Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 56-year-old woman presents with sudden palpitations
and lightheadedness. ECG description: "Rate ~180 bpm, regular,
narrow QRS complexes, no visible P waves — SVT." BP 88/54
mmHg, diaphoresis. What is the nurse’s priority action?
A. Attempt immediate synchronized cardioversion.
B. Perform carotid sinus massage at bedside.
C. Administer IV metoprolol 5 mg push.
D. Instruct the patient to perform Valsalva maneuver and
observe.
Answer: A
Rationale:
• Why the correct answer is correct: The patient is
hemodynamically unstable (hypotension, lightheadedness) with
SVT; immediate synchronized cardioversion is indicated to
restore perfusion.
• Why distractors are incorrect: B—Carotid sinus massage is
risky in unstable patients and may dislodge plaque in older
adults. C—IV beta-blocker is slower-acting and not first-line in
an unstable patient needing immediate rhythm control. D—
Valsalva maneuvers are for stable SVT and inappropriate when
the patient is hypotensive.
• Quick nursing action/priority: Prepare for and assist with
immediate synchronized cardioversion (ensure sedation per
protocol if time/condition allows).
,Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 70-year-old man on telemetry has this rhythm
description: "Irregularly irregular rhythm, no distinct P waves,
ventricular rate 140 bpm — atrial fibrillation with RVR." He is
stable (BP 128/76, O₂ sat 97%). What is the most appropriate
initial nursing action?
A. Administer IV diltiazem per order for rate control.
B. Prepare for immediate synchronized cardioversion.
C. Give IV amiodarone bolus now.
D. Start high-flow oxygen via nonrebreather.
Answer: A
Rationale:
• Why the correct answer is correct: For hemodynamically
stable AF with rapid ventricular response, initial management
focuses on rate control (IV diltiazem) to relieve symptoms and
improve hemodynamics.
• Why distractors are incorrect: B—Cardioversion is reserved for
unstable patients or after anticoagulation considerations. C—
Amiodarone can be used but calcium channel blockers are
commonly first-line for acute rate control in stable patients. D—
Oxygen is unnecessary with normal saturation.
• Quick nursing action/priority: Give prescribed IV diltiazem,
monitor HR and BP closely.
,Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 62-year-old post-op patient’s monitor shows: "Regular
rhythm, rate 50 bpm, P waves present before each QRS but PR
interval progressively lengthens until a dropped QRS — cycle
repeats." The patient is dizzy but BP 100/60 mmHg. What is the
rhythm and best next step?
A. Second-degree AV block Mobitz I (Wenckebach); observe and
assess for reversible causes.
B. Second-degree AV block Mobitz II; prepare for immediate
transcutaneous pacing.
C. Sinus bradycardia; administer IV atropine 0.5 mg.
D. Complete heart block; call for immediate emergent CPR.
Answer: A
Rationale:
• Why the correct answer is correct: Progressive PR
prolongation with dropped beats describes Mobitz I
(Wenckebach); if hemodynamically tolerable, assessment for
reversible causes (meds, electrolytes) and monitoring are
appropriate.
• Why distractors are incorrect: B—Mobitz II shows constant PR
intervals with sudden dropped beats, not progressive
prolongation. C—Sinus bradycardia lacks progressive PR
changes and P-R relationship remains 1:1. D—Complete heart
, block shows AV dissociation (independent atrial and ventricular
rates), not progressive PR changes.
• Quick nursing action/priority: Review
medications/electrolytes, monitor vitals and telemetry, and
notify provider if symptoms worsen.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 45-year-old with palpitations has telemetry: "Wide QRS
complexes at 150 bpm, monomorphic, regular — ventricular
tachycardia; patient is alert, BP 90/60 mmHg." What is the
nurse’s priority?
A. Prepare for immediate synchronized cardioversion.
B. Give IV amiodarone bolus and observe.
C. Start carotid sinus massage to break the rhythm.
D. Give oral metoprolol and monitor.
Answer: A
Rationale:
• Why the correct answer is correct: The patient has VT and is
borderline unstable (BP 90/60); synchronized cardioversion is
recommended for unstable or symptomatic VT to promptly
restore perfusion.
• Why distractors are incorrect: B—Amiodarone may be used
for stable VT, but cardioversion is preferred for compromised
hemodynamics. C—Carotid massage is ineffective and unsafe
Undergraduate
Q1. A 56-year-old woman presents with sudden palpitations
and lightheadedness. ECG description: "Rate ~180 bpm, regular,
narrow QRS complexes, no visible P waves — SVT." BP 88/54
mmHg, diaphoresis. What is the nurse’s priority action?
A. Attempt immediate synchronized cardioversion.
B. Perform carotid sinus massage at bedside.
C. Administer IV metoprolol 5 mg push.
D. Instruct the patient to perform Valsalva maneuver and
observe.
Answer: A
Rationale:
• Why the correct answer is correct: The patient is
hemodynamically unstable (hypotension, lightheadedness) with
SVT; immediate synchronized cardioversion is indicated to
restore perfusion.
• Why distractors are incorrect: B—Carotid sinus massage is
risky in unstable patients and may dislodge plaque in older
adults. C—IV beta-blocker is slower-acting and not first-line in
an unstable patient needing immediate rhythm control. D—
Valsalva maneuvers are for stable SVT and inappropriate when
the patient is hypotensive.
• Quick nursing action/priority: Prepare for and assist with
immediate synchronized cardioversion (ensure sedation per
protocol if time/condition allows).
,Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 70-year-old man on telemetry has this rhythm
description: "Irregularly irregular rhythm, no distinct P waves,
ventricular rate 140 bpm — atrial fibrillation with RVR." He is
stable (BP 128/76, O₂ sat 97%). What is the most appropriate
initial nursing action?
A. Administer IV diltiazem per order for rate control.
B. Prepare for immediate synchronized cardioversion.
C. Give IV amiodarone bolus now.
D. Start high-flow oxygen via nonrebreather.
Answer: A
Rationale:
• Why the correct answer is correct: For hemodynamically
stable AF with rapid ventricular response, initial management
focuses on rate control (IV diltiazem) to relieve symptoms and
improve hemodynamics.
• Why distractors are incorrect: B—Cardioversion is reserved for
unstable patients or after anticoagulation considerations. C—
Amiodarone can be used but calcium channel blockers are
commonly first-line for acute rate control in stable patients. D—
Oxygen is unnecessary with normal saturation.
• Quick nursing action/priority: Give prescribed IV diltiazem,
monitor HR and BP closely.
,Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A 62-year-old post-op patient’s monitor shows: "Regular
rhythm, rate 50 bpm, P waves present before each QRS but PR
interval progressively lengthens until a dropped QRS — cycle
repeats." The patient is dizzy but BP 100/60 mmHg. What is the
rhythm and best next step?
A. Second-degree AV block Mobitz I (Wenckebach); observe and
assess for reversible causes.
B. Second-degree AV block Mobitz II; prepare for immediate
transcutaneous pacing.
C. Sinus bradycardia; administer IV atropine 0.5 mg.
D. Complete heart block; call for immediate emergent CPR.
Answer: A
Rationale:
• Why the correct answer is correct: Progressive PR
prolongation with dropped beats describes Mobitz I
(Wenckebach); if hemodynamically tolerable, assessment for
reversible causes (meds, electrolytes) and monitoring are
appropriate.
• Why distractors are incorrect: B—Mobitz II shows constant PR
intervals with sudden dropped beats, not progressive
prolongation. C—Sinus bradycardia lacks progressive PR
changes and P-R relationship remains 1:1. D—Complete heart
, block shows AV dissociation (independent atrial and ventricular
rates), not progressive PR changes.
• Quick nursing action/priority: Review
medications/electrolytes, monitor vitals and telemetry, and
notify provider if symptoms worsen.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A 45-year-old with palpitations has telemetry: "Wide QRS
complexes at 150 bpm, monomorphic, regular — ventricular
tachycardia; patient is alert, BP 90/60 mmHg." What is the
nurse’s priority?
A. Prepare for immediate synchronized cardioversion.
B. Give IV amiodarone bolus and observe.
C. Start carotid sinus massage to break the rhythm.
D. Give oral metoprolol and monitor.
Answer: A
Rationale:
• Why the correct answer is correct: The patient has VT and is
borderline unstable (BP 90/60); synchronized cardioversion is
recommended for unstable or symptomatic VT to promptly
restore perfusion.
• Why distractors are incorrect: B—Amiodarone may be used
for stable VT, but cardioversion is preferred for compromised
hemodynamics. C—Carotid massage is ineffective and unsafe
