Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 72-year-old reports sudden palpitations and mild
syncope. EKG description: "Rate ~180 bpm, regular, narrow
QRS, P waves not discernible." BP 118/76 mm Hg, O2 97% RA.
What is the nurse’s best initial action?
A. Prepare for immediate synchronized cardioversion.
B. Attempt vagal maneuvers and obtain IV access.
C. Administer oral metoprolol now.
D. Give IV amiodarone bolus.
Answer: B
Rationale:
• Why correct: The EKG description is consistent with
supraventricular tachycardia (SVT) with a stable blood pressure;
initial management is noninvasive vagal maneuvers while
establishing IV access because they can terminate SVT without
drugs.
• Why A is incorrect: Synchronized cardioversion is indicated for
unstable patients (hypotension, ischemia, altered mental
status) and is premature here.
• Why C is incorrect: Oral metoprolol has a delayed onset and is
not the immediate first-line action in acute SVT.
• Why D is incorrect: IV amiodarone is not first-line for narrow-
complex SVT and is reserved for refractory cases; adenosine is
preferred pharmacologic choice after vagal maneuvers.
,• Quick nursing action/priority: Perform a Valsalva maneuver
(or carotid sinus massage if appropriate) while obtaining IV
access and notifying the provider.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular — Dysrhythmia management
Q2. A 60-year-old on telemetry has EKG: "Irregularly irregular
rhythm, no clear P waves, ventricular rate 140 bpm." The
patient is dizzy and short of breath. What is the nurse’s priority?
A. Administer IV diltiazem for rate control.
B. Prepare for synchronized cardioversion if hemodynamics
worsen.
C. Start oral aspirin and schedule a 24-hour Holter.
D. Encourage deep breathing and reassess in 1 hour.
Answer: B
Rationale:
• Why correct: The description indicates atrial fibrillation with
rapid ventricular response and symptomatic instability;
preparing for synchronized cardioversion is prudent if
hemodynamics do not improve or if instability occurs.
• Why A is incorrect: IV diltiazem may be used for rate control
but must be used cautiously if the patient is borderline
unstable; immediate preparation for cardioversion is higher
priority.
• Why C is incorrect: Aspirin and ambulatory monitoring are
,inappropriate acute responses for symptomatic rapid AF.
• Why D is incorrect: Simple breathing techniques are
inadequate for symptomatic rapid AF with hemodynamic
compromise.
• Quick nursing action/priority: Place patient on continuous
monitor, establish IV access, and prepare for possible emergent
cardioversion while notifying provider.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular — Dysrhythmia interpretation & management
Q3. A 55-year-old experiences palpitations after starting a new
medication. EKG reads "Wide QRS tachycardia at 170 bpm,
regular, monomorphic." The patient is pale and BP 86/52 mm
Hg. What is the nurse’s immediate action?
A. Give IV procainamide.
B. Prepare for immediate synchronized cardioversion.
C. Administer oral amlodipine.
D. Increase the patient's IV fluids and observe.
Answer: B
Rationale:
• Why correct: Wide-complex tachycardia at 170 bpm with
hypotension suggests unstable ventricular tachycardia;
immediate synchronized cardioversion is required to restore
perfusion.
• Why A is incorrect: Procainamide may be considered for
, stable VT but is too slow for an unstable patient who needs
immediate cardioversion.
• Why C is incorrect: Amlodipine is an oral antihypertensive that
is irrelevant and potentially harmful in unstable
tachyarrhythmia.
• Why D is incorrect: IV fluids do not address the primary issue
of an unstable ventricular arrhythmia and delay definitive
treatment.
• Quick nursing action/priority: Call for the crash cart, ensure
pads are in place, and deliver synchronized cardioversion per
ACLS.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular — Dysrhythmia emergency management
Q4. A patient’s telemetry shows "Progressive PR prolongation
with a dropped QRS every fourth beat; ventricular rate 52
bpm." The patient is asymptomatic. What rhythm is present?
A. Second-degree AV block, Mobitz type I (Wenckebach).
B. Second-degree AV block, Mobitz type II.
C. Third-degree (complete) AV block.
D. Sinus bradycardia with sinus pauses.
Answer: A
Rationale:
• Why correct: Progressive PR interval prolongation followed by
a dropped QRS is classic for Mobitz type I (Wenckebach)
Undergraduate
Q1. A 72-year-old reports sudden palpitations and mild
syncope. EKG description: "Rate ~180 bpm, regular, narrow
QRS, P waves not discernible." BP 118/76 mm Hg, O2 97% RA.
What is the nurse’s best initial action?
A. Prepare for immediate synchronized cardioversion.
B. Attempt vagal maneuvers and obtain IV access.
C. Administer oral metoprolol now.
D. Give IV amiodarone bolus.
Answer: B
Rationale:
• Why correct: The EKG description is consistent with
supraventricular tachycardia (SVT) with a stable blood pressure;
initial management is noninvasive vagal maneuvers while
establishing IV access because they can terminate SVT without
drugs.
• Why A is incorrect: Synchronized cardioversion is indicated for
unstable patients (hypotension, ischemia, altered mental
status) and is premature here.
• Why C is incorrect: Oral metoprolol has a delayed onset and is
not the immediate first-line action in acute SVT.
• Why D is incorrect: IV amiodarone is not first-line for narrow-
complex SVT and is reserved for refractory cases; adenosine is
preferred pharmacologic choice after vagal maneuvers.
,• Quick nursing action/priority: Perform a Valsalva maneuver
(or carotid sinus massage if appropriate) while obtaining IV
access and notifying the provider.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular — Dysrhythmia management
Q2. A 60-year-old on telemetry has EKG: "Irregularly irregular
rhythm, no clear P waves, ventricular rate 140 bpm." The
patient is dizzy and short of breath. What is the nurse’s priority?
A. Administer IV diltiazem for rate control.
B. Prepare for synchronized cardioversion if hemodynamics
worsen.
C. Start oral aspirin and schedule a 24-hour Holter.
D. Encourage deep breathing and reassess in 1 hour.
Answer: B
Rationale:
• Why correct: The description indicates atrial fibrillation with
rapid ventricular response and symptomatic instability;
preparing for synchronized cardioversion is prudent if
hemodynamics do not improve or if instability occurs.
• Why A is incorrect: IV diltiazem may be used for rate control
but must be used cautiously if the patient is borderline
unstable; immediate preparation for cardioversion is higher
priority.
• Why C is incorrect: Aspirin and ambulatory monitoring are
,inappropriate acute responses for symptomatic rapid AF.
• Why D is incorrect: Simple breathing techniques are
inadequate for symptomatic rapid AF with hemodynamic
compromise.
• Quick nursing action/priority: Place patient on continuous
monitor, establish IV access, and prepare for possible emergent
cardioversion while notifying provider.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular — Dysrhythmia interpretation & management
Q3. A 55-year-old experiences palpitations after starting a new
medication. EKG reads "Wide QRS tachycardia at 170 bpm,
regular, monomorphic." The patient is pale and BP 86/52 mm
Hg. What is the nurse’s immediate action?
A. Give IV procainamide.
B. Prepare for immediate synchronized cardioversion.
C. Administer oral amlodipine.
D. Increase the patient's IV fluids and observe.
Answer: B
Rationale:
• Why correct: Wide-complex tachycardia at 170 bpm with
hypotension suggests unstable ventricular tachycardia;
immediate synchronized cardioversion is required to restore
perfusion.
• Why A is incorrect: Procainamide may be considered for
, stable VT but is too slow for an unstable patient who needs
immediate cardioversion.
• Why C is incorrect: Amlodipine is an oral antihypertensive that
is irrelevant and potentially harmful in unstable
tachyarrhythmia.
• Why D is incorrect: IV fluids do not address the primary issue
of an unstable ventricular arrhythmia and delay definitive
treatment.
• Quick nursing action/priority: Call for the crash cart, ensure
pads are in place, and deliver synchronized cardioversion per
ACLS.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular — Dysrhythmia emergency management
Q4. A patient’s telemetry shows "Progressive PR prolongation
with a dropped QRS every fourth beat; ventricular rate 52
bpm." The patient is asymptomatic. What rhythm is present?
A. Second-degree AV block, Mobitz type I (Wenckebach).
B. Second-degree AV block, Mobitz type II.
C. Third-degree (complete) AV block.
D. Sinus bradycardia with sinus pauses.
Answer: A
Rationale:
• Why correct: Progressive PR interval prolongation followed by
a dropped QRS is classic for Mobitz type I (Wenckebach)
