Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 28-year-old patient complains of sudden palpitations and
lightheadedness. EKG: Rate ~180 bpm, regular, narrow QRS
complexes, absent visible P waves. BP 110/70 mmHg,
respirations 18/min. What is the most appropriate immediate
nursing action?
A. Prepare for synchronized cardioversion.
B. Attempt vagal maneuvers (e.g., carotid sinus massage).
C. Administer IV amiodarone bolus.
D. Give sublingual nitroglycerin.
Answer: B
Rationale:
• Why correct: The EKG description is consistent with
supraventricular tachycardia (SVT) (~180 bpm, regular, narrow
QRS, absent P waves) in a hemodynamically stable patient (BP
110/70); vagal maneuvers are the first-line immediate attempt
to terminate SVT.
• Why A is incorrect: Synchronized cardioversion is appropriate
for unstable patients (hypotension, chest pain, altered LOC) —
this patient is stable.
• Why C is incorrect: Amiodarone is not first-line for stable SVT;
adenosine is preferred if vagal maneuvers fail.
• Why D is incorrect: Nitroglycerin does not treat SVT and may
cause hypotension.
• Quick nursing action: Coach and assist the patient with a vagal
,maneuver (e.g., Valsalva) and prepare for adenosine per
protocol if unsuccessful.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 76-year-old with known atrial fibrillation presents with HR
150 bpm, irregularly irregular rhythm on EKG, BP 100/60
mmHg, and mild dyspnea. What is the nurse’s priority?
A. Administer IV diltiazem to control rate.
B. Begin immediate electrical cardioversion.
C. Give subcutaneous low-molecular-weight heparin.
D. Start oral metoprolol at home dose.
Answer: A
Rationale:
• Why correct: Rapid ventricular response in A-fib causing
symptoms and borderline BP is best managed acutely with IV
rate control (diltiazem or a beta blocker) to stabilize
hemodynamics. IV diltiazem provides rapid rate reduction.
• Why B is incorrect: Electrical cardioversion is reserved for
unstable patients or after anticoagulation evaluation; this
patient is borderline stable and should first receive rate control.
• Why C is incorrect: Anticoagulation is important for stroke
prevention but is not the immediate priority to control acute
high ventricular rate.
• Why D is incorrect: Oral metoprolol has slower onset than IV
,agents and may be insufficient for acute rate control.
• Quick nursing action: Administer IV diltiazem per protocol
while monitoring BP and preparing for escalation if
hemodynamics worsen.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A patient becomes unresponsive. Monitor shows a wide-
complex ventricular rhythm at ~220 bpm, no palpable pulse.
What should the nurse do first?
A. Begin immediate high-quality CPR and call for the code cart.
B. Prepare unsynchronized (defibrillate) shock at 200 J.
C. Administer IV amiodarone 150 mg bolus.
D. Attempt vagal maneuvers.
Answer: A
Rationale:
• Why correct: In pulseless ventricular tachycardia the
immediate priority is high-quality CPR and activation of
resuscitation team; defibrillation should follow but initial action
is CPR while equipment is prepared.
• Why B is incorrect: Defibrillation is required but cannot
supersede the immediate need for CPR and calling for help; CPR
should be started without delay while pads/defib are prepared.
• Why C is incorrect: Antiarrhythmics are secondary
interventions after CPR and defibrillation attempts in pulseless
, VT.
• Why D is incorrect: Vagal maneuvers are inappropriate and
ineffective for pulseless VT.
• Quick nursing action: Start chest compressions immediately,
ensure airway/oxygenation, attach defibrillator, and call the
code team.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A patient’s telemetry shows PR interval consistently 0.28
seconds; rate 72, regular rhythm, no symptoms. Which nursing
action is appropriate?
A. Notify provider immediately for urgent pacemaker
placement.
B. Continue routine monitoring and document first-degree AV
block.
C. Administer IV atropine to shorten PR interval.
D. Prepare to give IV beta blocker.
Answer: B
Rationale:
• Why correct: PR interval of 0.28 seconds (>0.20 s) indicates
first-degree AV block; in an asymptomatic, hemodynamically
stable patient, no immediate intervention is required—
monitoring and documentation are appropriate.
• Why A is incorrect: Pacemaker is not indicated for
Undergraduate
Q1. A 28-year-old patient complains of sudden palpitations and
lightheadedness. EKG: Rate ~180 bpm, regular, narrow QRS
complexes, absent visible P waves. BP 110/70 mmHg,
respirations 18/min. What is the most appropriate immediate
nursing action?
A. Prepare for synchronized cardioversion.
B. Attempt vagal maneuvers (e.g., carotid sinus massage).
C. Administer IV amiodarone bolus.
D. Give sublingual nitroglycerin.
Answer: B
Rationale:
• Why correct: The EKG description is consistent with
supraventricular tachycardia (SVT) (~180 bpm, regular, narrow
QRS, absent P waves) in a hemodynamically stable patient (BP
110/70); vagal maneuvers are the first-line immediate attempt
to terminate SVT.
• Why A is incorrect: Synchronized cardioversion is appropriate
for unstable patients (hypotension, chest pain, altered LOC) —
this patient is stable.
• Why C is incorrect: Amiodarone is not first-line for stable SVT;
adenosine is preferred if vagal maneuvers fail.
• Why D is incorrect: Nitroglycerin does not treat SVT and may
cause hypotension.
• Quick nursing action: Coach and assist the patient with a vagal
,maneuver (e.g., Valsalva) and prepare for adenosine per
protocol if unsuccessful.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 76-year-old with known atrial fibrillation presents with HR
150 bpm, irregularly irregular rhythm on EKG, BP 100/60
mmHg, and mild dyspnea. What is the nurse’s priority?
A. Administer IV diltiazem to control rate.
B. Begin immediate electrical cardioversion.
C. Give subcutaneous low-molecular-weight heparin.
D. Start oral metoprolol at home dose.
Answer: A
Rationale:
• Why correct: Rapid ventricular response in A-fib causing
symptoms and borderline BP is best managed acutely with IV
rate control (diltiazem or a beta blocker) to stabilize
hemodynamics. IV diltiazem provides rapid rate reduction.
• Why B is incorrect: Electrical cardioversion is reserved for
unstable patients or after anticoagulation evaluation; this
patient is borderline stable and should first receive rate control.
• Why C is incorrect: Anticoagulation is important for stroke
prevention but is not the immediate priority to control acute
high ventricular rate.
• Why D is incorrect: Oral metoprolol has slower onset than IV
,agents and may be insufficient for acute rate control.
• Quick nursing action: Administer IV diltiazem per protocol
while monitoring BP and preparing for escalation if
hemodynamics worsen.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A patient becomes unresponsive. Monitor shows a wide-
complex ventricular rhythm at ~220 bpm, no palpable pulse.
What should the nurse do first?
A. Begin immediate high-quality CPR and call for the code cart.
B. Prepare unsynchronized (defibrillate) shock at 200 J.
C. Administer IV amiodarone 150 mg bolus.
D. Attempt vagal maneuvers.
Answer: A
Rationale:
• Why correct: In pulseless ventricular tachycardia the
immediate priority is high-quality CPR and activation of
resuscitation team; defibrillation should follow but initial action
is CPR while equipment is prepared.
• Why B is incorrect: Defibrillation is required but cannot
supersede the immediate need for CPR and calling for help; CPR
should be started without delay while pads/defib are prepared.
• Why C is incorrect: Antiarrhythmics are secondary
interventions after CPR and defibrillation attempts in pulseless
, VT.
• Why D is incorrect: Vagal maneuvers are inappropriate and
ineffective for pulseless VT.
• Quick nursing action: Start chest compressions immediately,
ensure airway/oxygenation, attach defibrillator, and call the
code team.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A patient’s telemetry shows PR interval consistently 0.28
seconds; rate 72, regular rhythm, no symptoms. Which nursing
action is appropriate?
A. Notify provider immediately for urgent pacemaker
placement.
B. Continue routine monitoring and document first-degree AV
block.
C. Administer IV atropine to shorten PR interval.
D. Prepare to give IV beta blocker.
Answer: B
Rationale:
• Why correct: PR interval of 0.28 seconds (>0.20 s) indicates
first-degree AV block; in an asymptomatic, hemodynamically
stable patient, no immediate intervention is required—
monitoring and documentation are appropriate.
• Why A is incorrect: Pacemaker is not indicated for
