Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old patient with a history of hypertension is
admitted with palpitations. Vital signs: BP 110/70 mmHg, HR
160 bpm, RR 18/min, SpO2 96% on room air. The monitor
shows a regular rhythm with a rate of 160 bpm, narrow QRS
complexes, and no visible P waves. What is the nurse's priority
action?
A. Administer intravenous metoprolol 5 mg slow push.
B. Prepare for synchronized cardioversion.
C. Assess for vagal maneuvers by having the patient bear down.
D. Obtain a 12-lead EKG and continuous monitoring.
Answer: C
Rationale:
• The EKG description indicates supraventricular tachycardia
(SVT), and current guidelines recommend vagal maneuvers as a
first-line non-pharmacological intervention for stable SVT to
attempt rhythm conversion.
• A is incorrect because intravenous beta-blockers are typically
considered after vagal maneuvers if the patient remains stable.
• B is incorrect because synchronized cardioversion is reserved
for unstable patients with signs of hemodynamic compromise,
which this patient does not have.
• D is incorrect while assessment is important, the priority for
stable SVT is to attempt vagal maneuvers first to restore sinus
,rhythm.
• Quick nursing action: Perform vagal maneuvers such as
bearing down or carotid sinus massage while monitoring the
rhythm.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 55-year-old male presents to the ED with crushing
substernal chest pain radiating to his left arm, lasting 30
minutes. Vital signs: BP 150/90 mmHg, HR 100 bpm, RR 22/min.
The 12-lead EKG shows ST-segment elevation of 3 mm in leads
II, III, and aVF. What is the nurse's immediate priority?
A. Administer sublingual nitroglycerin every 5 minutes as
needed for pain.
B. Obtain cardiac enzymes and prepare for thrombolytic
therapy.
C. Notify the catheterization lab team for emergency
percutaneous coronary intervention (PCI).
D. Provide morphine sulfate 4 mg IV for pain relief.
Answer: C
Rationale:
• For a STEMI patient, the goal is to achieve reperfusion as
quickly as possible, and primary PCI is the preferred method if
available within 90 minutes of first medical contact.
• A is incorrect because nitroglycerin is used for symptom relief
,but does not address the urgent need for reperfusion.
• B is incorrect while thrombolytics are an option if PCI is not
available, PCI is preferred and should be activated immediately.
• D is incorrect because pain management is important but
secondary to activating the reperfusion strategy.
• Quick nursing action: Activate the STEMI protocol by notifying
the catheterization lab while preparing the patient for transfer.
Difficulty: Hard
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 72-year-old female with heart failure reports increasing
shortness of breath and weight gain of 2 kg in 2 days.
Assessment reveals bibasilar crackles, jugular venous distension
to 8 cm, and 2+ pitting edema in lower extremities. Vital signs:
BP 170/90 mmHg, HR 110 bpm, RR 28/min. What is the nurse's
priority intervention?
A. Administer furosemide 40 mg IV push.
B. Place the patient in high-Fowler's position and apply oxygen
via nasal cannula.
C. Obtain a serum BNP level and chest X-ray.
D. Restrict fluid intake to 1000 mL per day.
Answer: B
Rationale:
• The patient shows signs of acute decompensated heart failure
with pulmonary congestion; the immediate priority is to
, improve oxygenation and reduce preload by positioning and
oxygen therapy.
• A is incorrect because diuretic administration is important but
should be done after addressing airway and breathing.
• C is incorrect while diagnostics are necessary, they do not take
precedence over stabilizing the patient's respiratory status.
• D is incorrect because fluid restriction is a long-term
management strategy, not an immediate action for acute
symptoms.
• Quick nursing action: Position the patient to ease breathing
and administer oxygen to maintain SpO2 above 90%.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 65-year-old patient in the ICU has a pulmonary artery
catheter in place. The nurse notes the following hemodynamic
parameters: CO 3.0 L/min, CI 1.8 L/min/m², PAWP 22 mmHg,
SVR 1800 dynes/sec/cm⁻⁵. What type of shock do these findings
suggest?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock
Answer: B
Undergraduate
Q1. A 68-year-old patient with a history of hypertension is
admitted with palpitations. Vital signs: BP 110/70 mmHg, HR
160 bpm, RR 18/min, SpO2 96% on room air. The monitor
shows a regular rhythm with a rate of 160 bpm, narrow QRS
complexes, and no visible P waves. What is the nurse's priority
action?
A. Administer intravenous metoprolol 5 mg slow push.
B. Prepare for synchronized cardioversion.
C. Assess for vagal maneuvers by having the patient bear down.
D. Obtain a 12-lead EKG and continuous monitoring.
Answer: C
Rationale:
• The EKG description indicates supraventricular tachycardia
(SVT), and current guidelines recommend vagal maneuvers as a
first-line non-pharmacological intervention for stable SVT to
attempt rhythm conversion.
• A is incorrect because intravenous beta-blockers are typically
considered after vagal maneuvers if the patient remains stable.
• B is incorrect because synchronized cardioversion is reserved
for unstable patients with signs of hemodynamic compromise,
which this patient does not have.
• D is incorrect while assessment is important, the priority for
stable SVT is to attempt vagal maneuvers first to restore sinus
,rhythm.
• Quick nursing action: Perform vagal maneuvers such as
bearing down or carotid sinus massage while monitoring the
rhythm.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 55-year-old male presents to the ED with crushing
substernal chest pain radiating to his left arm, lasting 30
minutes. Vital signs: BP 150/90 mmHg, HR 100 bpm, RR 22/min.
The 12-lead EKG shows ST-segment elevation of 3 mm in leads
II, III, and aVF. What is the nurse's immediate priority?
A. Administer sublingual nitroglycerin every 5 minutes as
needed for pain.
B. Obtain cardiac enzymes and prepare for thrombolytic
therapy.
C. Notify the catheterization lab team for emergency
percutaneous coronary intervention (PCI).
D. Provide morphine sulfate 4 mg IV for pain relief.
Answer: C
Rationale:
• For a STEMI patient, the goal is to achieve reperfusion as
quickly as possible, and primary PCI is the preferred method if
available within 90 minutes of first medical contact.
• A is incorrect because nitroglycerin is used for symptom relief
,but does not address the urgent need for reperfusion.
• B is incorrect while thrombolytics are an option if PCI is not
available, PCI is preferred and should be activated immediately.
• D is incorrect because pain management is important but
secondary to activating the reperfusion strategy.
• Quick nursing action: Activate the STEMI protocol by notifying
the catheterization lab while preparing the patient for transfer.
Difficulty: Hard
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 72-year-old female with heart failure reports increasing
shortness of breath and weight gain of 2 kg in 2 days.
Assessment reveals bibasilar crackles, jugular venous distension
to 8 cm, and 2+ pitting edema in lower extremities. Vital signs:
BP 170/90 mmHg, HR 110 bpm, RR 28/min. What is the nurse's
priority intervention?
A. Administer furosemide 40 mg IV push.
B. Place the patient in high-Fowler's position and apply oxygen
via nasal cannula.
C. Obtain a serum BNP level and chest X-ray.
D. Restrict fluid intake to 1000 mL per day.
Answer: B
Rationale:
• The patient shows signs of acute decompensated heart failure
with pulmonary congestion; the immediate priority is to
, improve oxygenation and reduce preload by positioning and
oxygen therapy.
• A is incorrect because diuretic administration is important but
should be done after addressing airway and breathing.
• C is incorrect while diagnostics are necessary, they do not take
precedence over stabilizing the patient's respiratory status.
• D is incorrect because fluid restriction is a long-term
management strategy, not an immediate action for acute
symptoms.
• Quick nursing action: Position the patient to ease breathing
and administer oxygen to maintain SpO2 above 90%.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 65-year-old patient in the ICU has a pulmonary artery
catheter in place. The nurse notes the following hemodynamic
parameters: CO 3.0 L/min, CI 1.8 L/min/m², PAWP 22 mmHg,
SVR 1800 dynes/sec/cm⁻⁵. What type of shock do these findings
suggest?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock
Answer: B
