate and could
worsen hypotension in this unstable arrhythmia.
• Quick nursing action/priority: Call for the crash cart, position
defibrillator pads, and prepare sedation/orderly synchronized
cardioversion.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 75-year-old patient becomes unresponsive on the ward
and has no palpable pulse. Monitor shows chaotic fibrillatory
trace. Immediate action?
A. Start high-quality CPR and prepare for immediate
unsynchronized defibrillation.
B. Check blood pressure and wait for family consent.
C. Give IV atropine and observe rhythm.
D. Attempt synchronized cardioversion.
Answer: A
Rationale:
• Why correct: Ventricular fibrillation is a shockable rhythm;
immediate high-quality CPR and prompt unsynchronized
Undergraduate
Q1. A 28-year-old male in triage reports sudden palpitations
and mild lightheadedness. Vitals: HR ~180 bpm, BP 124/78, O₂
98% RA. EKG description: "Rate ~180 bpm, regular, narrow QRS
complexes, P waves not apparent — consistent with SVT." What
is the nurse’s priority action?
A. Immediately attempt modified Valsalva maneuver.
B. Administer IV adenosine 6 mg rapid push now.
C. Prepare for immediate synchronized cardioversion.
D. Give oral propranolol and observe.
Answer: A
Rationale:
• Why correct: In a hemodynamically stable patient with
narrow-complex SVT, vagal maneuvers (modified Valsalva) are
the recommended first-line, noninvasive attempt to terminate
the arrhythmia.
• Why B is incorrect: IV adenosine is appropriate if vagal
maneuvers fail but should not be the immediate first action in a
stable patient.
• Why C is incorrect: Synchronized cardioversion is indicated for
unstable patients (hypotension, chest pain, altered mental
status); this patient is stable.
• Why D is incorrect: Oral beta-blocker is too slow and not an
immediate termination strategy.
,• Quick nursing action/priority: Coach and assist the patient to
perform the modified Valsalva (e.g., blow into a 10-mL syringe
for 10–15 seconds) while monitoring rhythm continuously.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 66-year-old female with known atrial fibrillation presents
with palpitations and light dyspnea. Vitals: HR 140, BP 112/68.
EKG description: "Irregularly irregular rhythm, absent discrete P
waves, ventricular rate 140 bpm" (AF with RVR). Best next
action?
A. Immediate synchronized cardioversion.
B. Administer IV diltiazem bolus and infusion for rate control.
C. Start subcutaneous enoxaparin before rate control.
D. Give oral digoxin and discharge.
Answer: B
Rationale:
• Why correct: For symptomatic AF with rapid ventricular
response in a hemodynamically stable patient, IV diltiazem (a
rate-controlling calcium channel blocker) is an effective initial
choice to slow AV nodal conduction.
• Why A is incorrect: Cardioversion is reserved for unstable
patients or those who fail medical rate/rhythm control; this
patient is stable.
• Why C is incorrect: Anticoagulation is important for stroke
,prevention but does not acutely control ventricular rate and
should not delay symptomatic rate control.
• Why D is incorrect: Oral digoxin acts slowly and is not
appropriate as immediate inpatient therapy for symptomatic
RVR; discharge is inappropriate.
• Quick nursing action/priority: Prepare and administer IV
diltiazem per protocol and monitor BP and rhythm
continuously.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 70-year-old man on telemetry suddenly becomes pale,
diaphoretic, and hypotensive. Vitals: HR 160, BP 78/46, O₂ 90%.
EKG description: "Regular wide QRS complexes, rate ~160 bpm"
(monomorphic VT). What should the nurse do first?
A. Deliver unsynchronized high-energy defibrillation.
B. Prepare for synchronized cardioversion immediately.
C. Start IV amiodarone and observe rhythm.
D. Give sublingual nitroglycerin for chest pain.
Answer: B
Rationale:
• Why correct: The patient is unstable (hypotension, hypoxia)
with monomorphic ventricular tachycardia and a pulse;
immediate synchronized cardioversion is indicated to restore
perfusing rhythm.
, • Why A is incorrect: Unsynchronized defibrillation is for
pulseless VT/fibrillation, not for a pulsed unstable VT.
• Why C is incorrect: Antiarrhythmic infusion may be used if
cardioversion is delayed or if stable, but immediate
cardioversion is priority in unstable VT.
• Why D is incorrect: Nitroglycerin is inappropriate and could
worsen hypotension in this unstable arrhythmia.
• Quick nursing action/priority: Call for the crash cart, position
defibrillator pads, and prepare sedation/orderly synchronized
cardioversion.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 75-year-old patient becomes unresponsive on the ward
and has no palpable pulse. Monitor shows chaotic fibrillatory
trace. Immediate action?
A. Start high-quality CPR and prepare for immediate
unsynchronized defibrillation.
B. Check blood pressure and wait for family consent.
C. Give IV atropine and observe rhythm.
D. Attempt synchronized cardioversion.
Answer: A
Rationale:
• Why correct: Ventricular fibrillation is a shockable rhythm;
immediate high-quality CPR and prompt unsynchronized
