CARDIAC QUESTIONS - UNIT 2&3
A client presents with sinus bradycardia and a blood pressure of 78/45 mmHg.
Which intervention should the nurse anticipate?
A. Administer metoprolol
B. Initiate vagal maneuvers
C. Prepare for transcutaneous pacing
D. Administer digoxin
Correct Answer: C. Prepare for transcutaneous pacing
Rationale: Symptomatic bradycardia with hypotension requires immediate intervention
to maintain cardiac output. Transcutaneous pacing is a rapid, non-invasive measure.
NCLEX Must-Know:
● Bradycardia is <60 bpm.
● If symptomatic: treat with atropine, pacing, or dopamine/epinephrine infusion.
● NEVER use vagal maneuvers or beta-blockers in bradycardia.
2. A client is experiencing sinus tachycardia with HR 135 bpm after major surgery.
Which is the most appropriate initial action?
A. Administer propranolol
B. Assess for hypovolemia or pain
C. Begin synchronized cardioversion
D. Administer IV adenosine
Correct Answer: B. Assess for hypovolemia or pain
Rationale: Sinus tachycardia is often a compensatory response to underlying causes
like pain, dehydration, or hypoxia.
NCLEX Must-Know:
, ● Always address cause of sinus tachy first.
● Treat the underlying condition; medications are not first-line unless rate becomes
unstable.
3. A patient with atrial fibrillation has a new prescription for warfarin. Which lab
value is most critical to monitor?
A. PTT
B. Platelet count
C. INR
D. Sodium
Correct Answer: C. INR
Rationale: INR is used to monitor warfarin effectiveness. Therapeutic range is usually
2.0–3.0 in Afib.
NCLEX Must-Know:
● Afib increases stroke risk → need anticoagulation.
● Check INR regularly with warfarin; watch for bleeding.
4. Which ECG change is most concerning in a patient experiencing frequent
PVCs?
A. Uniform shape of PVCs
B. Two PVCs in a row
C. Couplet PVCs with R-on-T phenomenon
D. Isolated PVC every 10 beats
Correct Answer: C. Couplet PVCs with R-on-T phenomenon
Rationale: R-on-T can trigger ventricular tachycardia or fibrillation.
NCLEX Must-Know:
● PVCs are benign unless: >6/min, multifocal, or fall on T wave (R-on-T).
, ● Monitor electrolytes: K+, Mg++.
5. A patient with sustained ventricular tachycardia has no pulse. What is the
nurse’s first action?
A. Begin CPR
B. Administer amiodarone
C. Defibrillate
D. Give epinephrine
Correct Answer: A. Begin CPR
Rationale: For pulseless VT, initiate CPR immediately and prepare for defibrillation.
NCLEX Must-Know:
● Pulseless VT = treat as cardiac arrest.
● CPR first, then defibrillation.
● No pulse = no synchronized cardioversion.
6. What is the priority nursing action for a patient in ventricular fibrillation?
A. Check blood pressure
B. Prepare for pacemaker
C. Begin defibrillation
D. Assess mental status
Correct Answer: C. Begin defibrillation
Rationale: VFib is lethal and must be treated immediately with defibrillation.
NCLEX Must-Know:
● VF = no pulse, no CO.
● Start CPR, defibrillate ASAP.
, ● Defib = unsynchronized shock.
7. Which finding in a patient with infective endocarditis requires immediate
action?
A. Splinter hemorrhages
B. Fever of 100.8°F (38.2°C)
C. Sudden onset confusion
D. Osler's nodes
Correct Answer: C. Sudden onset confusion
Rationale: Could indicate embolic stroke — a complication of IE.
NCLEX Must-Know:
● IE can cause systemic emboli.
● Neuro changes = emergency.
● Maintain IV abx; monitor for HF or stroke.
8. Which symptom indicates possible cardiac tamponade?
A. Loud pericardial friction rub
B. Pulsus paradoxus and muffled heart sounds
C. Bounding peripheral pulses
D. S3 gallop
Correct Answer: B. Pulsus paradoxus and muffled heart sounds
Rationale: These are part of Beck’s Triad — hallmark signs of tamponade.
NCLEX Must-Know:
● Beck's Triad: low BP, JVD, muffled heart sounds.
● Requires emergency pericardiocentesis.
A client presents with sinus bradycardia and a blood pressure of 78/45 mmHg.
Which intervention should the nurse anticipate?
A. Administer metoprolol
B. Initiate vagal maneuvers
C. Prepare for transcutaneous pacing
D. Administer digoxin
Correct Answer: C. Prepare for transcutaneous pacing
Rationale: Symptomatic bradycardia with hypotension requires immediate intervention
to maintain cardiac output. Transcutaneous pacing is a rapid, non-invasive measure.
NCLEX Must-Know:
● Bradycardia is <60 bpm.
● If symptomatic: treat with atropine, pacing, or dopamine/epinephrine infusion.
● NEVER use vagal maneuvers or beta-blockers in bradycardia.
2. A client is experiencing sinus tachycardia with HR 135 bpm after major surgery.
Which is the most appropriate initial action?
A. Administer propranolol
B. Assess for hypovolemia or pain
C. Begin synchronized cardioversion
D. Administer IV adenosine
Correct Answer: B. Assess for hypovolemia or pain
Rationale: Sinus tachycardia is often a compensatory response to underlying causes
like pain, dehydration, or hypoxia.
NCLEX Must-Know:
, ● Always address cause of sinus tachy first.
● Treat the underlying condition; medications are not first-line unless rate becomes
unstable.
3. A patient with atrial fibrillation has a new prescription for warfarin. Which lab
value is most critical to monitor?
A. PTT
B. Platelet count
C. INR
D. Sodium
Correct Answer: C. INR
Rationale: INR is used to monitor warfarin effectiveness. Therapeutic range is usually
2.0–3.0 in Afib.
NCLEX Must-Know:
● Afib increases stroke risk → need anticoagulation.
● Check INR regularly with warfarin; watch for bleeding.
4. Which ECG change is most concerning in a patient experiencing frequent
PVCs?
A. Uniform shape of PVCs
B. Two PVCs in a row
C. Couplet PVCs with R-on-T phenomenon
D. Isolated PVC every 10 beats
Correct Answer: C. Couplet PVCs with R-on-T phenomenon
Rationale: R-on-T can trigger ventricular tachycardia or fibrillation.
NCLEX Must-Know:
● PVCs are benign unless: >6/min, multifocal, or fall on T wave (R-on-T).
, ● Monitor electrolytes: K+, Mg++.
5. A patient with sustained ventricular tachycardia has no pulse. What is the
nurse’s first action?
A. Begin CPR
B. Administer amiodarone
C. Defibrillate
D. Give epinephrine
Correct Answer: A. Begin CPR
Rationale: For pulseless VT, initiate CPR immediately and prepare for defibrillation.
NCLEX Must-Know:
● Pulseless VT = treat as cardiac arrest.
● CPR first, then defibrillation.
● No pulse = no synchronized cardioversion.
6. What is the priority nursing action for a patient in ventricular fibrillation?
A. Check blood pressure
B. Prepare for pacemaker
C. Begin defibrillation
D. Assess mental status
Correct Answer: C. Begin defibrillation
Rationale: VFib is lethal and must be treated immediately with defibrillation.
NCLEX Must-Know:
● VF = no pulse, no CO.
● Start CPR, defibrillate ASAP.
, ● Defib = unsynchronized shock.
7. Which finding in a patient with infective endocarditis requires immediate
action?
A. Splinter hemorrhages
B. Fever of 100.8°F (38.2°C)
C. Sudden onset confusion
D. Osler's nodes
Correct Answer: C. Sudden onset confusion
Rationale: Could indicate embolic stroke — a complication of IE.
NCLEX Must-Know:
● IE can cause systemic emboli.
● Neuro changes = emergency.
● Maintain IV abx; monitor for HF or stroke.
8. Which symptom indicates possible cardiac tamponade?
A. Loud pericardial friction rub
B. Pulsus paradoxus and muffled heart sounds
C. Bounding peripheral pulses
D. S3 gallop
Correct Answer: B. Pulsus paradoxus and muffled heart sounds
Rationale: These are part of Beck’s Triad — hallmark signs of tamponade.
NCLEX Must-Know:
● Beck's Triad: low BP, JVD, muffled heart sounds.
● Requires emergency pericardiocentesis.
