Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old patient is on a continuous cardiac monitor.
The rhythm strip shows a ventricular rate of 38 bpm, a regular
rhythm, and a constant PR interval of 0.24 seconds. Which
assessment finding is the nurse's priority?
A. Oxygen saturation of 96% on room air
B. Report of dizziness upon standing
C. Urine output of 40 mL over the past hour
D. Potassium level of 4.0 mEq/L
Answer: B
Rationale:
• Correct Answer: Symptomatic bradycardia requires immediate
intervention to prevent further deterioration like syncope or
cardiac arrest. Dizziness upon standing indicates cerebral
hypoperfusion, which is the priority concern .
• Distractor A: While important, adequate oxygen saturation
does not negate the risk from low cardiac output.
• Distractor C: Adequate urine output suggests sufficient renal
perfusion at this moment but is not the most immediate life-
threatening concern.
• Distractor D: This is a normal potassium level and is not
related to the current rhythm issue.
• Nursing Action: Assess the patient's level of consciousness
,and blood pressure, and prepare for potential administration of
atropine as ordered .
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q2. A healthcare provider asks a nurse to interpret the
following rhythm from a telemetry strip: atrial rate ~300 bpm
(flutter waves), ventricular rate ~75 bpm, regular rhythm. How
should the nurse document this rhythm?
A. Atrial fibrillation
B. Sinus tachycardia
C. Atrial flutter
D. Ventricular tachycardia
Answer: C
Rationale:
• Correct Answer: The presence of flutter waves (sawtooth
pattern) with a regular ventricular response is classic for atrial
flutter .
• Distractor A: Atrial fibrillation has an irregularly irregular
rhythm with no discernible P waves.
• Distractor B: Sinus tachycardia has a 1:1 ratio of P waves to
QRS complexes.
• Distractor D: Ventricular tachycardia originates in the
ventricles, producing wide, bizarre QRS complexes.
,• Nursing Action: Monitor for a sudden increase in ventricular
rate and assess for signs of decreased cardiac output .
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Alterations in Body Systems
Q3. A patient's ECG shows a rhythm with no P waves, an
irregularly irregular rhythm, and a ventricular rate of 118 bpm.
Which medication should the nurse anticipate administering to
control the heart rate?
A. Atropine
B. Digoxin
C. Metoprolol
D. Adenosine
Answer: C
Rationale:
• Correct Answer: The rhythm is atrial fibrillation. Beta-blockers
like metoprolol are first-line agents for rate control in AFib .
• Distractor A: Atropine is used for symptomatic bradycardia,
not tachycardia.
• Distractor B: Digoxin may be used for rate control but is not
typically a first-line agent, especially in acute settings.
• Distractor D: Adenosine is used to terminate supraventricular
tachycardia (SVT), not to control rate in atrial fibrillation.
• Nursing Action: Administer the medication as ordered and
, monitor the patient's blood pressure and heart rate for
response .
Difficulty: Application
Bloom’s level: Application
NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies: Cardiovascular Medications
Q4. A nurse is caring for a patient who suddenly becomes
pulseless and unresponsive. The cardiac monitor shows a
chaotic, disorganized rhythm with no discernible P waves or
QRS complexes. What is the nurse's immediate action?
A. Initiate CPR and prepare for defibrillation.
B. Administer Amiodarone IV push.
C. Obtain a 12-lead ECG.
D. Provide a precordial thump.
Answer: A
Rationale:
• Correct Answer: The rhythm described is ventricular
fibrillation, a lethal arrhythmia. The immediate treatment is
high-quality CPR and defibrillation as soon as possible .
• Distractor B: Medications like Amiodarone are administered
after initial defibrillation attempts and CPR.
• Distractor C: Obtaining a 12-lead ECG delays lifesaving
treatment.
• Distractor D: A precordial thump is not a standard first-line
treatment for VF.
• Nursing Action: Call a code blue, start chest compressions,
Undergraduate
Q1. A 68-year-old patient is on a continuous cardiac monitor.
The rhythm strip shows a ventricular rate of 38 bpm, a regular
rhythm, and a constant PR interval of 0.24 seconds. Which
assessment finding is the nurse's priority?
A. Oxygen saturation of 96% on room air
B. Report of dizziness upon standing
C. Urine output of 40 mL over the past hour
D. Potassium level of 4.0 mEq/L
Answer: B
Rationale:
• Correct Answer: Symptomatic bradycardia requires immediate
intervention to prevent further deterioration like syncope or
cardiac arrest. Dizziness upon standing indicates cerebral
hypoperfusion, which is the priority concern .
• Distractor A: While important, adequate oxygen saturation
does not negate the risk from low cardiac output.
• Distractor C: Adequate urine output suggests sufficient renal
perfusion at this moment but is not the most immediate life-
threatening concern.
• Distractor D: This is a normal potassium level and is not
related to the current rhythm issue.
• Nursing Action: Assess the patient's level of consciousness
,and blood pressure, and prepare for potential administration of
atropine as ordered .
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q2. A healthcare provider asks a nurse to interpret the
following rhythm from a telemetry strip: atrial rate ~300 bpm
(flutter waves), ventricular rate ~75 bpm, regular rhythm. How
should the nurse document this rhythm?
A. Atrial fibrillation
B. Sinus tachycardia
C. Atrial flutter
D. Ventricular tachycardia
Answer: C
Rationale:
• Correct Answer: The presence of flutter waves (sawtooth
pattern) with a regular ventricular response is classic for atrial
flutter .
• Distractor A: Atrial fibrillation has an irregularly irregular
rhythm with no discernible P waves.
• Distractor B: Sinus tachycardia has a 1:1 ratio of P waves to
QRS complexes.
• Distractor D: Ventricular tachycardia originates in the
ventricles, producing wide, bizarre QRS complexes.
,• Nursing Action: Monitor for a sudden increase in ventricular
rate and assess for signs of decreased cardiac output .
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Alterations in Body Systems
Q3. A patient's ECG shows a rhythm with no P waves, an
irregularly irregular rhythm, and a ventricular rate of 118 bpm.
Which medication should the nurse anticipate administering to
control the heart rate?
A. Atropine
B. Digoxin
C. Metoprolol
D. Adenosine
Answer: C
Rationale:
• Correct Answer: The rhythm is atrial fibrillation. Beta-blockers
like metoprolol are first-line agents for rate control in AFib .
• Distractor A: Atropine is used for symptomatic bradycardia,
not tachycardia.
• Distractor B: Digoxin may be used for rate control but is not
typically a first-line agent, especially in acute settings.
• Distractor D: Adenosine is used to terminate supraventricular
tachycardia (SVT), not to control rate in atrial fibrillation.
• Nursing Action: Administer the medication as ordered and
, monitor the patient's blood pressure and heart rate for
response .
Difficulty: Application
Bloom’s level: Application
NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies: Cardiovascular Medications
Q4. A nurse is caring for a patient who suddenly becomes
pulseless and unresponsive. The cardiac monitor shows a
chaotic, disorganized rhythm with no discernible P waves or
QRS complexes. What is the nurse's immediate action?
A. Initiate CPR and prepare for defibrillation.
B. Administer Amiodarone IV push.
C. Obtain a 12-lead ECG.
D. Provide a precordial thump.
Answer: A
Rationale:
• Correct Answer: The rhythm described is ventricular
fibrillation, a lethal arrhythmia. The immediate treatment is
high-quality CPR and defibrillation as soon as possible .
• Distractor B: Medications like Amiodarone are administered
after initial defibrillation attempts and CPR.
• Distractor C: Obtaining a 12-lead ECG delays lifesaving
treatment.
• Distractor D: A precordial thump is not a standard first-line
treatment for VF.
• Nursing Action: Call a code blue, start chest compressions,
