Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 28-year-old with sudden palpitations reports
lightheadedness but remains alert; vitals: HR 180, BP 110/68,
SpO2 98% on room air. ECG text description: Rate ~180 bpm,
regular narrow QRS complexes, absent visible P waves. What is
the nurse’s priority initial action?
A. Instruct the patient to perform a Valsalva maneuver (bearing
down).
B. Prepare for immediate synchronized cardioversion.
C. Give IV metoprolol 5 mg push.
D. Administer sublingual nitroglycerin.
Answer: A
Rationale:
• Why correct: The ECG description is consistent with SVT
(supraventricular tachycardia) in a hemodynamically stable
patient (BP 110/68); vagal maneuvers (e.g., Valsalva) are the
recommended first-line, nonpharmacologic attempt to
terminate SVT. Vagal maneuvers can increase vagal tone and
may restore sinus rhythm quickly.
• Distractor B incorrect: Synchronized cardioversion is indicated
for unstable patients (hypotension, altered mental status,
ischemia) or if vagal maneuvers and adenosine fail; this patient
is stable.
• Distractor C incorrect: IV beta-blocker may slow rate but is not
first-line immediate maneuver for stable SVT; adenosine is
,preferred pharmacologic agent if vagal maneuvers fail.
• Distractor D incorrect: Sublingual nitroglycerin is not effective
for terminating SVT and may cause hypotension.
• Quick nursing action: Coach and assist the patient to perform
a Valsalva maneuver while preparing suction/monitoring if vagal
maneuvers fail.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 72-year-old with new-onset palpitations has irregular
pulse and mild dyspnea; vitals: HR 140 irregular, BP 132/78. ECG
text description: Irregularly irregular rhythm with absent
distinct P waves and variable R–R intervals. The patient is
hemodynamically stable. Which is the best immediate nursing
action?
A. Administer IV diltiazem per protocol for rate control.
B. Start IV heparin immediately without other actions.
C. Prepare for immediate synchronized cardioversion.
D. Give sublingual nitroglycerin for symptom relief.
Answer: A
Rationale:
• Why correct: The ECG description is consistent with atrial
fibrillation with rapid ventricular response (AF with RVR); in a
hemodynamically stable patient, the priority is rate control
(e.g., IV diltiazem) to improve symptoms and prevent
,hemodynamic deterioration.
• Distractor B incorrect: Anticoagulation is important for
thromboembolism prevention but immediate anticoagulation
alone does not control rate and may be deferred until
assessment of bleeding risk and plan for cardioversion/consult.
• Distractor C incorrect: Synchronized cardioversion is reserved
for unstable patients or for elective cardioversion after
appropriate anticoagulation; this stable patient requires rate
control first.
• Distractor D incorrect: Sublingual nitroglycerin does not treat
AF with RVR and may lower blood pressure unnecessarily.
• Quick nursing action: Administer prescribed IV diltiazem and
continuously monitor rhythm, blood pressure, and symptoms.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 60-year-old becomes unresponsive at bedside; vitals: no
palpable pulse, apnea. Monitor shows wide QRS complexes at
~180 bpm with no organized P waves. What should the nurse
do first?
A. Start high-quality CPR and prepare for immediate
unsynchronized defibrillation.
B. Give IV amiodarone 300 mg bolus while awaiting pulse check.
C. Perform carotid sinus massage.
D. Give IV epinephrine and continue monitoring without CPR.
, Answer: A
Rationale:
• Why correct: The monitor shows pulseless ventricular
tachycardia (wide QRS, rapid rate, pulseless); immediate high-
quality CPR and prompt unsynchronized defibrillation
(asynchronous shock) are the highest-priority, evidence-based
interventions.
• Distractor B incorrect: Amiodarone may be given after
defibrillation attempts but should not delay CPR/defibrillation.
• Distractor C incorrect: Carotid sinus massage is
contraindicated in life-threatening ventricular arrhythmias and
can cause harm.
• Distractor D incorrect: Epinephrine is part of the algorithm
but should be given in the sequence with CPR and defibrillation;
it does not replace immediate CPR/defibrillation.
• Quick nursing action: Begin chest compressions immediately,
call for defibrillator, and continue ACLS algorithm.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 78-year-old post-op patient reports dizziness and
syncope; vitals: HR 34, BP 80/56, SpO2 95%. ECG text
description: P waves and QRS complexes present but with no
consistent relationship (P waves marching at 80/min, QRS at
32/min). The nurse’s priority is:
Undergraduate
Q1. A 28-year-old with sudden palpitations reports
lightheadedness but remains alert; vitals: HR 180, BP 110/68,
SpO2 98% on room air. ECG text description: Rate ~180 bpm,
regular narrow QRS complexes, absent visible P waves. What is
the nurse’s priority initial action?
A. Instruct the patient to perform a Valsalva maneuver (bearing
down).
B. Prepare for immediate synchronized cardioversion.
C. Give IV metoprolol 5 mg push.
D. Administer sublingual nitroglycerin.
Answer: A
Rationale:
• Why correct: The ECG description is consistent with SVT
(supraventricular tachycardia) in a hemodynamically stable
patient (BP 110/68); vagal maneuvers (e.g., Valsalva) are the
recommended first-line, nonpharmacologic attempt to
terminate SVT. Vagal maneuvers can increase vagal tone and
may restore sinus rhythm quickly.
• Distractor B incorrect: Synchronized cardioversion is indicated
for unstable patients (hypotension, altered mental status,
ischemia) or if vagal maneuvers and adenosine fail; this patient
is stable.
• Distractor C incorrect: IV beta-blocker may slow rate but is not
first-line immediate maneuver for stable SVT; adenosine is
,preferred pharmacologic agent if vagal maneuvers fail.
• Distractor D incorrect: Sublingual nitroglycerin is not effective
for terminating SVT and may cause hypotension.
• Quick nursing action: Coach and assist the patient to perform
a Valsalva maneuver while preparing suction/monitoring if vagal
maneuvers fail.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 72-year-old with new-onset palpitations has irregular
pulse and mild dyspnea; vitals: HR 140 irregular, BP 132/78. ECG
text description: Irregularly irregular rhythm with absent
distinct P waves and variable R–R intervals. The patient is
hemodynamically stable. Which is the best immediate nursing
action?
A. Administer IV diltiazem per protocol for rate control.
B. Start IV heparin immediately without other actions.
C. Prepare for immediate synchronized cardioversion.
D. Give sublingual nitroglycerin for symptom relief.
Answer: A
Rationale:
• Why correct: The ECG description is consistent with atrial
fibrillation with rapid ventricular response (AF with RVR); in a
hemodynamically stable patient, the priority is rate control
(e.g., IV diltiazem) to improve symptoms and prevent
,hemodynamic deterioration.
• Distractor B incorrect: Anticoagulation is important for
thromboembolism prevention but immediate anticoagulation
alone does not control rate and may be deferred until
assessment of bleeding risk and plan for cardioversion/consult.
• Distractor C incorrect: Synchronized cardioversion is reserved
for unstable patients or for elective cardioversion after
appropriate anticoagulation; this stable patient requires rate
control first.
• Distractor D incorrect: Sublingual nitroglycerin does not treat
AF with RVR and may lower blood pressure unnecessarily.
• Quick nursing action: Administer prescribed IV diltiazem and
continuously monitor rhythm, blood pressure, and symptoms.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 60-year-old becomes unresponsive at bedside; vitals: no
palpable pulse, apnea. Monitor shows wide QRS complexes at
~180 bpm with no organized P waves. What should the nurse
do first?
A. Start high-quality CPR and prepare for immediate
unsynchronized defibrillation.
B. Give IV amiodarone 300 mg bolus while awaiting pulse check.
C. Perform carotid sinus massage.
D. Give IV epinephrine and continue monitoring without CPR.
, Answer: A
Rationale:
• Why correct: The monitor shows pulseless ventricular
tachycardia (wide QRS, rapid rate, pulseless); immediate high-
quality CPR and prompt unsynchronized defibrillation
(asynchronous shock) are the highest-priority, evidence-based
interventions.
• Distractor B incorrect: Amiodarone may be given after
defibrillation attempts but should not delay CPR/defibrillation.
• Distractor C incorrect: Carotid sinus massage is
contraindicated in life-threatening ventricular arrhythmias and
can cause harm.
• Distractor D incorrect: Epinephrine is part of the algorithm
but should be given in the sequence with CPR and defibrillation;
it does not replace immediate CPR/defibrillation.
• Quick nursing action: Begin chest compressions immediately,
call for defibrillator, and continue ACLS algorithm.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 78-year-old post-op patient reports dizziness and
syncope; vitals: HR 34, BP 80/56, SpO2 95%. ECG text
description: P waves and QRS complexes present but with no
consistent relationship (P waves marching at 80/min, QRS at
32/min). The nurse’s priority is:
