Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 62-year-old patient reports sudden-onset palpitations and
lightheadedness. Vital signs: BP 110/70 mmHg, HR 180 bpm, RR
18, SpO2 98%. EKG description: Regular narrow-complex
tachycardia, rate ~180 bpm, P waves absent. What is the most
appropriate immediate nursing action?
A. Prepare for immediate synchronized cardioversion.
B. Attempt vagal maneuvers (bearing-down/Valsalva) and
obtain IV access.
C. Administer oral beta-blocker now.
D. Give IV amiodarone bolus.
Answer: B
Rationale:
• Why correct: The described rhythm is most consistent with
supraventricular tachycardia (SVT — regular narrow QRS, absent
visible P waves, rate ~180). In a hemodynamically stable patient
(BP 110/70, alert), initial therapy is vagal maneuvers and
establishing IV access before drug therapy or cardioversion.
• Why A is incorrect: Synchronized cardioversion is indicated for
unstable patients (hypotension, shock, ischemia, altered mental
status) — not first for a stable patient.
• Why C is incorrect: Oral beta-blocker onset is too slow for
acute rate control and is not first-line immediate action.
• Why D is incorrect: IV amiodarone is not first-line for typical
SVT and is reserved if vagal maneuvers/adenosine fail or for
,ventricular arrhythmias.
• Nursing action/priority: Perform/coach a Valsalva maneuver,
monitor rhythm, and establish IV access ready for adenosine.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 78-year-old with chronic atrial fibrillation presents with
HR 140 bpm, BP 92/58 mmHg, diaphoresis, and dyspnea. EKG:
Irregularly irregular rhythm, narrow QRS, no discrete P waves —
AF with RVR. What is the nurse’s priority?
A. Administer IV diltiazem bolus per protocol.
B. Prepare for immediate synchronized cardioversion.
C. Give oral digoxin now.
D. Start a heparin infusion.
Answer: B
Rationale:
• Why correct: The patient is hemodynamically unstable (BP
92/58, signs of poor perfusion—diaphoresis, dyspnea). For
unstable AF with RVR, synchronized cardioversion is priority to
restore perfusion.
• Why A is incorrect: IV rate-control agents (diltiazem) are
appropriate for stable patients; in instability, delay drug therapy
until after stabilization or synchronized cardioversion.
• Why C is incorrect: Oral digoxin is slow in onset and
inadequate for emergent rate control.
,• Why D is incorrect: Anticoagulation is important in AF but is
not the immediate priority in hemodynamic instability.
• Nursing action/priority: Notify the team, prepare defibrillator
for synchronized cardioversion, and ensure sedation/airway
readiness.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. Patient in telemetry: EKG text — "Wide QRS tachycardia at
160 bpm, regular, no palpable radial pulse." Nurse finds patient
unresponsive and pulseless. What is the correct immediate
nursing action?
A. Begin high-quality CPR and call for the code
team/defibrillator.
B. Administer IV amiodarone while continuing to monitor.
C. Deliver synchronized cardioversion at 200 J.
D. Attempt carotid sinus massage.
Answer: A
Rationale:
• Why correct: The patient is pulseless — immediate high-
quality CPR and activating the code team/defibrillator (treat as
pulseless VT/VF) is highest priority per ACLS.
• Why B is incorrect: Medications are adjuncts after initiating
CPR/defibrillation; delaying CPR to prepare drugs is
inappropriate.
, • Why C is incorrect: Synchronized cardioversion is for unstable
but perfusing rhythms; for pulseless VT an immediate
unsynchronized high-energy shock (defibrillation) is indicated
after CPR.
• Why D is incorrect: Carotid sinus massage is contraindicated in
wide-complex tachycardia and in unstable/pulseless patients.
• Nursing action/priority: Start chest compressions
immediately, attach defibrillator pads, and call for the code
team.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 55-year-old on telemetry has EKG: "Prolonged PR interval
of 0.28 seconds, QRS normal, regular rhythm." Patient is
asymptomatic. Which nursing action is most appropriate?
A. Prepare for immediate pacemaker insertion.
B. Continue routine monitoring and document first-degree AV
block.
C. Administer IV atropine now.
D. Hold all cardiac medications and notify physician
immediately.
Answer: B
Rationale:
• Why correct: First-degree AV block (PR >0.20 s; here 0.28 s) is
typically benign and asymptomatic; continuing monitoring and
Undergraduate
Q1. A 62-year-old patient reports sudden-onset palpitations and
lightheadedness. Vital signs: BP 110/70 mmHg, HR 180 bpm, RR
18, SpO2 98%. EKG description: Regular narrow-complex
tachycardia, rate ~180 bpm, P waves absent. What is the most
appropriate immediate nursing action?
A. Prepare for immediate synchronized cardioversion.
B. Attempt vagal maneuvers (bearing-down/Valsalva) and
obtain IV access.
C. Administer oral beta-blocker now.
D. Give IV amiodarone bolus.
Answer: B
Rationale:
• Why correct: The described rhythm is most consistent with
supraventricular tachycardia (SVT — regular narrow QRS, absent
visible P waves, rate ~180). In a hemodynamically stable patient
(BP 110/70, alert), initial therapy is vagal maneuvers and
establishing IV access before drug therapy or cardioversion.
• Why A is incorrect: Synchronized cardioversion is indicated for
unstable patients (hypotension, shock, ischemia, altered mental
status) — not first for a stable patient.
• Why C is incorrect: Oral beta-blocker onset is too slow for
acute rate control and is not first-line immediate action.
• Why D is incorrect: IV amiodarone is not first-line for typical
SVT and is reserved if vagal maneuvers/adenosine fail or for
,ventricular arrhythmias.
• Nursing action/priority: Perform/coach a Valsalva maneuver,
monitor rhythm, and establish IV access ready for adenosine.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 78-year-old with chronic atrial fibrillation presents with
HR 140 bpm, BP 92/58 mmHg, diaphoresis, and dyspnea. EKG:
Irregularly irregular rhythm, narrow QRS, no discrete P waves —
AF with RVR. What is the nurse’s priority?
A. Administer IV diltiazem bolus per protocol.
B. Prepare for immediate synchronized cardioversion.
C. Give oral digoxin now.
D. Start a heparin infusion.
Answer: B
Rationale:
• Why correct: The patient is hemodynamically unstable (BP
92/58, signs of poor perfusion—diaphoresis, dyspnea). For
unstable AF with RVR, synchronized cardioversion is priority to
restore perfusion.
• Why A is incorrect: IV rate-control agents (diltiazem) are
appropriate for stable patients; in instability, delay drug therapy
until after stabilization or synchronized cardioversion.
• Why C is incorrect: Oral digoxin is slow in onset and
inadequate for emergent rate control.
,• Why D is incorrect: Anticoagulation is important in AF but is
not the immediate priority in hemodynamic instability.
• Nursing action/priority: Notify the team, prepare defibrillator
for synchronized cardioversion, and ensure sedation/airway
readiness.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. Patient in telemetry: EKG text — "Wide QRS tachycardia at
160 bpm, regular, no palpable radial pulse." Nurse finds patient
unresponsive and pulseless. What is the correct immediate
nursing action?
A. Begin high-quality CPR and call for the code
team/defibrillator.
B. Administer IV amiodarone while continuing to monitor.
C. Deliver synchronized cardioversion at 200 J.
D. Attempt carotid sinus massage.
Answer: A
Rationale:
• Why correct: The patient is pulseless — immediate high-
quality CPR and activating the code team/defibrillator (treat as
pulseless VT/VF) is highest priority per ACLS.
• Why B is incorrect: Medications are adjuncts after initiating
CPR/defibrillation; delaying CPR to prepare drugs is
inappropriate.
, • Why C is incorrect: Synchronized cardioversion is for unstable
but perfusing rhythms; for pulseless VT an immediate
unsynchronized high-energy shock (defibrillation) is indicated
after CPR.
• Why D is incorrect: Carotid sinus massage is contraindicated in
wide-complex tachycardia and in unstable/pulseless patients.
• Nursing action/priority: Start chest compressions
immediately, attach defibrillator pads, and call for the code
team.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 55-year-old on telemetry has EKG: "Prolonged PR interval
of 0.28 seconds, QRS normal, regular rhythm." Patient is
asymptomatic. Which nursing action is most appropriate?
A. Prepare for immediate pacemaker insertion.
B. Continue routine monitoring and document first-degree AV
block.
C. Administer IV atropine now.
D. Hold all cardiac medications and notify physician
immediately.
Answer: B
Rationale:
• Why correct: First-degree AV block (PR >0.20 s; here 0.28 s) is
typically benign and asymptomatic; continuing monitoring and
