Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old patient with a history of heart failure is
admitted with worsening dyspnea. The cardiac monitor shows a
regular rhythm with a ventricular rate of 38 bpm. The P waves
are present and normal in configuration, but there are more P
waves than QRS complexes, and the P-R interval is progressively
lengthening until a QRS complex is dropped. What is the nurse's
priority action?
A. Prepare for transcutaneous pacing.
B. Administer atropine 0.5 mg IV push.
C. Assess the patient's level of consciousness and blood
pressure.
D. Increase the intravenous fluid rate to support blood pressure.
Answer: C
Rationale:
• Correct: The EKG description indicates second-degree AV
block, Type I (Wenckebach). The initial nursing priority is always
to assess the patient for symptoms of poor perfusion (e.g.,
dizziness, confusion, hypotension) caused by the bradycardia
before initiating any treatment.
• A is incorrect because transcutaneous pacing is not the first
action; the patient's clinical status must be determined first.
• B is incorrect because atropine is often ineffective in treating a
block at the AV node level, like Wenckebach, and should not be
,administered without assessing the patient's symptomatic
status.
• D is incorrect because increasing fluids could be dangerous in
a patient with worsening heart failure and is not the initial
response to bradycardia.
• Quick nursing action: Assess the patient's clinical response to
the rhythm (e.g., mentation, blood pressure, chest pain).
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 55-year-old male patient is 24 hours post-acute anterior
wall MI. His vital signs are stable. The nurse notes the rhythm
strip shows a regular wide-QRS complex rhythm at a rate of 110
bpm. The P waves are dissociated from the QRS complexes. The
patient is asymptomatic. What is the nurse's most appropriate
initial action?
A. Initiate synchronized cardioversion immediately.
B. Administer a bolus of amiodarone 150 mg IV.
C. Continue to monitor the patient and notify the physician.
D. Assess for a pulse, as this indicates ventricular fibrillation.
Answer: C
Rationale:
• Correct: The rhythm described is ventricular tachycardia (VT).
In a patient who is awake, alert, and has a pulse (stable VT), the
immediate action is continuous monitoring and physician
,notification to determine the need for pharmacological
intervention, not immediate cardioversion.
• A is incorrect because synchronized cardioversion is reserved
for unstable VT (e.g., with hypotension, chest pain, or
pulmonary edema).
• B is incorrect because while amiodarone may be ordered, it is
not the nurse's independent first action; assessment and
notification are priority.
• D is incorrect because the presence of a regular rhythm with
dissociated P waves confirms it is not V-fib, and the patient is
stated to be asymptomatic, implying a pulse is present.
• Quick nursing action: Monitor the patient closely for any signs
of instability while preparing to follow new orders.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A patient with acute decompensated heart failure has the
following hemodynamic parameters: Heart Rate 118 bpm, BP
85/50 mm Hg, Central Venous Pressure (CVP) 18 mm Hg,
Pulmonary Artery Wedge Pressure (PAWP) 28 mm Hg. The
nurse calculates the mean arterial pressure (MAP). Based on
the profile, what is the most likely clinical state?
A. Hypovolemic shock
B. Neurogenic shock
, C. Cardiogenic shock
D. Septic shock
Answer: C
Rationale:
• Correct: The patient has low blood pressure and cardiac
output (reflected by low MAP) combined with high filling
pressures (high CVP and PAWP), which is the hallmark of
cardiogenic shock, especially in the context of heart failure.
• A is incorrect because hypovolemic shock would present with
low filling pressures (low CVP and PAWP).
• B is incorrect because neurogenic shock typically involves
hypotension with bradycardia, not tachycardia, and normal or
low filling pressures.
• D is incorrect because septic shock usually involves a high
cardiac output state with low systemic vascular resistance,
leading to low filling pressures.
• Quick nursing action: Anticipate interventions to support
cardiac output and reduce preload, such as diuretics and
vasoactive medications.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A patient with an inferior wall MI suddenly becomes
diaphoretic and hypotensive. The monitor shows a regular
narrow-complex rhythm at a rate of 130 bpm. The P waves are
Undergraduate
Q1. A 68-year-old patient with a history of heart failure is
admitted with worsening dyspnea. The cardiac monitor shows a
regular rhythm with a ventricular rate of 38 bpm. The P waves
are present and normal in configuration, but there are more P
waves than QRS complexes, and the P-R interval is progressively
lengthening until a QRS complex is dropped. What is the nurse's
priority action?
A. Prepare for transcutaneous pacing.
B. Administer atropine 0.5 mg IV push.
C. Assess the patient's level of consciousness and blood
pressure.
D. Increase the intravenous fluid rate to support blood pressure.
Answer: C
Rationale:
• Correct: The EKG description indicates second-degree AV
block, Type I (Wenckebach). The initial nursing priority is always
to assess the patient for symptoms of poor perfusion (e.g.,
dizziness, confusion, hypotension) caused by the bradycardia
before initiating any treatment.
• A is incorrect because transcutaneous pacing is not the first
action; the patient's clinical status must be determined first.
• B is incorrect because atropine is often ineffective in treating a
block at the AV node level, like Wenckebach, and should not be
,administered without assessing the patient's symptomatic
status.
• D is incorrect because increasing fluids could be dangerous in
a patient with worsening heart failure and is not the initial
response to bradycardia.
• Quick nursing action: Assess the patient's clinical response to
the rhythm (e.g., mentation, blood pressure, chest pain).
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 55-year-old male patient is 24 hours post-acute anterior
wall MI. His vital signs are stable. The nurse notes the rhythm
strip shows a regular wide-QRS complex rhythm at a rate of 110
bpm. The P waves are dissociated from the QRS complexes. The
patient is asymptomatic. What is the nurse's most appropriate
initial action?
A. Initiate synchronized cardioversion immediately.
B. Administer a bolus of amiodarone 150 mg IV.
C. Continue to monitor the patient and notify the physician.
D. Assess for a pulse, as this indicates ventricular fibrillation.
Answer: C
Rationale:
• Correct: The rhythm described is ventricular tachycardia (VT).
In a patient who is awake, alert, and has a pulse (stable VT), the
immediate action is continuous monitoring and physician
,notification to determine the need for pharmacological
intervention, not immediate cardioversion.
• A is incorrect because synchronized cardioversion is reserved
for unstable VT (e.g., with hypotension, chest pain, or
pulmonary edema).
• B is incorrect because while amiodarone may be ordered, it is
not the nurse's independent first action; assessment and
notification are priority.
• D is incorrect because the presence of a regular rhythm with
dissociated P waves confirms it is not V-fib, and the patient is
stated to be asymptomatic, implying a pulse is present.
• Quick nursing action: Monitor the patient closely for any signs
of instability while preparing to follow new orders.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A patient with acute decompensated heart failure has the
following hemodynamic parameters: Heart Rate 118 bpm, BP
85/50 mm Hg, Central Venous Pressure (CVP) 18 mm Hg,
Pulmonary Artery Wedge Pressure (PAWP) 28 mm Hg. The
nurse calculates the mean arterial pressure (MAP). Based on
the profile, what is the most likely clinical state?
A. Hypovolemic shock
B. Neurogenic shock
, C. Cardiogenic shock
D. Septic shock
Answer: C
Rationale:
• Correct: The patient has low blood pressure and cardiac
output (reflected by low MAP) combined with high filling
pressures (high CVP and PAWP), which is the hallmark of
cardiogenic shock, especially in the context of heart failure.
• A is incorrect because hypovolemic shock would present with
low filling pressures (low CVP and PAWP).
• B is incorrect because neurogenic shock typically involves
hypotension with bradycardia, not tachycardia, and normal or
low filling pressures.
• D is incorrect because septic shock usually involves a high
cardiac output state with low systemic vascular resistance,
leading to low filling pressures.
• Quick nursing action: Anticipate interventions to support
cardiac output and reduce preload, such as diuretics and
vasoactive medications.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A patient with an inferior wall MI suddenly becomes
diaphoretic and hypotensive. The monitor shows a regular
narrow-complex rhythm at a rate of 130 bpm. The P waves are
