Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 28-year-old woman suddenly develops palpitations and
lightheadedness. Vital signs: HR ~180 bpm, BP 110/70 mmHg,
regular narrow QRS complexes, absent visible P waves — SVT.
What is the nurse’s priority action?
A. Prepare and administer IV adenosine bolus.
B. Begin synchronized cardioversion at 50–100 J.
C. Instruct the patient to perform carotid sinus massage.
D. Ask the patient to perform a Valsalva maneuver.
Answer: D
Rationale:
• Why the correct answer is correct: Valsalva maneuver is the
safest first-line noninvasive vagal maneuver for stable SVT and
can terminate re-entrant SVT by increasing vagal tone and
slowing AV nodal conduction. It is recommended to attempt
vagal maneuvers before drugs in a hemodynamically stable
patient.
• Why A is incorrect: IV adenosine is appropriate if vagal
maneuvers fail, but it should not be the first immediate bedside
action in a stable patient.
• Why B is incorrect: Synchronized cardioversion is indicated for
unstable patients (hypotension, altered mental status,
ischemia), not this hemodynamically stable patient.
• Why C is incorrect: Carotid sinus massage carries risk (stroke)
and should be avoided if carotid bruits or stroke risk factors are
,present; Valsalva is preferred initial maneuver.
• Quick nursing action/priority to perform at bedside: Position
the patient upright and coach/assist with a modified Valsalva
maneuver (strain then release) while preparing for next steps.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 67-year-old man with new-onset atrial fibrillation
presents with chest pain and BP 78/48 mmHg, altered mental
status, and cool extremities. Which action is the nurse’s first
priority?
A. Administer IV diltiazem to control rate.
B. Prepare for immediate synchronized cardioversion.
C. Give a bolus of IV heparin for anticoagulation.
D. Start oral warfarin and obtain INR later.
Answer: B
Rationale:
• Why the correct answer is correct: The patient is
hemodynamically unstable (hypotension, altered mental
status), and immediate synchronized cardioversion is indicated
to restore perfusing rhythm and prevent deterioration. Rapid
electrical cardioversion is recommended over rate control or
anticoagulation when instability is present.
• Why A is incorrect: Rate-control medications (diltiazem) act
too slowly and may worsen hypotension in an unstable patient.
,• Why C is incorrect: Anticoagulation is important in AF but is
not the immediate priority when the patient is unstable and
requires rhythm restoration.
• Why D is incorrect: Oral warfarin has delayed onset and is
inappropriate as an immediate intervention for instability.
• Quick nursing action/priority to perform at bedside: Ensure IV
access, apply synchronized defibrillator pads, and prepare
sedation if time permits while notifying the provider.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. EKG text: wide QRS complexes at ~220 bpm, regular
rhythm, no palpable pulse — monomorphic ventricular
tachycardia with pulselessness. What is the nurse’s immediate
action?
A. Administer IV amiodarone bolus.
B. Begin immediate unsynchronized (defibrillation) shock.
C. Begin synchronized cardioversion at 100 J.
D. Perform immediate synchronized shock after sedation.
Answer: B
Rationale:
• Why the correct answer is correct: Pulseless VT is a cardiac
arrest rhythm requiring immediate unsynchronized
defibrillation (electric shock) and simultaneous high-quality CPR
per advanced cardiac life support (ACLS) guidelines.
, Defibrillation is the priority over antiarrhythmic drugs.
• Why A is incorrect: Amiodarone may be given after
defibrillation attempts but is not the immediate first action for
pulseless VT.
• Why C is incorrect: Synchronized cardioversion is used for
unstable, perfusing VT; it is not used in pulseless VT where
unsynchronized defibrillation is required.
• Why D is incorrect: Sedation is inappropriate in cardiac arrest;
immediate defibrillation and CPR are required.
• Quick nursing action/priority to perform at bedside: Deliver
an immediate unsynchronized defibrillation shock and continue
high-quality CPR.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. EKG description: PR interval progressively lengthens across
consecutive beats until a QRS complex is dropped. Which
dysrhythmia does this describe?
A. First-degree AV block.
B. Second-degree AV block Mobitz II.
C. Second-degree AV block Mobitz I (Wenckebach).
D. Third-degree (complete) heart block.
Answer: C
Rationale:
• Why the correct answer is correct: Progressive PR
Undergraduate
Q1. A 28-year-old woman suddenly develops palpitations and
lightheadedness. Vital signs: HR ~180 bpm, BP 110/70 mmHg,
regular narrow QRS complexes, absent visible P waves — SVT.
What is the nurse’s priority action?
A. Prepare and administer IV adenosine bolus.
B. Begin synchronized cardioversion at 50–100 J.
C. Instruct the patient to perform carotid sinus massage.
D. Ask the patient to perform a Valsalva maneuver.
Answer: D
Rationale:
• Why the correct answer is correct: Valsalva maneuver is the
safest first-line noninvasive vagal maneuver for stable SVT and
can terminate re-entrant SVT by increasing vagal tone and
slowing AV nodal conduction. It is recommended to attempt
vagal maneuvers before drugs in a hemodynamically stable
patient.
• Why A is incorrect: IV adenosine is appropriate if vagal
maneuvers fail, but it should not be the first immediate bedside
action in a stable patient.
• Why B is incorrect: Synchronized cardioversion is indicated for
unstable patients (hypotension, altered mental status,
ischemia), not this hemodynamically stable patient.
• Why C is incorrect: Carotid sinus massage carries risk (stroke)
and should be avoided if carotid bruits or stroke risk factors are
,present; Valsalva is preferred initial maneuver.
• Quick nursing action/priority to perform at bedside: Position
the patient upright and coach/assist with a modified Valsalva
maneuver (strain then release) while preparing for next steps.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 67-year-old man with new-onset atrial fibrillation
presents with chest pain and BP 78/48 mmHg, altered mental
status, and cool extremities. Which action is the nurse’s first
priority?
A. Administer IV diltiazem to control rate.
B. Prepare for immediate synchronized cardioversion.
C. Give a bolus of IV heparin for anticoagulation.
D. Start oral warfarin and obtain INR later.
Answer: B
Rationale:
• Why the correct answer is correct: The patient is
hemodynamically unstable (hypotension, altered mental
status), and immediate synchronized cardioversion is indicated
to restore perfusing rhythm and prevent deterioration. Rapid
electrical cardioversion is recommended over rate control or
anticoagulation when instability is present.
• Why A is incorrect: Rate-control medications (diltiazem) act
too slowly and may worsen hypotension in an unstable patient.
,• Why C is incorrect: Anticoagulation is important in AF but is
not the immediate priority when the patient is unstable and
requires rhythm restoration.
• Why D is incorrect: Oral warfarin has delayed onset and is
inappropriate as an immediate intervention for instability.
• Quick nursing action/priority to perform at bedside: Ensure IV
access, apply synchronized defibrillator pads, and prepare
sedation if time permits while notifying the provider.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. EKG text: wide QRS complexes at ~220 bpm, regular
rhythm, no palpable pulse — monomorphic ventricular
tachycardia with pulselessness. What is the nurse’s immediate
action?
A. Administer IV amiodarone bolus.
B. Begin immediate unsynchronized (defibrillation) shock.
C. Begin synchronized cardioversion at 100 J.
D. Perform immediate synchronized shock after sedation.
Answer: B
Rationale:
• Why the correct answer is correct: Pulseless VT is a cardiac
arrest rhythm requiring immediate unsynchronized
defibrillation (electric shock) and simultaneous high-quality CPR
per advanced cardiac life support (ACLS) guidelines.
, Defibrillation is the priority over antiarrhythmic drugs.
• Why A is incorrect: Amiodarone may be given after
defibrillation attempts but is not the immediate first action for
pulseless VT.
• Why C is incorrect: Synchronized cardioversion is used for
unstable, perfusing VT; it is not used in pulseless VT where
unsynchronized defibrillation is required.
• Why D is incorrect: Sedation is inappropriate in cardiac arrest;
immediate defibrillation and CPR are required.
• Quick nursing action/priority to perform at bedside: Deliver
an immediate unsynchronized defibrillation shock and continue
high-quality CPR.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. EKG description: PR interval progressively lengthens across
consecutive beats until a QRS complex is dropped. Which
dysrhythmia does this describe?
A. First-degree AV block.
B. Second-degree AV block Mobitz II.
C. Second-degree AV block Mobitz I (Wenckebach).
D. Third-degree (complete) heart block.
Answer: C
Rationale:
• Why the correct answer is correct: Progressive PR
