Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. 62-year-old woman reports sudden palpitations and
lightheadedness. BP 86/50 mmHg, HR ~180 bpm; EKG text:
regular narrow QRS complexes at ~180 bpm, absent P waves —
SVT. What is the nurse’s priority?
A. Attempt vagal maneuvers (carotid sinus massage) at bedside
B. Administer IV adenosine rapid push 6 mg then 12 mg if no
effect
C. Prepare for immediate synchronized cardioversion
D. Give IV metoprolol 5 mg slow bolus
Answer: C
Rationale:
• Why correct: The patient is hemodynamically unstable (BP
86/50, lightheaded); immediate synchronized cardioversion is
indicated for unstable SVT to restore perfusing rhythm.
• Why A is incorrect: Vagal maneuvers are appropriate only for
stable patients and could delay definitive therapy in the
unstable patient.
• Why B is incorrect: Adenosine is for stable SVT; in unstable
patients, delaying cardioversion risks deterioration.
• Why D is incorrect: IV beta-blocker onset is slower and less
reliable than immediate cardioversion in instability.
• Quick nursing action/priority: Apply defibrillator pads, ensure
sedation/airway readiness, and deliver synchronized
cardioversion per protocol.
,Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. 74-year-old man with palpitations and mild dyspnea. BP
110/72 mmHg, HR 140 bpm; EKG text: irregularly irregular
rhythm, absent distinct P waves — atrial fibrillation with RVR.
History: COPD on inhalers. Which medication is best for acute
rate control?
A. IV metoprolol tartrate 5 mg bolus
B. IV diltiazem infusion after bolus (calcium channel blocker)
C. IV amiodarone bolus for rhythm conversion
D. Oral digoxin now for acute rate control
Answer: B
Rationale:
• Why correct: IV diltiazem is effective for rapid ventricular rate
control and is often preferred over beta-blockers in patients
with reactive airway disease (COPD) to reduce bronchospasm
risk.
• Why A is incorrect: Beta-blockers can precipitate
bronchospasm in patients with COPD.
• Why C is incorrect: Amiodarone is used for rhythm control or
refractory rate control but is not first choice for immediate rate
control in stable AF with RVR.
• Why D is incorrect: Digoxin has slow onset of action and is less
effective for acute control of RVR.
,• Quick nursing action/priority: Prepare and administer IV
diltiazem per protocol while continuously monitoring BP and
rhythm.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. 79-year-old woman reports dizziness and near-syncope. BP
70/40 mmHg, HR 38 bpm; EKG text: P waves present at 90/min
independent of QRS complexes at 38/min — complete (third-
degree) AV block. What is the immediate nursing action?
A. Give oral atropine 0.5 mg and observe
B. Prepare for transcutaneous pacing and call provider
C. Start a dopamine infusion at low dose to raise HR slowly
D. Administer IV metoprolol to control ventricular rate
Answer: B
Rationale:
• Why correct: In symptomatic complete heart block with
hypotension and bradycardia, immediate temporary pacing
(transcutaneous while arranging transvenous) is indicated to
restore adequate cardiac output.
• Why A is incorrect: Atropine may be ineffective in complete
heart block and oral route is inappropriate for urgent
management.
• Why C is incorrect: Dopamine may increase rate but pacing is
faster, more reliable, and preferred for unstable complete heart
, block.
• Why D is incorrect: Beta-blockers worsen bradycardia and are
contraindicated.
• Quick nursing action/priority: Apply pacing pads, prepare
defibrillator for transcutaneous pacing, secure IV access, and
notify provider.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. 58-year-old man found unresponsive. No pulse, CPR in
progress; EKG text: wide QRS complexes at ~180 bpm, pulseless
ventricular tachycardia. What should the nurse do immediately?
A. Deliver synchronized cardioversion at 100 J
B. Deliver immediate unsynchronized high-energy defibrillation
(shock)
C. Give IV amiodarone and continue CPR without shock
D. Start IV epinephrine and wait 2 minutes before defibrillation
Answer: B
Rationale:
• Why correct: Pulseless ventricular tachycardia is a shockable
rhythm that requires immediate unsynchronized defibrillation
plus CPR per ACLS algorithms.
• Why A is incorrect: Synchronized cardioversion is for unstable,
perfusing VT; in pulseless VT synchronization is not used.
• Why C is incorrect: Antiarrhythmics are adjuncts after
Undergraduate
Q1. 62-year-old woman reports sudden palpitations and
lightheadedness. BP 86/50 mmHg, HR ~180 bpm; EKG text:
regular narrow QRS complexes at ~180 bpm, absent P waves —
SVT. What is the nurse’s priority?
A. Attempt vagal maneuvers (carotid sinus massage) at bedside
B. Administer IV adenosine rapid push 6 mg then 12 mg if no
effect
C. Prepare for immediate synchronized cardioversion
D. Give IV metoprolol 5 mg slow bolus
Answer: C
Rationale:
• Why correct: The patient is hemodynamically unstable (BP
86/50, lightheaded); immediate synchronized cardioversion is
indicated for unstable SVT to restore perfusing rhythm.
• Why A is incorrect: Vagal maneuvers are appropriate only for
stable patients and could delay definitive therapy in the
unstable patient.
• Why B is incorrect: Adenosine is for stable SVT; in unstable
patients, delaying cardioversion risks deterioration.
• Why D is incorrect: IV beta-blocker onset is slower and less
reliable than immediate cardioversion in instability.
• Quick nursing action/priority: Apply defibrillator pads, ensure
sedation/airway readiness, and deliver synchronized
cardioversion per protocol.
,Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. 74-year-old man with palpitations and mild dyspnea. BP
110/72 mmHg, HR 140 bpm; EKG text: irregularly irregular
rhythm, absent distinct P waves — atrial fibrillation with RVR.
History: COPD on inhalers. Which medication is best for acute
rate control?
A. IV metoprolol tartrate 5 mg bolus
B. IV diltiazem infusion after bolus (calcium channel blocker)
C. IV amiodarone bolus for rhythm conversion
D. Oral digoxin now for acute rate control
Answer: B
Rationale:
• Why correct: IV diltiazem is effective for rapid ventricular rate
control and is often preferred over beta-blockers in patients
with reactive airway disease (COPD) to reduce bronchospasm
risk.
• Why A is incorrect: Beta-blockers can precipitate
bronchospasm in patients with COPD.
• Why C is incorrect: Amiodarone is used for rhythm control or
refractory rate control but is not first choice for immediate rate
control in stable AF with RVR.
• Why D is incorrect: Digoxin has slow onset of action and is less
effective for acute control of RVR.
,• Quick nursing action/priority: Prepare and administer IV
diltiazem per protocol while continuously monitoring BP and
rhythm.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. 79-year-old woman reports dizziness and near-syncope. BP
70/40 mmHg, HR 38 bpm; EKG text: P waves present at 90/min
independent of QRS complexes at 38/min — complete (third-
degree) AV block. What is the immediate nursing action?
A. Give oral atropine 0.5 mg and observe
B. Prepare for transcutaneous pacing and call provider
C. Start a dopamine infusion at low dose to raise HR slowly
D. Administer IV metoprolol to control ventricular rate
Answer: B
Rationale:
• Why correct: In symptomatic complete heart block with
hypotension and bradycardia, immediate temporary pacing
(transcutaneous while arranging transvenous) is indicated to
restore adequate cardiac output.
• Why A is incorrect: Atropine may be ineffective in complete
heart block and oral route is inappropriate for urgent
management.
• Why C is incorrect: Dopamine may increase rate but pacing is
faster, more reliable, and preferred for unstable complete heart
, block.
• Why D is incorrect: Beta-blockers worsen bradycardia and are
contraindicated.
• Quick nursing action/priority: Apply pacing pads, prepare
defibrillator for transcutaneous pacing, secure IV access, and
notify provider.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. 58-year-old man found unresponsive. No pulse, CPR in
progress; EKG text: wide QRS complexes at ~180 bpm, pulseless
ventricular tachycardia. What should the nurse do immediately?
A. Deliver synchronized cardioversion at 100 J
B. Deliver immediate unsynchronized high-energy defibrillation
(shock)
C. Give IV amiodarone and continue CPR without shock
D. Start IV epinephrine and wait 2 minutes before defibrillation
Answer: B
Rationale:
• Why correct: Pulseless ventricular tachycardia is a shockable
rhythm that requires immediate unsynchronized defibrillation
plus CPR per ACLS algorithms.
• Why A is incorrect: Synchronized cardioversion is for unstable,
perfusing VT; in pulseless VT synchronization is not used.
• Why C is incorrect: Antiarrhythmics are adjuncts after
