Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old man has an EKG described as: "Rate ~160
bpm, regular, narrow QRS complexes, P waves not visible,
abrupt onset" after receiving albuterol for COPD. He is pale and
diaphoretic but normotensive. What is the nurse’s priority
action?
A. Vagal maneuvers (bearing down) immediately
B. Prepare for synchronized cardioversion if unstable
C. Administer IV amiodarone bolus now
D. Give oral metoprolol and observe
Answer: B
Rationale:
• Why correct: The clinical picture (rate ~160 bpm, regular
narrow QRS, no visible P waves — consistent with
supraventricular tachycardia with hemodynamic compromise:
diaphoresis/pallor) and abrupt onset indicate potential
instability; synchronized cardioversion is the immediate
treatment for unstable SVT. Cardioversion restores perfusion
quickly.
• Why A is incorrect: Vagal maneuvers are appropriate for
stable SVT but not the priority when signs of instability are
present.
• Why C is incorrect: IV amiodarone is not first-line for unstable
narrow-complex SVT and takes longer to act.
• Why D is incorrect: Oral metoprolol is too slow and
,inappropriate for an acutely unstable, high-rate arrhythmia.
• Quick nursing action/priority to perform at bedside: Prepare
and notify provider for immediate synchronized cardioversion
and ensure airway/IV access.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 54-year-old woman with chest pain has this EKG
description: "ST-segment elevation 3 mm in leads V2–V4,
reciprocal ST depression in leads II and III." Which immediate
intervention should the nurse anticipate?
A. Administer sublingual nitroglycerin and observe for pain
relief
B. Prepare the patient for emergent percutaneous coronary
intervention (PCI) within 90 minutes
C. Give thrombolytic therapy immediately without additional
consult
D. Obtain a chest CT to rule out pulmonary embolism before
reperfusion
Answer: B
Rationale:
• Why correct: ST elevation in V2–V4 indicates an acute anterior
STEMI; emergent PCI within guideline door-to-balloon
timeframe (ideally ≤90 minutes) is indicated for reperfusion. PCI
is preferred when available.
,• Why A is incorrect: Sublingual nitroglycerin can relieve
ischemic pain but is not the definitive emergent reperfusion
strategy for an evolving large anterior STEMI.
• Why C is incorrect: Thrombolysis may be considered if PCI is
unavailable, but decision requires contraindication review and is
not automatic without provider order.
• Why D is incorrect: Chest CT would delay life-saving
reperfusion and is not indicated given clear STEMI EKG.
• Quick nursing action/priority to perform at bedside: Notify
cath lab/PCI team immediately and maintain IV access and
oxygen as needed.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 72-year-old man in the ED is diagnosed with an inferior
STEMI. He is on aspirin 325 mg chewed and oxygen. He has a
history of peptic ulcer disease with recent GI bleed 2 weeks
ago. Which antithrombotic is contraindicated or requires
caution?
A. Heparin infusion (unfractionated)
B. Clopidogrel loading dose
C. Tenecteplase (fibrinolytic)
D. Glycoprotein IIb/IIIa inhibitor (eptifibatide)
Answer: C
, Rationale:
• Why correct: Recent active or recent significant GI bleeding
(within past 2 weeks) is a contraindication to fibrinolytic
therapy due to high hemorrhagic risk. Tenecteplase should be
avoided.
• Why A is incorrect: Heparin may be used with caution and
monitoring; it is not an absolute contraindication in recent GI
bleed but requires risk–benefit evaluation.
• Why B is incorrect: Clopidogrel is typically used unless active
bleeding; recent healed ulcer is cautionary but generally
allowable after assessment.
• Why D is incorrect: GP IIb/IIIa inhibitors increase bleeding risk
and require caution, but they are not absolute contraindications
solely for recent GI bleed in all cases; decision is individualized.
• Quick nursing action/priority to perform at bedside: Notify
the provider of recent GI bleed and clarify reperfusion strategy;
hold fibrinolytic agents.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A patient with chronic heart failure is admitted with sudden
dyspnea and pink, frothy sputum. Vital signs: HR 110 bpm, BP
170/100 mmHg, RR 28, SpO2 86% on room air. Which is the
highest priority nursing action?
A. Administer IV furosemide with a loop diuretic order
Undergraduate
Q1. A 68-year-old man has an EKG described as: "Rate ~160
bpm, regular, narrow QRS complexes, P waves not visible,
abrupt onset" after receiving albuterol for COPD. He is pale and
diaphoretic but normotensive. What is the nurse’s priority
action?
A. Vagal maneuvers (bearing down) immediately
B. Prepare for synchronized cardioversion if unstable
C. Administer IV amiodarone bolus now
D. Give oral metoprolol and observe
Answer: B
Rationale:
• Why correct: The clinical picture (rate ~160 bpm, regular
narrow QRS, no visible P waves — consistent with
supraventricular tachycardia with hemodynamic compromise:
diaphoresis/pallor) and abrupt onset indicate potential
instability; synchronized cardioversion is the immediate
treatment for unstable SVT. Cardioversion restores perfusion
quickly.
• Why A is incorrect: Vagal maneuvers are appropriate for
stable SVT but not the priority when signs of instability are
present.
• Why C is incorrect: IV amiodarone is not first-line for unstable
narrow-complex SVT and takes longer to act.
• Why D is incorrect: Oral metoprolol is too slow and
,inappropriate for an acutely unstable, high-rate arrhythmia.
• Quick nursing action/priority to perform at bedside: Prepare
and notify provider for immediate synchronized cardioversion
and ensure airway/IV access.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 54-year-old woman with chest pain has this EKG
description: "ST-segment elevation 3 mm in leads V2–V4,
reciprocal ST depression in leads II and III." Which immediate
intervention should the nurse anticipate?
A. Administer sublingual nitroglycerin and observe for pain
relief
B. Prepare the patient for emergent percutaneous coronary
intervention (PCI) within 90 minutes
C. Give thrombolytic therapy immediately without additional
consult
D. Obtain a chest CT to rule out pulmonary embolism before
reperfusion
Answer: B
Rationale:
• Why correct: ST elevation in V2–V4 indicates an acute anterior
STEMI; emergent PCI within guideline door-to-balloon
timeframe (ideally ≤90 minutes) is indicated for reperfusion. PCI
is preferred when available.
,• Why A is incorrect: Sublingual nitroglycerin can relieve
ischemic pain but is not the definitive emergent reperfusion
strategy for an evolving large anterior STEMI.
• Why C is incorrect: Thrombolysis may be considered if PCI is
unavailable, but decision requires contraindication review and is
not automatic without provider order.
• Why D is incorrect: Chest CT would delay life-saving
reperfusion and is not indicated given clear STEMI EKG.
• Quick nursing action/priority to perform at bedside: Notify
cath lab/PCI team immediately and maintain IV access and
oxygen as needed.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 72-year-old man in the ED is diagnosed with an inferior
STEMI. He is on aspirin 325 mg chewed and oxygen. He has a
history of peptic ulcer disease with recent GI bleed 2 weeks
ago. Which antithrombotic is contraindicated or requires
caution?
A. Heparin infusion (unfractionated)
B. Clopidogrel loading dose
C. Tenecteplase (fibrinolytic)
D. Glycoprotein IIb/IIIa inhibitor (eptifibatide)
Answer: C
, Rationale:
• Why correct: Recent active or recent significant GI bleeding
(within past 2 weeks) is a contraindication to fibrinolytic
therapy due to high hemorrhagic risk. Tenecteplase should be
avoided.
• Why A is incorrect: Heparin may be used with caution and
monitoring; it is not an absolute contraindication in recent GI
bleed but requires risk–benefit evaluation.
• Why B is incorrect: Clopidogrel is typically used unless active
bleeding; recent healed ulcer is cautionary but generally
allowable after assessment.
• Why D is incorrect: GP IIb/IIIa inhibitors increase bleeding risk
and require caution, but they are not absolute contraindications
solely for recent GI bleed in all cases; decision is individualized.
• Quick nursing action/priority to perform at bedside: Notify
the provider of recent GI bleed and clarify reperfusion strategy;
hold fibrinolytic agents.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A patient with chronic heart failure is admitted with sudden
dyspnea and pink, frothy sputum. Vital signs: HR 110 bpm, BP
170/100 mmHg, RR 28, SpO2 86% on room air. Which is the
highest priority nursing action?
A. Administer IV furosemide with a loop diuretic order
