NUR 254 Medical-Surgical Nursing II Exam 2 Question Bank
(150 High-Yield Questions) | Full Explanations Included |
Advanced Critical Care, Neurological Crises, DIC/HIT, and
Parkland Fluid Resuscitation
Advanced Cardiovascular & Dysrhythmia Management (Questions 1–20)
1. A patient with a history of acute myocardial infarction is admitted to the
progressive care unit. The cardiac monitor suddenly sounds an alarm, displaying
a rapid, regular, saw-tooth waveform at a atrial rate of 300 beats/minute. The
ventricular rate is stable at 75 beats/minute. The nurse identifies this rhythm as:
A. Ventricular Fibrillation
B. Atrial Flutter with 4:1 conduction block
C. Sinus Tachycardia with artifact
D. Third-degree Atrioventricular Block
Rationale: Atrial flutter is characterized by a classic, regular "saw-tooth" or
"picket fence" baseline flutter (F) wave pattern. When the atrial rate is 300 and
the ventricular rate is 75, it demonstrates a precise 4:1 conduction block, where
the AV node blocks every 4th impulse to protect the ventricles.
,2. The nurse notes a patient's telemetry strip displays a normal sinus rhythm
that is interrupted by a sudden pause, followed by a wide, distorted QRS
complex (> 0.12 seconds) that lacks an preceding P wave. The T wave is oriented
in the opposite direction of the QRS. How should the nurse document this beat?
A. Premature Atrial Contraction (PAC)
B. Junctional Escape Beat
C. Premature Ventricular Contraction (PVC)
D. First-degree AV Block
Rationale: PVCs originate from an ectopic focus in the ventricles. Because
they bypass the normal fast-conducting His-Purkinje system, ventricular
depolarization is slow and inefficient, resulting in a wide, bizarre QRS complex
with no preceding P wave and a compensatory pause.
3. A patient diagnosed with persistent Atrial Fibrillation is scheduled for an
elective synchronized cardioversion. Which diagnostic test must the nurse verify
has been performed and cleared to rule out localized atrial thrombi before the
procedure?
A. 12-lead Electrocardiogram (ECG)
B. Transesophageal Echocardiogram (TEE)
,C. Exercise Stress Test
D. Pulmonary Function Test (PFT)
Rationale: Atrial fibrillation causes structural blood stasis in the atria,
increasing clot formation risks. A synchronized cardioversion can dislodge a hidden
clot, triggering an embolic stroke. A TEE visually checks the left atrial appendage
for thrombi prior to the shock.
4. The nurse answers a call light and finds a patient unresponsive, pulseless, and
apneic. The cardiac monitor displays an disorganized, chaotic, undulating
baseline with no identifiable P waves, QRS complexes, or T waves. What is the
nurse's very first action?
A. Administer a 1 mg IV push dose of epinephrine
B. Deliver a synchronized cardioversion shock at 100 Joules
C. Call for help, initiate high-quality chest compressions, and prepare to
defibrillate
D. Intubate the patient immediately using an endotracheal tube
Rationale: Ventricular Fibrillation (VF) is a lethal, pulseless dysrhythmia. The
immediate treatment priorities are calling a code, starting CPR to preserve vital
, organ perfusion, and delivering an unsynchronized shock (defibrillation) as soon as
the machine arrives.
5. A patient on the telemetry floor develops Third-degree (Complete)
Atrioventricular Block. The nurse reviews the strip. Which relationship between
P waves and QRS complexes defines this dysrhythmia?
A. The PR interval progressively lengthens until a QRS complex is dropped
B. P waves are completely absent, replaced by fine fibrillatory vectors
C. P waves and QRS complexes walk out regularly but occur completely
independent of each other
D. The PR interval is fixed and prolonged to over 0.24 seconds
Rationale: In third-degree AV block, there is a complete block of impulses
from the atria to the ventricles. The atria beat independently (driven by the SA
node) and the ventricles beat independently (driven by an escape pacemaker),
causing total AV dissociation.
6. Which first-line pharmacologic agent should the nurse prepare to administer
intravenously to a symptomatic patient presenting with a sinus bradycardia of
38 beats/minute, hypotension, and diaphoresis?
A. Atropine sulfate
(150 High-Yield Questions) | Full Explanations Included |
Advanced Critical Care, Neurological Crises, DIC/HIT, and
Parkland Fluid Resuscitation
Advanced Cardiovascular & Dysrhythmia Management (Questions 1–20)
1. A patient with a history of acute myocardial infarction is admitted to the
progressive care unit. The cardiac monitor suddenly sounds an alarm, displaying
a rapid, regular, saw-tooth waveform at a atrial rate of 300 beats/minute. The
ventricular rate is stable at 75 beats/minute. The nurse identifies this rhythm as:
A. Ventricular Fibrillation
B. Atrial Flutter with 4:1 conduction block
C. Sinus Tachycardia with artifact
D. Third-degree Atrioventricular Block
Rationale: Atrial flutter is characterized by a classic, regular "saw-tooth" or
"picket fence" baseline flutter (F) wave pattern. When the atrial rate is 300 and
the ventricular rate is 75, it demonstrates a precise 4:1 conduction block, where
the AV node blocks every 4th impulse to protect the ventricles.
,2. The nurse notes a patient's telemetry strip displays a normal sinus rhythm
that is interrupted by a sudden pause, followed by a wide, distorted QRS
complex (> 0.12 seconds) that lacks an preceding P wave. The T wave is oriented
in the opposite direction of the QRS. How should the nurse document this beat?
A. Premature Atrial Contraction (PAC)
B. Junctional Escape Beat
C. Premature Ventricular Contraction (PVC)
D. First-degree AV Block
Rationale: PVCs originate from an ectopic focus in the ventricles. Because
they bypass the normal fast-conducting His-Purkinje system, ventricular
depolarization is slow and inefficient, resulting in a wide, bizarre QRS complex
with no preceding P wave and a compensatory pause.
3. A patient diagnosed with persistent Atrial Fibrillation is scheduled for an
elective synchronized cardioversion. Which diagnostic test must the nurse verify
has been performed and cleared to rule out localized atrial thrombi before the
procedure?
A. 12-lead Electrocardiogram (ECG)
B. Transesophageal Echocardiogram (TEE)
,C. Exercise Stress Test
D. Pulmonary Function Test (PFT)
Rationale: Atrial fibrillation causes structural blood stasis in the atria,
increasing clot formation risks. A synchronized cardioversion can dislodge a hidden
clot, triggering an embolic stroke. A TEE visually checks the left atrial appendage
for thrombi prior to the shock.
4. The nurse answers a call light and finds a patient unresponsive, pulseless, and
apneic. The cardiac monitor displays an disorganized, chaotic, undulating
baseline with no identifiable P waves, QRS complexes, or T waves. What is the
nurse's very first action?
A. Administer a 1 mg IV push dose of epinephrine
B. Deliver a synchronized cardioversion shock at 100 Joules
C. Call for help, initiate high-quality chest compressions, and prepare to
defibrillate
D. Intubate the patient immediately using an endotracheal tube
Rationale: Ventricular Fibrillation (VF) is a lethal, pulseless dysrhythmia. The
immediate treatment priorities are calling a code, starting CPR to preserve vital
, organ perfusion, and delivering an unsynchronized shock (defibrillation) as soon as
the machine arrives.
5. A patient on the telemetry floor develops Third-degree (Complete)
Atrioventricular Block. The nurse reviews the strip. Which relationship between
P waves and QRS complexes defines this dysrhythmia?
A. The PR interval progressively lengthens until a QRS complex is dropped
B. P waves are completely absent, replaced by fine fibrillatory vectors
C. P waves and QRS complexes walk out regularly but occur completely
independent of each other
D. The PR interval is fixed and prolonged to over 0.24 seconds
Rationale: In third-degree AV block, there is a complete block of impulses
from the atria to the ventricles. The atria beat independently (driven by the SA
node) and the ventricles beat independently (driven by an escape pacemaker),
causing total AV dissociation.
6. Which first-line pharmacologic agent should the nurse prepare to administer
intravenously to a symptomatic patient presenting with a sinus bradycardia of
38 beats/minute, hypotension, and diaphoresis?
A. Atropine sulfate
