Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old woman on telemetry develops sudden
palpitations and lightheadedness. Vital signs: HR 180 bpm, BP
110/68 mm Hg, RR 18, SpO₂ 98%. EKG text: Regular, narrow QRS
complexes at ~180 bpm, P waves not visible — consistent with
paroxysmal supraventricular tachycardia (PSVT). What is the
nurse’s priority action?
A. Prepare for immediate synchronized cardioversion.
B. Instruct the patient to perform a Valsalva maneuver and
attempt carotid sinus massage if trained.
C. Administer IV amiodarone 150 mg bolus.
D. Give IV metoprolol 5 mg slowly.
Answer: B
Rationale:
• Why correct: For stable narrow-complex SVT, initial
management is vagal maneuvers (Valsalva; carotid sinus
massage only if provider-trained) before medications or
cardioversion. (AHA Journals)
• Distractor A incorrect: Synchronized cardioversion is reserved
for unstable patients (shock, hypotension, severe ischemia,
altered mental status). (cpr.heart.org)
• Distractor C incorrect: Amiodarone is not first-line for stable
narrow-complex SVT and is used more for ventricular
arrhythmias or refractory cases. (Learn & Master ACLS/PALS)
• Distractor D incorrect: Beta-blockers may control rate but are
,not the immediate priority before attempting
nonpharmacologic vagal maneuvers in stable SVT. (AHA
Journals)
• Nursing action: Coach and assist the patient to perform a
Valsalva (blow into a 10 mL syringe or bear down) and prepare
for rapid escalation if ineffective.
Difficulty: Easy
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 74-year-old man with COPD reports new-onset fatigue.
Vitals: HR 140 bpm, BP 128/72 mm Hg, SpO₂ 92% on room air.
EKG text: Regular atrial activity with “sawtooth” waves at atrial
rate ~300 bpm and ventricular rate ~150 bpm — atrial flutter
with 2:1 conduction. Which treatment is most appropriate to
control the ventricular rate acutely?
A. IV diltiazem bolus/infusion for rate control.
B. Start oral aspirin and observe.
C. Immediate transvenous pacemaker insertion.
D. Subcutaneous low-molecular-weight heparin alone.
Answer: A
Rationale:
• Why correct: Atrial flutter with rapid ventricular response
requires acute rate control (IV calcium channel blocker like
diltiazem or IV beta-blocker) to reduce ventricular rate and
symptoms. (Medscape)
,• Distractor B incorrect: Aspirin addresses thromboembolism
risk but does not acutely control ventricular rate and is not sole
therapy.
• Distractor C incorrect: Pacemaker is not indicated for acute
rate control in atrial flutter unless bradyarrhythmias or
symptomatic pauses occur.
• Distractor D incorrect: Anticoagulation may be indicated
based on duration and stroke risk but does not control rate
acutely.
• Nursing action: Administer prescribed IV diltiazem per
protocol and monitor heart rate, blood pressure, and rhythm on
telemetry.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 59-year-old man suddenly becomes pale and diaphoretic
on the ward. Telemetry: wide-complex tachycardia at 220 bpm,
BP 78/46 mm Hg, RR 24, altered mental status. EKG text:
Regular wide QRS complexes (~220 bpm) consistent with
ventricular tachycardia. What is the nurse’s priority action?
A. Give IV amiodarone bolus while watching the monitor.
B. Prepare the patient for immediate synchronized
cardioversion.
C. Attempt vagal maneuvers and observe.
D. Administer oral beta-blocker.
, Answer: B
Rationale:
• Why correct: Hemodynamically unstable VT (hypotension,
altered mental status) requires immediate synchronized
cardioversion. (aclsmedicaltraining.com)
• Distractor A incorrect: Amiodarone is used for stable VT or
post-defibrillation management, but unstable VT needs
immediate cardioversion. (Learn & Master ACLS/PALS)
• Distractor C incorrect: Vagal maneuvers are for narrow-
complex SVT and are ineffective for VT.
• Distractor D incorrect: Oral beta-blocker is too slow and
inappropriate for an unstable, life-threatening ventricular
arrhythmia.
• Nursing action: Call for help/arrhythmia cart, ensure sync on
defibrillator, provide rapid sedation if time allows, and deliver
synchronized shock per protocol.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 79-year-old patient on metoprolol for hypertension has
an EKG that shows PR interval 0.28 seconds (prolonged) with
regular P–QRS relationship and heart rate 58 bpm. The provider
asks if the PR prolongation is clinically significant. Which
statement is most accurate?
A. This is first-degree AV block likely from beta-blocker effect;
Undergraduate
Q1. A 68-year-old woman on telemetry develops sudden
palpitations and lightheadedness. Vital signs: HR 180 bpm, BP
110/68 mm Hg, RR 18, SpO₂ 98%. EKG text: Regular, narrow QRS
complexes at ~180 bpm, P waves not visible — consistent with
paroxysmal supraventricular tachycardia (PSVT). What is the
nurse’s priority action?
A. Prepare for immediate synchronized cardioversion.
B. Instruct the patient to perform a Valsalva maneuver and
attempt carotid sinus massage if trained.
C. Administer IV amiodarone 150 mg bolus.
D. Give IV metoprolol 5 mg slowly.
Answer: B
Rationale:
• Why correct: For stable narrow-complex SVT, initial
management is vagal maneuvers (Valsalva; carotid sinus
massage only if provider-trained) before medications or
cardioversion. (AHA Journals)
• Distractor A incorrect: Synchronized cardioversion is reserved
for unstable patients (shock, hypotension, severe ischemia,
altered mental status). (cpr.heart.org)
• Distractor C incorrect: Amiodarone is not first-line for stable
narrow-complex SVT and is used more for ventricular
arrhythmias or refractory cases. (Learn & Master ACLS/PALS)
• Distractor D incorrect: Beta-blockers may control rate but are
,not the immediate priority before attempting
nonpharmacologic vagal maneuvers in stable SVT. (AHA
Journals)
• Nursing action: Coach and assist the patient to perform a
Valsalva (blow into a 10 mL syringe or bear down) and prepare
for rapid escalation if ineffective.
Difficulty: Easy
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 74-year-old man with COPD reports new-onset fatigue.
Vitals: HR 140 bpm, BP 128/72 mm Hg, SpO₂ 92% on room air.
EKG text: Regular atrial activity with “sawtooth” waves at atrial
rate ~300 bpm and ventricular rate ~150 bpm — atrial flutter
with 2:1 conduction. Which treatment is most appropriate to
control the ventricular rate acutely?
A. IV diltiazem bolus/infusion for rate control.
B. Start oral aspirin and observe.
C. Immediate transvenous pacemaker insertion.
D. Subcutaneous low-molecular-weight heparin alone.
Answer: A
Rationale:
• Why correct: Atrial flutter with rapid ventricular response
requires acute rate control (IV calcium channel blocker like
diltiazem or IV beta-blocker) to reduce ventricular rate and
symptoms. (Medscape)
,• Distractor B incorrect: Aspirin addresses thromboembolism
risk but does not acutely control ventricular rate and is not sole
therapy.
• Distractor C incorrect: Pacemaker is not indicated for acute
rate control in atrial flutter unless bradyarrhythmias or
symptomatic pauses occur.
• Distractor D incorrect: Anticoagulation may be indicated
based on duration and stroke risk but does not control rate
acutely.
• Nursing action: Administer prescribed IV diltiazem per
protocol and monitor heart rate, blood pressure, and rhythm on
telemetry.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 59-year-old man suddenly becomes pale and diaphoretic
on the ward. Telemetry: wide-complex tachycardia at 220 bpm,
BP 78/46 mm Hg, RR 24, altered mental status. EKG text:
Regular wide QRS complexes (~220 bpm) consistent with
ventricular tachycardia. What is the nurse’s priority action?
A. Give IV amiodarone bolus while watching the monitor.
B. Prepare the patient for immediate synchronized
cardioversion.
C. Attempt vagal maneuvers and observe.
D. Administer oral beta-blocker.
, Answer: B
Rationale:
• Why correct: Hemodynamically unstable VT (hypotension,
altered mental status) requires immediate synchronized
cardioversion. (aclsmedicaltraining.com)
• Distractor A incorrect: Amiodarone is used for stable VT or
post-defibrillation management, but unstable VT needs
immediate cardioversion. (Learn & Master ACLS/PALS)
• Distractor C incorrect: Vagal maneuvers are for narrow-
complex SVT and are ineffective for VT.
• Distractor D incorrect: Oral beta-blocker is too slow and
inappropriate for an unstable, life-threatening ventricular
arrhythmia.
• Nursing action: Call for help/arrhythmia cart, ensure sync on
defibrillator, provide rapid sedation if time allows, and deliver
synchronized shock per protocol.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 79-year-old patient on metoprolol for hypertension has
an EKG that shows PR interval 0.28 seconds (prolonged) with
regular P–QRS relationship and heart rate 58 bpm. The provider
asks if the PR prolongation is clinically significant. Which
statement is most accurate?
A. This is first-degree AV block likely from beta-blocker effect;
