Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old patient is admitted with dizziness. The
telemetry monitor shows a regular rhythm with a rate of 40
bpm. The nurse notes visible P waves before each QRS complex,
but the PR interval is consistently 0.24 seconds. Which rhythm
does this describe?
A. Sinus bradycardia
B. First-degree atrioventricular (AV) block
C. Third-degree AV block
D. Junctional rhythm
Answer: B
Rationale:
• The correct answer is B because a consistent PR interval
greater than 0.20 seconds (5 small boxes on EKG) with a 1:1
relationship between P waves and QRS complexes defines first-
degree AV block .
• Distractor A is incorrect because sinus bradycardia involves a
rate below 60 bpm but has a normal PR interval (0.12-0.20
seconds).
• Distractor C is incorrect because third-degree AV block shows
no relationship between P waves and QRS complexes (AV
dissociation).
• Distractor D is incorrect because a junctional rhythm typically
has no P waves or has inverted P waves that occur close to the
QRS complex.
,• The nurse's priority is to assess the patient for symptoms of
low cardiac output, such as hypotension or syncope.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Alterations in Body Systems
Q2. A nurse reviews an EKG strip for a patient with chest pain.
The rhythm is regular with a rate of 160 bpm. The QRS
complexes are wide (>0.12 seconds) and bizarre-looking, and no
P waves are visible. Which rhythm is this?
A. Atrial flutter
B. Sinus tachycardia
C. Ventricular tachycardia
D. Supraventricular tachycardia (SVT)
Answer: C
Rationale:
• The correct answer is C because a rapid, regular rhythm with
wide, abnormal QRS complexes and absent P waves is
characteristic of ventricular tachycardia .
• Distractor A is incorrect because atrial flutter typically shows a
sawtooth pattern of atrial flutter waves.
• Distractor B is incorrect because sinus tachycardia has a
normal P wave before each QRS complex and a normal QRS
duration.
• Distractor D is incorrect because SVT typically has a narrow
QRS complex (<0.12 seconds).
,• The nurse's immediate action is to assess the patient's
responsiveness and pulse, as this is a life-threatening rhythm.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q3. A patient's EKG shows an irregular rhythm with no
discernible P waves. The ventricular rate is approximately 110
bpm. Based on this description, which finding is the nurse most
likely to document?
A. Normal sinus rhythm
B. Atrial fibrillation
C. Second-degree AV block, Type I
D. Ventricular fibrillation
Answer: B
Rationale:
• The correct answer is B because the classic presentation of
atrial fibrillation is an irregularly irregular rhythm with absent P
waves .
• Distractor A is incorrect because normal sinus rhythm is
regular and has clearly visible P waves.
• Distractor C is incorrect because second-degree AV block,
Type I, has a characteristic pattern of progressive PR interval
prolongation until a QRS complex is dropped.
• Distractor D is incorrect because ventricular fibrillation is a
chaotic rhythm with no organized P waves or QRS complexes.
, • The nurse should prepare for administration of anticoagulant
therapy due to the high risk of thrombus formation associated
with this rhythm.
Difficulty: Easy
Bloom’s level: Recall
NCLEX client need & subcategory: Physiological Adaptation:
Diagnostic Tests
Q4. A 58-year-old male arrives at the ED reporting severe,
crushing substernal chest pain that radiates to his left arm. Vital
signs are BP 148/90 mmHg, HR 108 bpm, RR 24 bpm, SpO2 92%
on room air. An EKG shows ST-segment elevation in leads II, III,
and aVF. What is the nurse's priority action?
A. Administer sublingual nitroglycerin every 5 minutes as
needed for pain.
B. Prepare the patient for emergent cardiac catheterization.
C. Obtain a full set of cardiac enzymes.
D. Provide a high-flow oxygen mask at 10 L/min.
Answer: B
Rationale:
• The correct answer is B because the patient's symptoms and
EKG findings are consistent with an ST-elevation myocardial
infarction (STEMI). The priority goal is to restore coronary blood
flow as quickly as possible, and emergent percutaneous
coronary intervention (cardiac catheterization) is the standard
of care .
• Distractor A is incorrect because while nitroglycerin is
Undergraduate
Q1. A 68-year-old patient is admitted with dizziness. The
telemetry monitor shows a regular rhythm with a rate of 40
bpm. The nurse notes visible P waves before each QRS complex,
but the PR interval is consistently 0.24 seconds. Which rhythm
does this describe?
A. Sinus bradycardia
B. First-degree atrioventricular (AV) block
C. Third-degree AV block
D. Junctional rhythm
Answer: B
Rationale:
• The correct answer is B because a consistent PR interval
greater than 0.20 seconds (5 small boxes on EKG) with a 1:1
relationship between P waves and QRS complexes defines first-
degree AV block .
• Distractor A is incorrect because sinus bradycardia involves a
rate below 60 bpm but has a normal PR interval (0.12-0.20
seconds).
• Distractor C is incorrect because third-degree AV block shows
no relationship between P waves and QRS complexes (AV
dissociation).
• Distractor D is incorrect because a junctional rhythm typically
has no P waves or has inverted P waves that occur close to the
QRS complex.
,• The nurse's priority is to assess the patient for symptoms of
low cardiac output, such as hypotension or syncope.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Alterations in Body Systems
Q2. A nurse reviews an EKG strip for a patient with chest pain.
The rhythm is regular with a rate of 160 bpm. The QRS
complexes are wide (>0.12 seconds) and bizarre-looking, and no
P waves are visible. Which rhythm is this?
A. Atrial flutter
B. Sinus tachycardia
C. Ventricular tachycardia
D. Supraventricular tachycardia (SVT)
Answer: C
Rationale:
• The correct answer is C because a rapid, regular rhythm with
wide, abnormal QRS complexes and absent P waves is
characteristic of ventricular tachycardia .
• Distractor A is incorrect because atrial flutter typically shows a
sawtooth pattern of atrial flutter waves.
• Distractor B is incorrect because sinus tachycardia has a
normal P wave before each QRS complex and a normal QRS
duration.
• Distractor D is incorrect because SVT typically has a narrow
QRS complex (<0.12 seconds).
,• The nurse's immediate action is to assess the patient's
responsiveness and pulse, as this is a life-threatening rhythm.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q3. A patient's EKG shows an irregular rhythm with no
discernible P waves. The ventricular rate is approximately 110
bpm. Based on this description, which finding is the nurse most
likely to document?
A. Normal sinus rhythm
B. Atrial fibrillation
C. Second-degree AV block, Type I
D. Ventricular fibrillation
Answer: B
Rationale:
• The correct answer is B because the classic presentation of
atrial fibrillation is an irregularly irregular rhythm with absent P
waves .
• Distractor A is incorrect because normal sinus rhythm is
regular and has clearly visible P waves.
• Distractor C is incorrect because second-degree AV block,
Type I, has a characteristic pattern of progressive PR interval
prolongation until a QRS complex is dropped.
• Distractor D is incorrect because ventricular fibrillation is a
chaotic rhythm with no organized P waves or QRS complexes.
, • The nurse should prepare for administration of anticoagulant
therapy due to the high risk of thrombus formation associated
with this rhythm.
Difficulty: Easy
Bloom’s level: Recall
NCLEX client need & subcategory: Physiological Adaptation:
Diagnostic Tests
Q4. A 58-year-old male arrives at the ED reporting severe,
crushing substernal chest pain that radiates to his left arm. Vital
signs are BP 148/90 mmHg, HR 108 bpm, RR 24 bpm, SpO2 92%
on room air. An EKG shows ST-segment elevation in leads II, III,
and aVF. What is the nurse's priority action?
A. Administer sublingual nitroglycerin every 5 minutes as
needed for pain.
B. Prepare the patient for emergent cardiac catheterization.
C. Obtain a full set of cardiac enzymes.
D. Provide a high-flow oxygen mask at 10 L/min.
Answer: B
Rationale:
• The correct answer is B because the patient's symptoms and
EKG findings are consistent with an ST-elevation myocardial
infarction (STEMI). The priority goal is to restore coronary blood
flow as quickly as possible, and emergent percutaneous
coronary intervention (cardiac catheterization) is the standard
of care .
• Distractor A is incorrect because while nitroglycerin is
