Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 65-year-old patient with a history of heart failure is
admitted with dyspnea. The cardiac 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 QRS
complex only once every 3-4 waves. The PR interval for the
conducted beats is constant. Which rhythm does the nurse
identify?
A. First-degree atrioventricular (AV) block
B. Second-degree atrioventricular (AV) block, Type I
(Wenckebach)
C. Second-degree atrioventricular (AV) block, Type II
D. Third-degree atrioventricular (AV) block
Answer: C
Rationale:
• The rhythm is identified as Second-degree AV block, Type II
because there are more P waves than QRS complexes, with
intermittent non-conducted P waves. Crucially, the PR interval
for the conducted beats remains constant, which distinguishes
it from Type I.
• A is incorrect because first-degree AV block presents with a
prolonged but constant PR interval with every P wave followed
by a QRS.
• B is incorrect because in Type I (Wenckebach), the PR interval
,progressively lengthens until a QRS is dropped.
• D is incorrect because in third-degree block, there is no
relationship between P waves and QRS complexes (AV
dissociation).
• The nurse's priority is to prepare for transcutaneous pacing
due to the low ventricular rate and risk of progression to
complete heart block.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A patient with an acute ST-elevation myocardial infarction
(STEMI) is scheduled for emergency percutaneous coronary
intervention (PCI). The nurse should ensure which medication is
administered prior to the procedure, as ordered?
A. Metoprolol 5 mg IV
B. Furosemide 40 mg IV
C. Clopidogrel 600 mg PO
D. Regular Insulin 10 units IV
Answer: C
Rationale:
• A loading dose of a P2Y12 inhibitor like clopidogrel is given
prior to PCI to achieve rapid platelet inhibition and prevent
stent thrombosis.
• A is incorrect because while beta-blockers are important in
MI, they are not a pre-PCI requirement and may be withheld in
,unstable patients.
• B is incorrect because furosemide is a diuretic for heart
failure, not a standard pre-PCI medication.
• D is incorrect because IV insulin is used for hyperkalemia or
diabetic ketoacidosis, not routinely before PCI.
• The nurse should verify the patient has no contraindications
(e.g., active bleeding) before administering the loading dose.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies: Cardiovascular
Q3. A patient with heart failure has been receiving a continuous
IV infusion of nitroglycerin at 15 mcg/min for pulmonary
edema. The nurse assesses a blood pressure of 85/50 mm Hg,
down from 110/70 mm Hg an hour ago. What is the nurse's
priority action?
A. Increase the IV fluid rate to support blood pressure.
B. Stop the nitroglycerin infusion and notify the physician.
C. Administer a stat dose of furosemide 40 mg IV.
D. Place the patient in a high Fowler's position.
Answer: B
Rationale:
• The priority action is to stop the nitroglycerin infusion
because the significant hypotension is a direct adverse effect of
the vasodilator, and continuing it could compromise coronary
perfusion.
, • A is incorrect because increasing IV fluids could worsen
pulmonary edema in a heart failure patient.
• C is incorrect because diuretics would further reduce preload
and exacerbate the hypotension.
• D is incorrect; while positioning can aid breathing, it does not
address the primary problem of medication-induced
hypotension.
• After stopping the infusion, the nurse should monitor the
patient's BP and prepare to administer a fluid bolus if ordered
and appropriate.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A patient in the ICU has an arterial line. The nurse obtains a
reading showing a systolic pressure of 140 mm Hg, diastolic
pressure of 80 mm Hg, and a mean arterial pressure (MAP) of
93 mm Hg. How did the nurse calculate this MAP? Show the
math.
A. (140 + 80) / 2 = 110 mm Hg
B. (140 - 80) / 3 + 80 = 100 mm Hg
C. (SBP + 2(DBP)) / 3 = (140 + 160) / 3 = = 100 mm Hg
D. (2(DBP) + SBP) / 3 = (160 + 140) / 3 = = 100 mm Hg
Answer: C
Rationale:
• The correct formula for MAP is (Systolic BP + 2(Diastolic BP)) /
Undergraduate
Q1. A 65-year-old patient with a history of heart failure is
admitted with dyspnea. The cardiac 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 QRS
complex only once every 3-4 waves. The PR interval for the
conducted beats is constant. Which rhythm does the nurse
identify?
A. First-degree atrioventricular (AV) block
B. Second-degree atrioventricular (AV) block, Type I
(Wenckebach)
C. Second-degree atrioventricular (AV) block, Type II
D. Third-degree atrioventricular (AV) block
Answer: C
Rationale:
• The rhythm is identified as Second-degree AV block, Type II
because there are more P waves than QRS complexes, with
intermittent non-conducted P waves. Crucially, the PR interval
for the conducted beats remains constant, which distinguishes
it from Type I.
• A is incorrect because first-degree AV block presents with a
prolonged but constant PR interval with every P wave followed
by a QRS.
• B is incorrect because in Type I (Wenckebach), the PR interval
,progressively lengthens until a QRS is dropped.
• D is incorrect because in third-degree block, there is no
relationship between P waves and QRS complexes (AV
dissociation).
• The nurse's priority is to prepare for transcutaneous pacing
due to the low ventricular rate and risk of progression to
complete heart block.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q2. A patient with an acute ST-elevation myocardial infarction
(STEMI) is scheduled for emergency percutaneous coronary
intervention (PCI). The nurse should ensure which medication is
administered prior to the procedure, as ordered?
A. Metoprolol 5 mg IV
B. Furosemide 40 mg IV
C. Clopidogrel 600 mg PO
D. Regular Insulin 10 units IV
Answer: C
Rationale:
• A loading dose of a P2Y12 inhibitor like clopidogrel is given
prior to PCI to achieve rapid platelet inhibition and prevent
stent thrombosis.
• A is incorrect because while beta-blockers are important in
MI, they are not a pre-PCI requirement and may be withheld in
,unstable patients.
• B is incorrect because furosemide is a diuretic for heart
failure, not a standard pre-PCI medication.
• D is incorrect because IV insulin is used for hyperkalemia or
diabetic ketoacidosis, not routinely before PCI.
• The nurse should verify the patient has no contraindications
(e.g., active bleeding) before administering the loading dose.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies: Cardiovascular
Q3. A patient with heart failure has been receiving a continuous
IV infusion of nitroglycerin at 15 mcg/min for pulmonary
edema. The nurse assesses a blood pressure of 85/50 mm Hg,
down from 110/70 mm Hg an hour ago. What is the nurse's
priority action?
A. Increase the IV fluid rate to support blood pressure.
B. Stop the nitroglycerin infusion and notify the physician.
C. Administer a stat dose of furosemide 40 mg IV.
D. Place the patient in a high Fowler's position.
Answer: B
Rationale:
• The priority action is to stop the nitroglycerin infusion
because the significant hypotension is a direct adverse effect of
the vasodilator, and continuing it could compromise coronary
perfusion.
, • A is incorrect because increasing IV fluids could worsen
pulmonary edema in a heart failure patient.
• C is incorrect because diuretics would further reduce preload
and exacerbate the hypotension.
• D is incorrect; while positioning can aid breathing, it does not
address the primary problem of medication-induced
hypotension.
• After stopping the infusion, the nurse should monitor the
patient's BP and prepare to administer a fluid bolus if ordered
and appropriate.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q4. A patient in the ICU has an arterial line. The nurse obtains a
reading showing a systolic pressure of 140 mm Hg, diastolic
pressure of 80 mm Hg, and a mean arterial pressure (MAP) of
93 mm Hg. How did the nurse calculate this MAP? Show the
math.
A. (140 + 80) / 2 = 110 mm Hg
B. (140 - 80) / 3 + 80 = 100 mm Hg
C. (SBP + 2(DBP)) / 3 = (140 + 160) / 3 = = 100 mm Hg
D. (2(DBP) + SBP) / 3 = (160 + 140) / 3 = = 100 mm Hg
Answer: C
Rationale:
• The correct formula for MAP is (Systolic BP + 2(Diastolic BP)) /
