2026 NR 341 2025 Quiz and Review Pack: Critical Thinking and Clinical Scenarios

Inotropic drugs primarily affect: a. The force of cardiac contraction b. Heart rate c. Conduction velocity d. Blood pressure Rationale: Inotropic drugs modify myocardial contractility. Chronotropic drugs affect heart rate, and dromotropic drugs affect conduction velocity. A positive dromotropic drug example is: a. Phenytoin b. Verapamil c. Epinephrine d. Digoxin Rationale: Positive dromotropic drugs increase conduction velocity. Verapamil is negative dromotropic, epinephrine is positive chronotropic, and digoxin is negative chronotropic. A patient with acute respiratory failure has the nursing diagnosis "Risk for Ineffective Airway Clearance." Which intervention is most relevant? a. Elevate head of bed to 30° b. Obtain VTE prophylaxis order c. Provide sedation d. Reposition patient every 2 hours Rationale: Repositioning helps mobilize secretions and maintain airway clearance. Head elevation and sedation are supportive, VTE prophylaxis is unrelated to airway clearance. Which patient should the nurse call rapid response EMS for? (Select all that apply) a. 53-year-old with pneumonia and severe respiratory distress c. 24-year-old experiencing a severe asthmatic attack with stridor d. 73-year-old patient with bradycardia of 40 beats/min Rationale: Patients with severe respiratory distress or hemodynamic compromise require immediate evaluation. Apnea and absent pulse are emergencies as well. A patient with ARDS is likely to exhibit: a. Decreasing PaO2 despite increased FiO2 b. Elevated alveolar surfactant c. Increased lung compliance d. Respiratory alkalosis Rationale: ARDS causes hypoxemia that does not respond to oxygen therapy. Surfactant is reduced, compliance is decreased, and respiratory acidosis may develop, not alkalosis. Fluid in the alveoli causes: a. Alveoli collapse b. Impaired diffusion of oxygen and carbon dioxide c. Hypoventilation d. Heart failure Rationale: Alveolar fluid hinders gas exchange, impairing oxygen and CO2 diffusion. It does not necessarily collapse alveoli or indicate heart failure directly. The underlying pathophysiology of ARDS involves: a. Decreased WBCs b. Right mainstem bronchus damage c. Damage to type II pneumocytes d. Decreased capillary permeability Rationale: Type II pneumocyte injury decreases surfactant production, causing alveolar collapse and impaired gas exchange. A patient with COPD exacerbation and acute respiratory failure may initially receive: a. Emergency tracheostomy b. Endotracheal intubation c. Noninvasive positive-pressure ventilation (NPPV) d. Oxygen via bag-valve-mask Rationale: NPPV reduces the need for intubation in COPD exacerbations. Emergency airway measures are reserved for severe or failing patients. Which acid-base disturbance occurs in severe asthma exacerbation with impaired gas exchange? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis Rationale: Hypoventilation from airway obstruction causes CO2 retention, leading to respiratory acidosis. Pulmonary embolism (PE) should be suspected in: a. Any patient with unexplained cardiorespiratory complaints and VTE risk factors b. Patients with bradycardia and hyperventilation c. Patients with dyspnea, chest pain, and hemoptysis in all cases d. Critically ill patients at low risk Rationale: PE can present variably; unexplained symptoms in at-risk patients warrant suspicion. Classic triad occurs in only a minority. Definitive diagnosis of PE is made by: a. ABG analysis b. Chest X-ray c. Pulmonary angiogram d. V/Q scan Rationale: Pulmonary angiography is gold standard for PE diagnosis. Other tests are supportive. For patients at risk of PE who cannot take anticoagulants, the preventive strategy is: a. Aspirin b. Thrombolytics c. Vena cava filter d. Subcutaneous heparin Rationale: IVC filters mechanically prevent emboli from reaching pulmonary circulation. A treatment for dissolving a thrombus in the pulmonary artery is: a. Aspirin b. Embolectomy c. Heparin d. Thrombolytics Rationale: Thrombolytics actively lyse clots. Heparin prevents propagation, embolectomy is surgical, aspirin is not sufficient. ARDS assessment may include: a. Increased oxygen saturation b. Increased peak inspiratory pressure on ventilator c. Normal chest radiograph d. PaO2/FiO2 ratio >300 Rationale: Poor lung compliance increases ventilator pressures. Hypoxemia and bilateral infiltrates are expected. PaO2/FiO2 ratio calculation: PaO2 = 78 mm Hg, FiO2 = 0.6 a. 46.8 b. 130 c. 468 d. Not enough data Rationale: 78 ÷ 0.6 = 130, meeting ARDS criteria (PaO2/FiO2 <200–300). ACE inhibitors started within 24 hours post-AMI reduce: a. Myocardial stunning b. Hibernating myocardium c. Myocardial remodeling d. Tachycardia Rationale: ACE inhibitors prevent ventricular remodeling after AMI, reducing risk of heart failure. Unstable angina is caused by: a. Complete coronary occlusion b. Fatty streak c. Partial occlusion with thrombus d. Vasospasm Rationale: Blood flow is partially reduced by thrombus formation, leading to unstable angina. An initial drug regimen for angina includes: a. ACE inhibitors and diuretics b. Morphine and oxygen c. Nitroglycerin, oxygen, and beta blockers d. Statins and nicotinic acid Rationale: These medications relieve ischemia and reduce myocardial oxygen demand. Which drug effect increases heart rate? a. Chronotropic b. Inotropic c. Dromotropic d. Antiarrhythmic Rationale: Chronotropic effects influence the rate of cardiac contractions. Inotropic affects force, dromotropic affects conduction velocity. A negative chronotropic drug example is: a. Epinephrine b. Digoxin c. Dopamine d. Dobutamine Rationale: Digoxin slows the heart rate (negative chronotropic). Epinephrine increases heart rate. Dopamine and dobutamine primarily affect contractility. A patient with severe respiratory distress has low oxygen saturation and tachypnea. The nurse should: a. Call rapid response immediately b. Monitor and reassess in 30 minutes c. Administer routine oxygen only d. Place patient in semi-Fowler’s Rationale: Severe respiratory distress with hypoxemia requires immediate rapid response intervention. Which patient requires rapid response due to airway compromise? a. 40-year-old with mild cough b. 24-year-old with severe asthmatic attack and stridor c. 60-year-old post-op with stable vitals d. 18-year-old with mild dyspnea Rationale: Stridor indicates upper airway obstruction; immediate intervention is required. In ARDS, PaO2 does not improve despite high FiO2 because: a. CO2 retention is excessive b. Alveolar-capillary membrane damage prevents gas exchange c. Lung compliance is high d. Surfactant levels are elevated Rationale: ARDS damages alveolar-capillary membrane, impairing oxygen diffusion regardless of supplemental oxygen. Noninvasive positive-pressure ventilation (NPPV) is preferred in: a. Cardiac arrest b. Severe hypoxemic respiratory failure c. COPD exacerbation with hypercapnia d. Status asthmaticus unresponsive to therapy Rationale: NPPV supports ventilation in COPD exacerbations to reduce intubation risk. A patient with PE may present with: a. Dyspnea, chest pain, unexplained hypoxemia b. Bradycardia and hyperventilation only c. Classic triad in all cases d. Low VTE risk Rationale: PE presentation is variable; unexplained dyspnea or hypoxemia with risk factors should raise suspicion. Which diagnostic test definitively confirms PE? a. Chest X-ray b. ABG c. Pulmonary angiogram d. V/Q scan Rationale: Pulmonary angiography is the gold standard. ABG and V/Q scan are supportive but not definitive. For a patient who cannot receive anticoagulants, PE prevention may involve: a. Aspirin b. Thrombolytics c. Vena cava filter d. Subcutaneous heparin Rationale: IVC filters prevent emboli from reaching lungs mechanically. A thrombolytic drug is used to: a. Prevent clot formation b. Surgically remove a thrombus c. Anticoagulate blood d. Dissolve an existing thrombus Rationale: Thrombolytics actively lyse existing clots. Anticoagulants only prevent growth. In ARDS, an expected ventilator finding is: a. Decreased peak inspiratory pressure b. Increased peak inspiratory pressure c. PaO2/FiO2 ratio >300 d. Normal compliance Rationale: Stiff lungs in ARDS increase peak inspiratory pressures. A PaO2/FiO2 ratio of 130 indicates: a. Normal lung function b. Moderate ARDS c. Severe hyperoxia d. Insufficient data Rationale: Ratio <200–300 meets ARDS criteria. After AMI, ACE inhibitors reduce: a. Myocardial stunning b. Tachycardia c. Ventricular remodeling d. Hibernating myocardium Rationale: ACE inhibitors prevent ventricular dilation and remodeling, reducing heart failure risk. Unstable angina occurs due to: a. Complete coronary occlusion b. Vasospasm alone c. Partial occlusion with thrombus d. Fatty streak Rationale: Blood flow is partially restricted by thrombus formation, causing ischemia without full infarction. Initial drug therapy for angina includes: a. Statins and diuretics b. Morphine and oxygen c. Nitroglycerin, oxygen, and beta blockers d. ACE inhibitors and calcium channel blockers Rationale: These drugs reduce myocardial oxygen demand and improve perfusion. For a suspected papillary muscle rupture post-MI, the nurse should assess for: a. S3 heart sound b. New murmur c. S1 heart sound d. Gallop rhythm Rationale: Papillary muscle rupture produces acute mitral regurgitation, indicated by a new systolic murmur. Silent MI is most likely in patients who present with: a. Hypokalemia b. Non-Q wave MI c. Silent myocardial infarction d. Unstable angina Rationale: Elderly or diabetic patients may present with minimal or atypical symptoms despite elevated troponins and ECG changes. A patient with chest pain >12 hours is not a candidate for thrombolysis because: a. Symptoms exceed the therapeutic window b. Thrombolysis is contraindicated in all MI c. History favors non-Q wave MI only d. Thrombolysis is unnecessary with ST depression Rationale: Thrombolysis is only effective within 12 hours of symptom onset. For 80% left main coronary artery occlusion, the preferred procedure is: a. Coronary artery bypass graft (CABG) b. Percutaneous coronary intervention c. Stent placement d. Transmyocardial revascularization Rationale: Significant left main occlusion requires surgical revascularization to ensure adequate perfusion. Recurrent supraventricular tachycardia related to reentry pathway is treated with: a. Permanent pacemaker b. Implantable cardioverter-defibrillator c. Radiofrequency catheter ablation d. Temporary transvenous pacing Rationale: Catheter ablation interrupts abnormal conduction pathways, curing SVT. Acute aortic dissection is suspected when: a. Cardiac enzymes elevated b. Prepare for thrombolysis c. Systolic BP discrepancy and severe chest/back pain d. Administer aspirin and heparin Rationale: Sudden chest/back pain with unequal arm pressures indicates aortic dissection, a surgical emergency.