Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 72-year-old man complains of sudden palpitations; ECG
text: "Rate ~170 bpm, regular, narrow QRS, absent distinct P
waves." He is hemodynamically stable. What is the nurse’s best
immediate action?
A. Perform carotid sinus massage (after assessing for carotid
bruit).
B. Prepare for immediate synchronized cardioversion.
C. Administer IV amiodarone bolus.
D. Apply supplemental oxygen and observe.
Answer: A
Rationale:
• Why correct: The ECG description is consistent with
paroxysmal supraventricular tachycardia (SVT); in a stable
patient, vagal maneuvers such as carotid sinus massage (if no
bruit) are first-line, noninvasive attempts to terminate SVT.
• Why B is incorrect: Synchronized cardioversion is reserved for
unstable patients (hypotension, altered mental status,
ischemia); this patient is stable.
• Why C is incorrect: Amiodarone is not first-line for typical SVT
and is used more for ventricular arrhythmias or refractory atrial
arrhythmias.
• Why D is incorrect: Oxygen and observation alone do not
address the arrhythmia and may delay effective therapy.
• Quick nursing action/priority: Assess for carotid bruit, then
,attempt vagal maneuvers while preparing resuscitation
equipment.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. ECG text: "Irregularly irregular rhythm, no distinct P waves,
narrow QRS, ventricular rate 130 bpm." The nurse recognizes
atrial fibrillation with RVR. The patient is stable but
symptomatic with mild dyspnea. Which medication is most
appropriate for acute rate control?
A. IV diltiazem bolus/infusion.
B. IV procainamide.
C. Oral digoxin immediate dose.
D. IV epinephrine bolus.
Answer: A
Rationale:
• Why correct: IV diltiazem (a nondihydropyridine calcium
channel blocker) is effective for acute ventricular rate control in
AF with RVR in hemodynamically stable patients by slowing AV
nodal conduction.
• Why B is incorrect: Procainamide is primarily used for certain
ventricular arrhythmias or for AF with pre-excitation, not first-
line for rate control in typical AF with RVR.
• Why C is incorrect: Oral digoxin has slow onset and is not ideal
for rapid rate control in an acute symptomatic setting.
,• Why D is incorrect: Epinephrine increases sympathetic tone
and would worsen tachycardia.
• Quick nursing action/priority: Verify IV access and blood
pressure, then administer diltiazem per protocol while
monitoring HR and BP.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A monitored patient’s ECG reads: "Regular rhythm, rate 48
bpm; P waves present before each QRS; PR interval constant at
0.28 seconds." The patient feels lightheaded. Which is the most
likely diagnosis and appropriate immediate nursing priority?
A. First-degree AV block; hold AV-nodal blocking meds and
notify provider.
B. Sinus bradycardia; encourage ambulation to increase rate.
C. Complete heart block; prepare for immediate transvenous
pacing.
D. Ventricular escape rhythm; administer IV amiodarone.
Answer: A
Rationale:
• Why correct: A prolonged but constant PR interval (>0.20
seconds) with each P before QRS indicates first-degree AV block;
symptomatic bradycardia may be medication-related, so
holding AV-nodal blockers and notifying the provider is
appropriate.
, • Why B is incorrect: Sinus bradycardia has normal PR interval;
the prolonged PR indicates AV conduction delay rather than
simple sinus bradycardia.
• Why C is incorrect: Complete (third-degree) heart block shows
no relationship between P waves and QRS complexes, unlike
this tracing.
• Why D is incorrect: Ventricular escape rhythms produce wide
QRS complexes and absent preceding P waves.
• Quick nursing action/priority: Review recent medication
administration (beta-blockers, calcium channel blockers,
digoxin), hold suspected drugs, and notify the provider.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. ECG text: "Regular rhythm, wide QRS complexes at 160
bpm, patient is hypotensive and diaphoretic." The nurse’s
priority action is:
A. Prepare for immediate synchronized cardioversion.
B. Administer oral metoprolol.
C. Apply oxygen and wait for physician orders.
D. Obtain a 12-lead ECG only.
Answer: A
Rationale:
• Why correct: Wide-complex tachycardia with hemodynamic
instability suggests ventricular tachycardia; immediate
Undergraduate
Q1. A 72-year-old man complains of sudden palpitations; ECG
text: "Rate ~170 bpm, regular, narrow QRS, absent distinct P
waves." He is hemodynamically stable. What is the nurse’s best
immediate action?
A. Perform carotid sinus massage (after assessing for carotid
bruit).
B. Prepare for immediate synchronized cardioversion.
C. Administer IV amiodarone bolus.
D. Apply supplemental oxygen and observe.
Answer: A
Rationale:
• Why correct: The ECG description is consistent with
paroxysmal supraventricular tachycardia (SVT); in a stable
patient, vagal maneuvers such as carotid sinus massage (if no
bruit) are first-line, noninvasive attempts to terminate SVT.
• Why B is incorrect: Synchronized cardioversion is reserved for
unstable patients (hypotension, altered mental status,
ischemia); this patient is stable.
• Why C is incorrect: Amiodarone is not first-line for typical SVT
and is used more for ventricular arrhythmias or refractory atrial
arrhythmias.
• Why D is incorrect: Oxygen and observation alone do not
address the arrhythmia and may delay effective therapy.
• Quick nursing action/priority: Assess for carotid bruit, then
,attempt vagal maneuvers while preparing resuscitation
equipment.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. ECG text: "Irregularly irregular rhythm, no distinct P waves,
narrow QRS, ventricular rate 130 bpm." The nurse recognizes
atrial fibrillation with RVR. The patient is stable but
symptomatic with mild dyspnea. Which medication is most
appropriate for acute rate control?
A. IV diltiazem bolus/infusion.
B. IV procainamide.
C. Oral digoxin immediate dose.
D. IV epinephrine bolus.
Answer: A
Rationale:
• Why correct: IV diltiazem (a nondihydropyridine calcium
channel blocker) is effective for acute ventricular rate control in
AF with RVR in hemodynamically stable patients by slowing AV
nodal conduction.
• Why B is incorrect: Procainamide is primarily used for certain
ventricular arrhythmias or for AF with pre-excitation, not first-
line for rate control in typical AF with RVR.
• Why C is incorrect: Oral digoxin has slow onset and is not ideal
for rapid rate control in an acute symptomatic setting.
,• Why D is incorrect: Epinephrine increases sympathetic tone
and would worsen tachycardia.
• Quick nursing action/priority: Verify IV access and blood
pressure, then administer diltiazem per protocol while
monitoring HR and BP.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A monitored patient’s ECG reads: "Regular rhythm, rate 48
bpm; P waves present before each QRS; PR interval constant at
0.28 seconds." The patient feels lightheaded. Which is the most
likely diagnosis and appropriate immediate nursing priority?
A. First-degree AV block; hold AV-nodal blocking meds and
notify provider.
B. Sinus bradycardia; encourage ambulation to increase rate.
C. Complete heart block; prepare for immediate transvenous
pacing.
D. Ventricular escape rhythm; administer IV amiodarone.
Answer: A
Rationale:
• Why correct: A prolonged but constant PR interval (>0.20
seconds) with each P before QRS indicates first-degree AV block;
symptomatic bradycardia may be medication-related, so
holding AV-nodal blockers and notifying the provider is
appropriate.
, • Why B is incorrect: Sinus bradycardia has normal PR interval;
the prolonged PR indicates AV conduction delay rather than
simple sinus bradycardia.
• Why C is incorrect: Complete (third-degree) heart block shows
no relationship between P waves and QRS complexes, unlike
this tracing.
• Why D is incorrect: Ventricular escape rhythms produce wide
QRS complexes and absent preceding P waves.
• Quick nursing action/priority: Review recent medication
administration (beta-blockers, calcium channel blockers,
digoxin), hold suspected drugs, and notify the provider.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. ECG text: "Regular rhythm, wide QRS complexes at 160
bpm, patient is hypotensive and diaphoretic." The nurse’s
priority action is:
A. Prepare for immediate synchronized cardioversion.
B. Administer oral metoprolol.
C. Apply oxygen and wait for physician orders.
D. Obtain a 12-lead ECG only.
Answer: A
Rationale:
• Why correct: Wide-complex tachycardia with hemodynamic
instability suggests ventricular tachycardia; immediate
