Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old patient is admitted with chest pain. The
monitor shows a rhythm with a ventricular rate of 140 bpm,
regular narrow QRS complexes, and no discernible P waves. The
patient is alert but anxious. Which action should the nurse take
first?
A. Administer intravenous amiodarone as ordered.
B. Prepare for synchronized cardioversion.
C. Instruct the patient to perform a vagal maneuver.
D. Assess for possible triggers like caffeine or hypoxia.
Answer: D
Rationale:
• Correct: The rhythm description (regular narrow QRS, no P
waves) indicates supraventricular tachycardia (SVT). The initial
nursing priority for a stable patient is to assess for underlying
causes before initiating specific treatments.
Incorrect: A. Administering amiodarone is an advanced
intervention typically considered after initial measures. B.
Synchronized cardioversion is reserved for unstable patients
with signs of poor perfusion. C. Vagal maneuvers are a first-line
treatment, but assessment for potential triggers should precede
or accompany the attempt.
• Nursing action: Continuously monitor vital signs and oxygen
saturation while identifying and addressing reversible causes.
Difficulty: Moderate
Bloom’s level: Analysis
,NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q2. A nurse is reviewing a telemetry strip. The rhythm is
irregular, with a fluctuating atrial rate between 350-600 bpm
(fibrillation waves) and a ventricular rate of approximately 110
bpm. The QRS complexes are narrow. How should the nurse
document this rhythm?
A. Sinus tachycardia with premature atrial contractions.
B. Atrial flutter with variable ventricular response.
C. Ventricular tachycardia.
D. Atrial fibrillation with rapid ventricular response.
Answer: D
Rationale:
• Correct: The description of an irregular rhythm with no
discernible P waves (replaced by fibrillation waves) and an
uncontrolled ventricular rate over 100 bpm is classic for atrial
fibrillation with rapid ventricular response.
Incorrect: A. Sinus tachycardia has a regular rhythm with
upright P waves before each QRS. B. Atrial flutter typically
shows a regular atrial rhythm with sawtooth flutter waves. C.
Ventricular tachycardia has wide, bizarre QRS complexes.
• Nursing action: Monitor the patient for symptoms related to
poor cardiac output and prepare for anticoagulation and rate
control strategies as ordered.
Difficulty: Moderate
Bloom’s level: Application
,NCLEX client need & subcategory: Physiological Adaptation:
Dysrhythmia Management
Q3. A patient's ECG shows a pattern where the PR interval
progressively lengthens until a QRS complex is dropped. This
cycle then repeats. What is the nurse's primary concern?
A. The rhythm will rapidly degenerate into asystole.
B. The patient is at high risk for systemic embolization.
C. This second-degree AV block (Type I) can cause symptomatic
bradycardia.
D. The patient requires immediate transcutaneous pacing.
Answer: C
Rationale:
• Correct: The described pattern is characteristic of Second-
Degree AV Block, Type I (Wenckebach). The nurse should be
concerned about the potential for symptomatic bradycardia,
such as hypotension or dizziness.
Incorrect: A. This rhythm is often transient and does not usually
progress abruptly to asystole. B. This rhythm is not typically
associated with embolic risk like atrial fibrillation is. D.
Immediate pacing is not usually required for this type of block
unless the patient becomes symptomatic.
• Nursing action: Assess the patient for symptoms of
bradycardia (e.g., dizziness, hypotension) and notify the
provider of the rhythm finding.
Difficulty: Hard
Bloom’s level: Analysis
, NCLEX client need & subcategory: Physiological Adaptation:
Reduction of Risk Potential
Q4. A 55-year-old male presents to the ED with severe, crushing
substernal chest pain radiating to his left jaw. A 12-lead ECG
shows ST-segment elevation of 3mm in leads II, III, and aVF.
What is the nurse's priority action after initiating oxygen and IV
access?
A. Administer sublingual nitroglycerin.
B. Give 324 mg of chewable aspirin.
C. Administer intravenous morphine sulfate.
D. Draw cardiac enzyme labs.
Answer: B
Rationale:
• Correct: For a patient with an ST-elevation myocardial
infarction (STEMI), early administration of aspirin to inhibit
platelet aggregation is a critical, life-saving intervention that
should be prioritized.
Incorrect: A. Nitroglycerin is important for pain relief and
reducing preload but follows aspirin in priority for STEMI
management. C. Morphine can be used for pain unrelieved by
nitroglycerin but is secondary to antiplatelet therapy. D. While
drawing labs is necessary, it should not delay the administration
of aspirin.
• Nursing action: Ensure the patient chews and swallows the
aspirin promptly to achieve rapid therapeutic effect.
Difficulty: Moderate
Bloom’s level: Application
Undergraduate
Q1. A 68-year-old patient is admitted with chest pain. The
monitor shows a rhythm with a ventricular rate of 140 bpm,
regular narrow QRS complexes, and no discernible P waves. The
patient is alert but anxious. Which action should the nurse take
first?
A. Administer intravenous amiodarone as ordered.
B. Prepare for synchronized cardioversion.
C. Instruct the patient to perform a vagal maneuver.
D. Assess for possible triggers like caffeine or hypoxia.
Answer: D
Rationale:
• Correct: The rhythm description (regular narrow QRS, no P
waves) indicates supraventricular tachycardia (SVT). The initial
nursing priority for a stable patient is to assess for underlying
causes before initiating specific treatments.
Incorrect: A. Administering amiodarone is an advanced
intervention typically considered after initial measures. B.
Synchronized cardioversion is reserved for unstable patients
with signs of poor perfusion. C. Vagal maneuvers are a first-line
treatment, but assessment for potential triggers should precede
or accompany the attempt.
• Nursing action: Continuously monitor vital signs and oxygen
saturation while identifying and addressing reversible causes.
Difficulty: Moderate
Bloom’s level: Analysis
,NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q2. A nurse is reviewing a telemetry strip. The rhythm is
irregular, with a fluctuating atrial rate between 350-600 bpm
(fibrillation waves) and a ventricular rate of approximately 110
bpm. The QRS complexes are narrow. How should the nurse
document this rhythm?
A. Sinus tachycardia with premature atrial contractions.
B. Atrial flutter with variable ventricular response.
C. Ventricular tachycardia.
D. Atrial fibrillation with rapid ventricular response.
Answer: D
Rationale:
• Correct: The description of an irregular rhythm with no
discernible P waves (replaced by fibrillation waves) and an
uncontrolled ventricular rate over 100 bpm is classic for atrial
fibrillation with rapid ventricular response.
Incorrect: A. Sinus tachycardia has a regular rhythm with
upright P waves before each QRS. B. Atrial flutter typically
shows a regular atrial rhythm with sawtooth flutter waves. C.
Ventricular tachycardia has wide, bizarre QRS complexes.
• Nursing action: Monitor the patient for symptoms related to
poor cardiac output and prepare for anticoagulation and rate
control strategies as ordered.
Difficulty: Moderate
Bloom’s level: Application
,NCLEX client need & subcategory: Physiological Adaptation:
Dysrhythmia Management
Q3. A patient's ECG shows a pattern where the PR interval
progressively lengthens until a QRS complex is dropped. This
cycle then repeats. What is the nurse's primary concern?
A. The rhythm will rapidly degenerate into asystole.
B. The patient is at high risk for systemic embolization.
C. This second-degree AV block (Type I) can cause symptomatic
bradycardia.
D. The patient requires immediate transcutaneous pacing.
Answer: C
Rationale:
• Correct: The described pattern is characteristic of Second-
Degree AV Block, Type I (Wenckebach). The nurse should be
concerned about the potential for symptomatic bradycardia,
such as hypotension or dizziness.
Incorrect: A. This rhythm is often transient and does not usually
progress abruptly to asystole. B. This rhythm is not typically
associated with embolic risk like atrial fibrillation is. D.
Immediate pacing is not usually required for this type of block
unless the patient becomes symptomatic.
• Nursing action: Assess the patient for symptoms of
bradycardia (e.g., dizziness, hypotension) and notify the
provider of the rhythm finding.
Difficulty: Hard
Bloom’s level: Analysis
, NCLEX client need & subcategory: Physiological Adaptation:
Reduction of Risk Potential
Q4. A 55-year-old male presents to the ED with severe, crushing
substernal chest pain radiating to his left jaw. A 12-lead ECG
shows ST-segment elevation of 3mm in leads II, III, and aVF.
What is the nurse's priority action after initiating oxygen and IV
access?
A. Administer sublingual nitroglycerin.
B. Give 324 mg of chewable aspirin.
C. Administer intravenous morphine sulfate.
D. Draw cardiac enzyme labs.
Answer: B
Rationale:
• Correct: For a patient with an ST-elevation myocardial
infarction (STEMI), early administration of aspirin to inhibit
platelet aggregation is a critical, life-saving intervention that
should be prioritized.
Incorrect: A. Nitroglycerin is important for pain relief and
reducing preload but follows aspirin in priority for STEMI
management. C. Morphine can be used for pain unrelieved by
nitroglycerin but is secondary to antiplatelet therapy. D. While
drawing labs is necessary, it should not delay the administration
of aspirin.
• Nursing action: Ensure the patient chews and swallows the
aspirin promptly to achieve rapid therapeutic effect.
Difficulty: Moderate
Bloom’s level: Application
