Cardiac & Vascular Nursing Essentials Test Bank (NCLEX-RN,
Undergraduate
Q1. A 68-year-old patient is admitted with palpitations. The
monitor shows a rhythm with a rate of 150 bpm, regular,
narrow QRS complexes, and no visible P waves. Which rhythm
does this describe?
A. Atrial fibrillation
B. Sinus tachycardia
C. Ventricular tachycardia
D. Supraventricular tachycardia
Answer: D
Rationale:
• Supraventricular tachycardia (SVT) is characterized by a rapid
rate (150-250 bpm), regular rhythm, narrow QRS, and absent P
waves due to reentry mechanisms above the ventricles.
• A is incorrect because atrial fibrillation has an irregular
rhythm with no discernible P waves.
• B is incorrect because sinus tachycardia has visible P waves
preceding each QRS complex.
• C is incorrect because ventricular tachycardia has wide QRS
complexes (>0.12 seconds).
• Quick nursing action: Assess for hemodynamic stability and
prepare for vagal maneuvers or adenosine administration.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
,Q2. A patient's EKG shows a rhythm with a rate of 40 bpm,
regular, wide QRS complexes, and no association between P
waves and QRS complexes. What is the priority nursing action?
A. Administer atropine 0.5 mg IV.
B. Prepare for transcutaneous pacing.
C. Assess the patient's level of consciousness.
D. Obtain a 12-lead EKG.
Answer: C
Rationale:
• The rhythm described is third-degree AV block, which can
cause hemodynamic compromise; assessing consciousness and
perfusion status is the first priority to determine urgency of
intervention.
• A is incorrect because atropine is often ineffective in third-
degree AV block as the block is typically infra-nodal.
• B is incorrect while pacing may be needed, assessment must
come first to guide treatment.
• D is incorrect because diagnostic tests should not delay
assessment of patient stability.
• Quick nursing action: Check for signs of poor perfusion such
as dizziness, hypotension, or syncope.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A patient with atrial fibrillation is prescribed warfarin. The
nurse is educating the patient about the medication. Which
,statement by the patient indicates understanding?
A. "I will avoid eating green leafy vegetables."
B. "I need to have my blood drawn weekly to check my INR."
C. "If I miss a dose, I should double up the next day."
D. "I can take aspirin for headaches instead of acetaminophen."
Answer: B
Rationale:
• Warfarin requires regular INR monitoring to maintain
therapeutic levels and prevent thromboembolism or bleeding.
• A is incorrect because patients should maintain consistent
vitamin K intake rather than avoid it entirely.
• C is incorrect because doubling doses can lead to overdose
and bleeding; missed doses should be managed as per protocol.
• D is incorrect because aspirin increases bleeding risk when
combined with warfarin.
• Quick nursing action: Reinforce the importance of adherence
to monitoring and avoiding interacting medications.
Difficulty: Easy
Bloom’s level: Application
NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies
Q4. The nurse is calculating the heart rate from an EKG strip.
The strip shows 25 small boxes between two R waves. What is
the heart rate? (Show math)
A. 60 bpm
B. 75 bpm
C. 100 bpm
, D. 150 bpm
Answer: A
Rationale:
• The heart rate is calculated by dividing 1500 by the number of
small boxes between R waves: 1500 ÷ 25 = 60 bpm.
• Math: 1500 ÷ 25 = 60 bpm.
• B is incorrect because 1500 ÷ 20 = 75 bpm, but here there are
25 boxes.
• C is incorrect because 1500 ÷ 15 = 100 bpm.
• D is incorrect because 1500 ÷ 10 = 150 bpm.
• Quick nursing action: Verify the rate manually and correlate
with patient symptoms.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q5. A 55-year-old male presents to the ED with crushing
substernal chest pain radiating to the left arm, nausea, and
diaphoresis. Vital signs: BP 148/90, HR 110, RR 24, SpO2 94%.
What is the priority nursing action?
A. Administer morphine sulfate 4 mg IV.
B. Obtain a 12-lead EKG within 10 minutes.
C. Give sublingual nitroglycerin every 5 minutes.
D. Draw blood for cardiac enzymes.
Answer: B
Rationale:
• Rapid EKG acquisition is critical to identify STEMI and activate
Undergraduate
Q1. A 68-year-old patient is admitted with palpitations. The
monitor shows a rhythm with a rate of 150 bpm, regular,
narrow QRS complexes, and no visible P waves. Which rhythm
does this describe?
A. Atrial fibrillation
B. Sinus tachycardia
C. Ventricular tachycardia
D. Supraventricular tachycardia
Answer: D
Rationale:
• Supraventricular tachycardia (SVT) is characterized by a rapid
rate (150-250 bpm), regular rhythm, narrow QRS, and absent P
waves due to reentry mechanisms above the ventricles.
• A is incorrect because atrial fibrillation has an irregular
rhythm with no discernible P waves.
• B is incorrect because sinus tachycardia has visible P waves
preceding each QRS complex.
• C is incorrect because ventricular tachycardia has wide QRS
complexes (>0.12 seconds).
• Quick nursing action: Assess for hemodynamic stability and
prepare for vagal maneuvers or adenosine administration.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
,Q2. A patient's EKG shows a rhythm with a rate of 40 bpm,
regular, wide QRS complexes, and no association between P
waves and QRS complexes. What is the priority nursing action?
A. Administer atropine 0.5 mg IV.
B. Prepare for transcutaneous pacing.
C. Assess the patient's level of consciousness.
D. Obtain a 12-lead EKG.
Answer: C
Rationale:
• The rhythm described is third-degree AV block, which can
cause hemodynamic compromise; assessing consciousness and
perfusion status is the first priority to determine urgency of
intervention.
• A is incorrect because atropine is often ineffective in third-
degree AV block as the block is typically infra-nodal.
• B is incorrect while pacing may be needed, assessment must
come first to guide treatment.
• D is incorrect because diagnostic tests should not delay
assessment of patient stability.
• Quick nursing action: Check for signs of poor perfusion such
as dizziness, hypotension, or syncope.
Difficulty: Hard
Bloom’s level: Analysis
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q3. A patient with atrial fibrillation is prescribed warfarin. The
nurse is educating the patient about the medication. Which
,statement by the patient indicates understanding?
A. "I will avoid eating green leafy vegetables."
B. "I need to have my blood drawn weekly to check my INR."
C. "If I miss a dose, I should double up the next day."
D. "I can take aspirin for headaches instead of acetaminophen."
Answer: B
Rationale:
• Warfarin requires regular INR monitoring to maintain
therapeutic levels and prevent thromboembolism or bleeding.
• A is incorrect because patients should maintain consistent
vitamin K intake rather than avoid it entirely.
• C is incorrect because doubling doses can lead to overdose
and bleeding; missed doses should be managed as per protocol.
• D is incorrect because aspirin increases bleeding risk when
combined with warfarin.
• Quick nursing action: Reinforce the importance of adherence
to monitoring and avoiding interacting medications.
Difficulty: Easy
Bloom’s level: Application
NCLEX client need & subcategory: Pharmacological and
Parenteral Therapies
Q4. The nurse is calculating the heart rate from an EKG strip.
The strip shows 25 small boxes between two R waves. What is
the heart rate? (Show math)
A. 60 bpm
B. 75 bpm
C. 100 bpm
, D. 150 bpm
Answer: A
Rationale:
• The heart rate is calculated by dividing 1500 by the number of
small boxes between R waves: 1500 ÷ 25 = 60 bpm.
• Math: 1500 ÷ 25 = 60 bpm.
• B is incorrect because 1500 ÷ 20 = 75 bpm, but here there are
25 boxes.
• C is incorrect because 1500 ÷ 15 = 100 bpm.
• D is incorrect because 1500 ÷ 10 = 150 bpm.
• Quick nursing action: Verify the rate manually and correlate
with patient symptoms.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need & subcategory: Physiological Adaptation:
Cardiovascular & Pulmonary
Q5. A 55-year-old male presents to the ED with crushing
substernal chest pain radiating to the left arm, nausea, and
diaphoresis. Vital signs: BP 148/90, HR 110, RR 24, SpO2 94%.
What is the priority nursing action?
A. Administer morphine sulfate 4 mg IV.
B. Obtain a 12-lead EKG within 10 minutes.
C. Give sublingual nitroglycerin every 5 minutes.
D. Draw blood for cardiac enzymes.
Answer: B
Rationale:
• Rapid EKG acquisition is critical to identify STEMI and activate
