Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old client with a history of heart failure is
admitted with dizziness. The monitor shows a regular rhythm at
a rate of 38 bpm. The P waves are present and normal in
configuration, but each P wave is followed by a P-R interval that
gets progressively longer until a QRS complex is dropped. This
pattern repeats. What is the nurse's priority action?
A. Prepare for transcutaneous pacing.
B. Administer atropine 0.5 mg IV.
C. Assess the client's responsiveness and blood pressure.
D. Increase the intravenous fluid rate.
Answer: C
Rationale:
• The correct answer is C because the EKG description indicates
second-degree AV block, Type I (Wenckebach). The initial
nursing priority is always to assess the client's clinical status
(e.g., symptoms, BP, perfusion) to determine the urgency of the
situation before intervening.
• A is incorrect because transcutaneous pacing is typically
reserved for unstable bradycardias or higher-grade blocks;
assessment must come first.
• B is incorrect because atropine is often ineffective for Type II
or third-degree AV blocks and should not be administered
without a full assessment.
• D is incorrect because increasing fluids could exacerbate
,underlying heart failure and is not indicated for this rhythm
disturbance.
• The nurse's immediate action is to check for signs of poor
perfusion, such as altered mental status or hypotension.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 55-year-old client is 24 hours post-acute anterior wall MI.
The nurse notes the rhythm strip shows a regular wide-complex
tachycardia at a rate of 170 bpm. The client is alert but reports
dizziness and has a blood pressure of 88/50 mm Hg. What is the
nurse's priority action?
A. Initiate synchronized cardioversion.
B. Administer amiodarone 150 mg IV bolus.
C. Apply oxygen via nasal cannula.
D. Perform vagal maneuvers.
Answer: A
Rationale:
• The correct answer is A because the client is exhibiting
unstable tachycardia (hypotension, dizziness) with a wide-
complex rhythm, which is a medical emergency requiring
immediate cardioversion.
• B is incorrect because medication administration is
appropriate for stable wide-complex tachycardia, but instability
requires immediate electrical intervention.
,• C is incorrect because while oxygen may be beneficial, it does
not address the life-threatening arrhythmia causing
hypotension.
• D is incorrect because vagal maneuvers are used for stable
supraventricular tachycardias, not for unstable wide-complex
tachycardias post-MI, which could be ventricular tachycardia.
• The priority is to prepare for immediate synchronized
cardioversion while ensuring the client's safety.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q3. A client with an acute ST-elevation myocardial infarction
(STEMI) is a candidate for fibrinolytic therapy. Which finding, if
present, would be a contraindication to this therapy?
A. Blood pressure of 160/95 mm Hg
B. Recent dental cleaning 3 days ago
C. History of hemorrhagic stroke 2 years ago
D. Current use of clopidogrel
Answer: C
Rationale:
• The correct answer is C because a history of hemorrhagic
stroke is an absolute contraindication for fibrinolytic therapy
due to the high risk of causing another catastrophic bleed.
• A is incorrect because while severe hypertension is a relative
concern, a BP of 160/95 is not an absolute contraindication and
, can be managed.
• B is incorrect because a recent dental cleaning is a minor
procedure and not a significant risk for major bleeding.
• D is incorrect because while antiplatelet use increases
bleeding risk, it is not an absolute contraindication; the benefits
and risks are weighed in a STEMI.
• The nurse must identify absolute contraindications to prevent
serious complications.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A client with heart failure has been started on furosemide
40 mg IV twice daily. Which assessment finding indicates to the
nurse that the medication is effective?
A. A decrease in heart rate from 112 to 98 bpm
B. A weight loss of 1.5 kg (3.3 lbs) in 24 hours
C. An increase in urine output from 30 mL/hr to 100 mL/hr
D. A resolution of bibasilar crackles on lung auscultation
Answer: D
Rationale:
• The correct answer is D because the primary goal of diuretic
therapy in heart failure is to reduce pulmonary fluid overload,
with resolution of crackles being a direct sign of improved
pulmonary status.
• A is incorrect; a decreased heart rate may indicate reduced
Undergraduate
Q1. A 68-year-old client with a history of heart failure is
admitted with dizziness. The monitor shows a regular rhythm at
a rate of 38 bpm. The P waves are present and normal in
configuration, but each P wave is followed by a P-R interval that
gets progressively longer until a QRS complex is dropped. This
pattern repeats. What is the nurse's priority action?
A. Prepare for transcutaneous pacing.
B. Administer atropine 0.5 mg IV.
C. Assess the client's responsiveness and blood pressure.
D. Increase the intravenous fluid rate.
Answer: C
Rationale:
• The correct answer is C because the EKG description indicates
second-degree AV block, Type I (Wenckebach). The initial
nursing priority is always to assess the client's clinical status
(e.g., symptoms, BP, perfusion) to determine the urgency of the
situation before intervening.
• A is incorrect because transcutaneous pacing is typically
reserved for unstable bradycardias or higher-grade blocks;
assessment must come first.
• B is incorrect because atropine is often ineffective for Type II
or third-degree AV blocks and should not be administered
without a full assessment.
• D is incorrect because increasing fluids could exacerbate
,underlying heart failure and is not indicated for this rhythm
disturbance.
• The nurse's immediate action is to check for signs of poor
perfusion, such as altered mental status or hypotension.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A 55-year-old client is 24 hours post-acute anterior wall MI.
The nurse notes the rhythm strip shows a regular wide-complex
tachycardia at a rate of 170 bpm. The client is alert but reports
dizziness and has a blood pressure of 88/50 mm Hg. What is the
nurse's priority action?
A. Initiate synchronized cardioversion.
B. Administer amiodarone 150 mg IV bolus.
C. Apply oxygen via nasal cannula.
D. Perform vagal maneuvers.
Answer: A
Rationale:
• The correct answer is A because the client is exhibiting
unstable tachycardia (hypotension, dizziness) with a wide-
complex rhythm, which is a medical emergency requiring
immediate cardioversion.
• B is incorrect because medication administration is
appropriate for stable wide-complex tachycardia, but instability
requires immediate electrical intervention.
,• C is incorrect because while oxygen may be beneficial, it does
not address the life-threatening arrhythmia causing
hypotension.
• D is incorrect because vagal maneuvers are used for stable
supraventricular tachycardias, not for unstable wide-complex
tachycardias post-MI, which could be ventricular tachycardia.
• The priority is to prepare for immediate synchronized
cardioversion while ensuring the client's safety.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Medical Emergencies
Q3. A client with an acute ST-elevation myocardial infarction
(STEMI) is a candidate for fibrinolytic therapy. Which finding, if
present, would be a contraindication to this therapy?
A. Blood pressure of 160/95 mm Hg
B. Recent dental cleaning 3 days ago
C. History of hemorrhagic stroke 2 years ago
D. Current use of clopidogrel
Answer: C
Rationale:
• The correct answer is C because a history of hemorrhagic
stroke is an absolute contraindication for fibrinolytic therapy
due to the high risk of causing another catastrophic bleed.
• A is incorrect because while severe hypertension is a relative
concern, a BP of 160/95 is not an absolute contraindication and
, can be managed.
• B is incorrect because a recent dental cleaning is a minor
procedure and not a significant risk for major bleeding.
• D is incorrect because while antiplatelet use increases
bleeding risk, it is not an absolute contraindication; the benefits
and risks are weighed in a STEMI.
• The nurse must identify absolute contraindications to prevent
serious complications.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A client with heart failure has been started on furosemide
40 mg IV twice daily. Which assessment finding indicates to the
nurse that the medication is effective?
A. A decrease in heart rate from 112 to 98 bpm
B. A weight loss of 1.5 kg (3.3 lbs) in 24 hours
C. An increase in urine output from 30 mL/hr to 100 mL/hr
D. A resolution of bibasilar crackles on lung auscultation
Answer: D
Rationale:
• The correct answer is D because the primary goal of diuretic
therapy in heart failure is to reduce pulmonary fluid overload,
with resolution of crackles being a direct sign of improved
pulmonary status.
• A is incorrect; a decreased heart rate may indicate reduced
