NUR 265 – MEDICAL-SURGICAL NURSING
EXAM 2 (2025/2026) QUESTIONS AND CORRECT
ANSWERS GRADED A+ GALEN
A nurse cares for a client with an intravenous temporary pacemaker for
bradycardia. The nurse observes the presence of a pacing spike but no QRS
complex on the client's electrocardiogram. Which action should the nurse take
next?
a.Administer intravenous diltiazem (Cardizem).
b.Assess vital signs and level of consciousness.
c.Administer sublingual nitroglycerin.
d.Assess capillary refill and temperature.
ANS: B
In temporary pacing, the wires are threaded onto the epicardial surface of the heart
and exit through the chest wall. The pacemaker spike should be followed
immediately by a QRS complex. Pacing spikes seen without subsequent QRS
complexes imply loss of capture. If there is no capture, then there is no ventricular
depolarization and contraction. The nurse should assess for cardiac output via vital
signs and level of consciousness. The other interventions would not determine if
the client is tolerating the loss of capture.
A nurse is assessing clients on a medical-surgical unit. Which client should the
nurse identify as being at greatest risk for atrial fibrillation?
a.A 45-year-old who takes an aspirin daily
b.A 50-year-old who is post coronary artery bypass graft surgery
c.A 78-year-old who had a carotid endarterectomy
d.An 80-year-old with chronic obstructive pulmonary disease
,ANS: B
Atrial fibrillation occurs commonly in clients with cardiac disease and is a
common occurrence after coronary artery bypass graft surgery. The other
conditions do not place these clients at higher risk for atrial fibrillation.
A nurse assesses a client with atrial fibrillation. Which manifestation should alert
the nurse to the possibility of a serious complication from this condition?
a.Sinus tachycardia
b.Speech alterations
c.Fatigue
d.Dyspnea with activity
ANS: B
Clients with atrial fibrillation are at risk for embolic stroke. Evidence of embolic
events includes changes in mentation, speech, sensory function, and motor
function. Clients with atrial fibrillation often have a rapid ventricular response as a
result. Fatigue is a nonspecific complaint. Clients with atrial fibrillation often have
dyspnea as a result of the decreased cardiac output caused by the rhythm
disturbance.
A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which
medication should the nurse expect to find on this client's medication
administration record to prevent a common complication of this condition?
a.
Sotalol (Betapace)
b.
Warfarin (Coumadin)
c.
,Atropine (Sal-Tropine)
d.
Lidocaine (Xylocaine)
ANS: B
Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for
emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin.
Sotalol, atropine, and lidocaine are not appropriate for this complication.
A nurse assesses a client's electrocardiograph tracing and observes that not all QRS
complexes are preceded by a P wave. How should the nurse interpret this
observation?
a.
The client has hyperkalemia causing irregular QRS complexes.
b.
Ventricular tachycardia is overriding the normal atrial rhythm.
c.
The client's chest leads are not making sufficient contact with the skin.
d.
Ventricular and atrial depolarizations are initiated from different sites.
ANS: D
Normal rhythm shows one P wave preceding each QRS complex, indicating that
all depolarization is initiated at the sinoatrial node. QRS complexes without a P
wave indicate a different source of initiation of depolarization. This finding on an
electrocardiograph tracing is not an indication of hyperkalemia, ventricular
tachycardia, or disconnection of leads.
, A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which
priority intervention should the nurse perform prior to defibrillating this client?
a.
Make sure the defibrillator is set to the synchronous mode.
b.
Administer 1 mg of intravenous epinephrine.
c.
Test the equipment by delivering a smaller shock at 100 joules.
d.
Ensure that everyone is clear of contact with the client and the bed.
ANS: D
To avoid injury, the rescuer commands that all personnel clear contact with the
client or the bed and ensures their compliance before delivery of the shock. A
precordial thump can be delivered when no defibrillator is available. Defibrillation
is done in asynchronous mode. Equipment should not be tested before a client is
defibrillated because this is an emergency procedure; equipment should be checked
on a routine basis. Epinephrine should be administered after defibrillation.
After teaching a client who has an implantable cardioverter-defibrillator (ICD), a
nurse assesses the client's understanding. Which statement by the client indicates a
correct understanding of the teaching?
a.
"I should wear a snug-fitting shirt over the ICD."
b.
"I will avoid sources of strong electromagnetic fields."
c.
"I should participate in a strenuous exercise program."
EXAM 2 (2025/2026) QUESTIONS AND CORRECT
ANSWERS GRADED A+ GALEN
A nurse cares for a client with an intravenous temporary pacemaker for
bradycardia. The nurse observes the presence of a pacing spike but no QRS
complex on the client's electrocardiogram. Which action should the nurse take
next?
a.Administer intravenous diltiazem (Cardizem).
b.Assess vital signs and level of consciousness.
c.Administer sublingual nitroglycerin.
d.Assess capillary refill and temperature.
ANS: B
In temporary pacing, the wires are threaded onto the epicardial surface of the heart
and exit through the chest wall. The pacemaker spike should be followed
immediately by a QRS complex. Pacing spikes seen without subsequent QRS
complexes imply loss of capture. If there is no capture, then there is no ventricular
depolarization and contraction. The nurse should assess for cardiac output via vital
signs and level of consciousness. The other interventions would not determine if
the client is tolerating the loss of capture.
A nurse is assessing clients on a medical-surgical unit. Which client should the
nurse identify as being at greatest risk for atrial fibrillation?
a.A 45-year-old who takes an aspirin daily
b.A 50-year-old who is post coronary artery bypass graft surgery
c.A 78-year-old who had a carotid endarterectomy
d.An 80-year-old with chronic obstructive pulmonary disease
,ANS: B
Atrial fibrillation occurs commonly in clients with cardiac disease and is a
common occurrence after coronary artery bypass graft surgery. The other
conditions do not place these clients at higher risk for atrial fibrillation.
A nurse assesses a client with atrial fibrillation. Which manifestation should alert
the nurse to the possibility of a serious complication from this condition?
a.Sinus tachycardia
b.Speech alterations
c.Fatigue
d.Dyspnea with activity
ANS: B
Clients with atrial fibrillation are at risk for embolic stroke. Evidence of embolic
events includes changes in mentation, speech, sensory function, and motor
function. Clients with atrial fibrillation often have a rapid ventricular response as a
result. Fatigue is a nonspecific complaint. Clients with atrial fibrillation often have
dyspnea as a result of the decreased cardiac output caused by the rhythm
disturbance.
A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which
medication should the nurse expect to find on this client's medication
administration record to prevent a common complication of this condition?
a.
Sotalol (Betapace)
b.
Warfarin (Coumadin)
c.
,Atropine (Sal-Tropine)
d.
Lidocaine (Xylocaine)
ANS: B
Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for
emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin.
Sotalol, atropine, and lidocaine are not appropriate for this complication.
A nurse assesses a client's electrocardiograph tracing and observes that not all QRS
complexes are preceded by a P wave. How should the nurse interpret this
observation?
a.
The client has hyperkalemia causing irregular QRS complexes.
b.
Ventricular tachycardia is overriding the normal atrial rhythm.
c.
The client's chest leads are not making sufficient contact with the skin.
d.
Ventricular and atrial depolarizations are initiated from different sites.
ANS: D
Normal rhythm shows one P wave preceding each QRS complex, indicating that
all depolarization is initiated at the sinoatrial node. QRS complexes without a P
wave indicate a different source of initiation of depolarization. This finding on an
electrocardiograph tracing is not an indication of hyperkalemia, ventricular
tachycardia, or disconnection of leads.
, A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which
priority intervention should the nurse perform prior to defibrillating this client?
a.
Make sure the defibrillator is set to the synchronous mode.
b.
Administer 1 mg of intravenous epinephrine.
c.
Test the equipment by delivering a smaller shock at 100 joules.
d.
Ensure that everyone is clear of contact with the client and the bed.
ANS: D
To avoid injury, the rescuer commands that all personnel clear contact with the
client or the bed and ensures their compliance before delivery of the shock. A
precordial thump can be delivered when no defibrillator is available. Defibrillation
is done in asynchronous mode. Equipment should not be tested before a client is
defibrillated because this is an emergency procedure; equipment should be checked
on a routine basis. Epinephrine should be administered after defibrillation.
After teaching a client who has an implantable cardioverter-defibrillator (ICD), a
nurse assesses the client's understanding. Which statement by the client indicates a
correct understanding of the teaching?
a.
"I should wear a snug-fitting shirt over the ICD."
b.
"I will avoid sources of strong electromagnetic fields."
c.
"I should participate in a strenuous exercise program."
