Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 72-year-old on telemetry reports sudden palpitations.
Text EKG: Rate ~190 bpm, regular, narrow QRS complexes, P
waves not visible. BP 118/76 mmHg, patient slightly anxious.
What is the nurse’s best first action?
A. Prepare for immediate synchronized cardioversion.
B. Perform vagal maneuvers (e.g., carotid sinus massage if no
carotid bruit) and obtain a 12-lead ECG.
C. Administer IV amiodarone bolus.
D. Start a dopamine infusion.
Answer: B
Rationale:
• Why correct: The rhythm description is consistent with
supraventricular tachycardia (SVT); in a hemodynamically stable
patient, noninvasive vagal maneuvers are first-line to attempt
termination and obtaining a 12-lead confirms the rhythm.
• Why A is incorrect: Synchronized cardioversion is indicated for
unstable patients (hypotension, ischemia, altered mental
status); this patient is stable.
• Why C is incorrect: Amiodarone is not the initial therapy for
stable narrow-complex SVT and is usually reserved for other
arrhythmias or refractory cases.
• Why D is incorrect: Dopamine is a vasopressor/inotrope and
would worsen tachycardia; it is not indicated for SVT.
,• Quick nursing action/priority: Attempt vagal maneuvers and
place a 12-lead ECG while preparing adenosine and monitoring.
Difficulty: Easy
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. Text EKG: Irregularly irregular rhythm, absent discrete P
waves, ventricular rate 140 bpm. Patient with history of AF
presents with chest tightness. What is the nurse’s priority
action?
A. Start IV lidocaine.
B. Assess oxygenation and notify provider for rate-control
medication (e.g., IV beta-blocker).
C. Give sublingual nitroglycerin and send home.
D. Prepare for immediate transcutaneous pacing.
Answer: B
Rationale:
• Why correct: The EKG indicates atrial fibrillation with rapid
ventricular response (AF with RVR); immediate nursing
priorities are to assess oxygenation, hemodynamic status, and
initiate rate control with provider collaboration.
• Why A is incorrect: Lidocaine is for ventricular arrhythmias,
not AF.
• Why C is incorrect: Sublingual nitroglycerin may be used for
ischemic chest pain but does not address rapid ventricular rate
and sending home would be unsafe.
,• Why D is incorrect: Transcutaneous pacing is for symptomatic
bradyarrhythmias, not tachyarrhythmias like AF with RVR.
• Quick nursing action/priority: Apply oxygen if needed, obtain
vitals/12-lead ECG, and contact provider for rate-control orders.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. Text EKG: Wide QRS complexes at 170 bpm, regular rhythm,
patient is pale and reports lightheadedness but has a weak
carotid pulse. What should the nurse do first?
A. Prepare for immediate unsynchronized defibrillation.
B. Administer IV amiodarone while calling the rapid response
team.
C. Encourage the patient to perform Valsalva maneuver.
D. Observe and document the rhythm change.
Answer: B
Rationale:
• Why correct: Wide-complex tachycardia at 170 bpm with
signs of poor perfusion suggests sustained ventricular
tachycardia with pulse; immediate IV antiarrhythmic therapy
(e.g., amiodarone) and rapid response activation are
appropriate while preparing for synchronized cardioversion if
deterioration occurs.
• Why A is incorrect: Unsynchronized defibrillation is for
pulseless VT/VF; this patient has a pulse.
, • Why C is incorrect: Vagal maneuvers target supraventricular
arrhythmias and are ineffective for ventricular tachycardia.
• Why D is incorrect: Observation alone risks progression to
pulseless arrest; action is required.
• Quick nursing action/priority: Establish IV access, give ordered
IV amiodarone, and call the rapid response/team.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. Text EKG: Atrial rate 90 bpm with P waves; ventricular rate
40 bpm with wide QRS complexes; P waves and QRS complexes
occur independently. BP 82/48 mmHg; patient is confused.
What is the nurse’s immediate priority?
A. Administer oral metoprolol.
B. Prepare for immediate transcutaneous pacing.
C. Give IV diltiazem to slow atrial rate.
D. Encourage the patient to cough forcefully.
Answer: B
Rationale:
• Why correct: The EKG and clinical signs indicate complete
(third-degree) AV block with symptomatic bradycardia and
hypotension; immediate external (transcutaneous) pacing is
required to restore adequate heart rate and perfusion.
• Why A is incorrect: Metoprolol would further depress
ventricular rate and worsen hypotension.
Undergraduate
Q1. A 72-year-old on telemetry reports sudden palpitations.
Text EKG: Rate ~190 bpm, regular, narrow QRS complexes, P
waves not visible. BP 118/76 mmHg, patient slightly anxious.
What is the nurse’s best first action?
A. Prepare for immediate synchronized cardioversion.
B. Perform vagal maneuvers (e.g., carotid sinus massage if no
carotid bruit) and obtain a 12-lead ECG.
C. Administer IV amiodarone bolus.
D. Start a dopamine infusion.
Answer: B
Rationale:
• Why correct: The rhythm description is consistent with
supraventricular tachycardia (SVT); in a hemodynamically stable
patient, noninvasive vagal maneuvers are first-line to attempt
termination and obtaining a 12-lead confirms the rhythm.
• Why A is incorrect: Synchronized cardioversion is indicated for
unstable patients (hypotension, ischemia, altered mental
status); this patient is stable.
• Why C is incorrect: Amiodarone is not the initial therapy for
stable narrow-complex SVT and is usually reserved for other
arrhythmias or refractory cases.
• Why D is incorrect: Dopamine is a vasopressor/inotrope and
would worsen tachycardia; it is not indicated for SVT.
,• Quick nursing action/priority: Attempt vagal maneuvers and
place a 12-lead ECG while preparing adenosine and monitoring.
Difficulty: Easy
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. Text EKG: Irregularly irregular rhythm, absent discrete P
waves, ventricular rate 140 bpm. Patient with history of AF
presents with chest tightness. What is the nurse’s priority
action?
A. Start IV lidocaine.
B. Assess oxygenation and notify provider for rate-control
medication (e.g., IV beta-blocker).
C. Give sublingual nitroglycerin and send home.
D. Prepare for immediate transcutaneous pacing.
Answer: B
Rationale:
• Why correct: The EKG indicates atrial fibrillation with rapid
ventricular response (AF with RVR); immediate nursing
priorities are to assess oxygenation, hemodynamic status, and
initiate rate control with provider collaboration.
• Why A is incorrect: Lidocaine is for ventricular arrhythmias,
not AF.
• Why C is incorrect: Sublingual nitroglycerin may be used for
ischemic chest pain but does not address rapid ventricular rate
and sending home would be unsafe.
,• Why D is incorrect: Transcutaneous pacing is for symptomatic
bradyarrhythmias, not tachyarrhythmias like AF with RVR.
• Quick nursing action/priority: Apply oxygen if needed, obtain
vitals/12-lead ECG, and contact provider for rate-control orders.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. Text EKG: Wide QRS complexes at 170 bpm, regular rhythm,
patient is pale and reports lightheadedness but has a weak
carotid pulse. What should the nurse do first?
A. Prepare for immediate unsynchronized defibrillation.
B. Administer IV amiodarone while calling the rapid response
team.
C. Encourage the patient to perform Valsalva maneuver.
D. Observe and document the rhythm change.
Answer: B
Rationale:
• Why correct: Wide-complex tachycardia at 170 bpm with
signs of poor perfusion suggests sustained ventricular
tachycardia with pulse; immediate IV antiarrhythmic therapy
(e.g., amiodarone) and rapid response activation are
appropriate while preparing for synchronized cardioversion if
deterioration occurs.
• Why A is incorrect: Unsynchronized defibrillation is for
pulseless VT/VF; this patient has a pulse.
, • Why C is incorrect: Vagal maneuvers target supraventricular
arrhythmias and are ineffective for ventricular tachycardia.
• Why D is incorrect: Observation alone risks progression to
pulseless arrest; action is required.
• Quick nursing action/priority: Establish IV access, give ordered
IV amiodarone, and call the rapid response/team.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. Text EKG: Atrial rate 90 bpm with P waves; ventricular rate
40 bpm with wide QRS complexes; P waves and QRS complexes
occur independently. BP 82/48 mmHg; patient is confused.
What is the nurse’s immediate priority?
A. Administer oral metoprolol.
B. Prepare for immediate transcutaneous pacing.
C. Give IV diltiazem to slow atrial rate.
D. Encourage the patient to cough forcefully.
Answer: B
Rationale:
• Why correct: The EKG and clinical signs indicate complete
(third-degree) AV block with symptomatic bradycardia and
hypotension; immediate external (transcutaneous) pacing is
required to restore adequate heart rate and perfusion.
• Why A is incorrect: Metoprolol would further depress
ventricular rate and worsen hypotension.
