NUR 417 Final Exam (2026/2027) | Care of Adult II | Concordia
University St. Paul (PDF), Exams of Nursing Comprehensive
Assessment
2026-2027 | 100 Questions | 100% VERIFIED
Introduction
This comprehensive assessment is designed in strict alignment with the NUR 417 Care of Adult II
curriculum standards and advanced medical-surgical critical care nursing competencies at Concordia
University St. Paul. The question bank provides rigorous, in-depth evaluation across eight core
foundational domains: Complex Cardiovascular and Hemodynamic Disorders (acute coronary
syndromes, invasive arterial and pulmonary artery catheter monitoring, cardiogenic shock, lethal
ventricular arrhythmias, advanced heart blocks, hypertensive crisis, aortic dissection, and tamponade),
Advanced Respiratory and Pulmonary Pathophysiology (ARDS lung-protective ventilation, prone
positioning, VAP prevention bundle, massive pulmonary embolism, tension pneumothorax, status
asthmaticus, and advanced acid-base analysis), Neurological and Neurosurgical Care (intracranial
pressure dynamics, Monro-Kellie hypothesis, Cushing's triad, ischemic stroke thrombolytic protocols,
subarachnoid hemorrhage vasospasm, spinal cord injury, autonomic dysreflexia, and brain death
determination), Endocrine and Metabolic Alterations (diabetic ketoacidosis resuscitation, hyperosmolar
hyperglycemic state, SIADH, diabetes insipidus, thyroid storm, myxedema coma, and adrenal crisis),
Gastrointestinal and Hepatic Disorders (acute liver failure, esophageal varices, hepatic encephalopathy,
acute necrotizing pancreatitis, small bowel obstruction, mesenteric ischemia, and abdominal
compartment syndrome), Renal and Urological Dysfunction (KDIGO acute kidney injury staging,
rhabdomyolysis, severe hyperkalemia management stacks, hemodialysis vascular access, continuous
renal replacement therapy, peritoneal dialysis peritonitis, and renal transplantation), Oncology and
Palliative Care (tumor lysis syndrome, superior vena cava syndrome, spinal cord compression,
hypercalcemia of malignancy, neutropenic fever, vesicant extravasation, radiation safety, and hospice
end-of-life symptom control), and Multisystem Complications and Critical Care Nursing (Surviving
Sepsis Campaign Hour-1 bundle, massive transfusion protocols, anaphylactic shock, disseminated
intravascular coagulation, multiple organ dysfunction syndrome, Parkland burn resuscitation, carbon
monoxide poisoning, targeted temperature management, and critical care delirium bundles). Mastering
these advanced clinical competencies is essential for achieving academic progression, NCLEX-RN
mastery, and delivering superior adult health nursing clinical execution.
Question 1: A 62-year-old client presents to the emergency department with severe crushing
substernal chest pain radiating to the left jaw. The 12-lead ECG demonstrates ST-segment elevation of 3
mm in leads V1, V2, V3, and V4. Which coronary artery is occluded, and what is the target door-to-
balloon time for emergent percutaneous coronary intervention (PCI)?
A) Left anterior descending (LAD) artery; target door-to-balloon time is within 90 minutes of hospital
arrival
, B) Posterior descending artery (PDA); target door-to-balloon time is within 12 hours of hospital arrival
C) Right coronary artery (RCA); target door-to-balloon time is within 180 minutes of hospital arrival
D) Left circumflex (LCx) artery; target door-to-balloon time is within 24 hours of hospital arrival
Correct Answer: A) Left anterior descending (LAD) artery; target door-to-balloon time is
within 90 minutes of hospital arrival
Rationale: ST-segment elevation in precordial leads V1 through V4 indicates an acute anterior wall
myocardial infarction, which is caused by occlusion of the Left Anterior Descending (LAD) coronary
artery ('the widow maker'). According to American College of Cardiology (ACC) and American Heart
Association (AHA) emergency clinical guidelines, the benchmark standard for emergent reperfusion
therapy via primary Percutaneous Coronary Intervention (PCI) is a door-to-balloon time of ≤ 90 minutes
from hospital arrival.
Question 2: A nurse is caring for a critically ill client who has a left radial arterial line in place for
continuous blood pressure monitoring. To ensure accurate hemodynamic pressure readings, at which
anatomical landmark must the pressure transducer be leveled and zeroed?
A) The 6th intercostal space at the anterior axillary line (representing the left ventricular apex)
B) The 2nd intercostal space at the right sternal border (representing the aortic arch)
C) The sternal notch at the base of the neck
D) The phlebostatic axis, located at the 4th intercostal space at the mid-axillary line (representing the
level of the right atrium)
Correct Answer: D) The phlebostatic axis, located at the 4th intercostal space at the mid-
axillary line (representing the level of the right atrium)
Rationale: Accurate invasive arterial and central venous pressure monitoring requires zeroing and
leveling the transducer to the phlebostatic axis. The phlebostatic axis is anatomically located at the
intersection of the 4th intercostal space and the mid-axillary line (or midway between anterior and
posterior chest surfaces), corresponding to the level of the right and left atria. Leveling above this point
produces falsely low readings; leveling below produces falsely high readings.
Question 3: A nurse is interpreting hemodynamic parameters from a pulmonary artery (Swan-Ganz)
catheter in a client in acute cardiogenic shock. Which set of hemodynamic values is characteristic of
cardiogenic shock?
A) Decreased CVP (< 2 mmHg), decreased PAOP (< 6 mmHg), elevated CI (> 4.5 L/min/m²), and
profoundly decreased SVR (< 500 dynes·s/cm⁵)
B) Decreased CVP (< 2 mmHg), decreased PAOP (< 6 mmHg), decreased CI (< 2.0 L/min/m²), and
elevated SVR (> 1,600 dynes·s/cm⁵)
C) Elevated Central Venous Pressure (CVP > 12 mmHg), elevated Pulmonary Artery Occlusion Pressure
(PAOP/PCWP > 18 mmHg), markedly decreased Cardiac Index (CI < 2.0 L/min/m²), and elevated
Systemic Vascular Resistance (SVR > 1,600 dynes·s/cm⁵)
D) Normal CVP (4 mmHg), normal PAOP (8 mmHg), normal CI (3.0 L/min/m²), and decreased SVR (<
600 dynes·s/cm⁵)
Correct Answer: C) Elevated Central Venous Pressure (CVP > 12 mmHg), elevated Pulmonary
Artery Occlusion Pressure (PAOP/PCWP > 18 mmHg), markedly decreased Cardiac Index (CI
< 2.0 L/min/m²), and elevated Systemic Vascular Resistance (SVR > 1,600 dynes·s/cm⁵)
Rationale: Cardiogenic shock results from severe primary pump failure (often secondary to massive
myocardial infarction). Because the left and right ventricles fail to eject blood forward, filling pressures
back up, causing elevated Central Venous Pressure (CVP > 12 mmHg, normal 2-6) and elevated
, Pulmonary Artery Occlusion Pressure (PAOP > 18 mmHg, normal 6-12). Cardiac Output/Index falls
precipitously (CI < 2.0 L/min/m², normal 2.5-4.0), and compensatory systemic vasoconstriction causes
elevated Systemic Vascular Resistance (SVR > 1,600 dynes·s/cm⁵, normal 800-1,200).
Question 4: An Intra-Aortic Balloon Pump (IABP) is inserted via the femoral artery for a client
experiencing refractory cardiogenic shock. During which phase of the cardiac cycle does the balloon
inflate, and what is the primary therapeutic mechanism achieved?
A) The balloon inflates during systole, forcing blood through the stenotic aortic valve, and deflates
during diastole
B) The balloon remains continuously inflated to create permanent retrograde flow into the pulmonary
veins
C) The balloon inflates during diastole (at the dicrotic notch on the arterial waveform), augmenting
coronary artery perfusion pressure, and deflates immediately prior to systole, reducing left ventricular
afterload and myocardial oxygen consumption
D) The balloon inflates during the P wave to stimulate atrial contraction, and deflates during the T wave
Correct Answer: C) The balloon inflates during diastole (at the dicrotic notch on the arterial
waveform), augmenting coronary artery perfusion pressure, and deflates immediately prior
to systole, reducing left ventricular afterload and myocardial oxygen consumption
Rationale: The Intra-Aortic Balloon Pump (IABP) operates through counterpulsation. Balloon inflation
occurs precisely at the onset of diastole (marked by the dicrotic notch on the arterial pressure trace),
displacing blood retrograde into the aortic root to augment coronary and cerebral artery perfusion.
Balloon deflation occurs immediately before ventricular systole (just prior to aortic valve opening),
creating a sudden vacuum effect that drastically reduces left ventricular afterload, cardiac workload, and
myocardial oxygen demand.
Question 5: A nurse monitors a telemetry rhythm strip showing coarse Ventricular Fibrillation (V-fib).
The client is unresponsive, pulseless, and apneic. According to current Advanced Cardiovascular Life
Support (ACLS) guidelines, which sequence of emergency interventions is correct?
A) Infuse a 1-liter bolus of 0.9% normal saline over 5 minutes and obtain a 12-lead ECG before initiating
compressions
B) Call for help and initiate high-quality CPR immediately, deliver an immediate unsynchronized
defibrillation shock (120 to 200 J biphasic), resume CPR for 2 minutes, establish IV/IO access, and
administer Epinephrine 1 mg IV every 3 to 5 minutes, followed by Amiodarone 300 mg IV bolus for
refractory V-fib
C) Perform transcutaneous pacing immediately at 80 mA, administer Adenosine 6 mg rapid IV push, and
withhold chest compressions
D) Administer synchronized cardioversion at 50 J, deliver Atropine 1 mg IV push, and check the carotid
pulse for 60 seconds
Correct Answer: B) Call for help and initiate high-quality CPR immediately, deliver an
immediate unsynchronized defibrillation shock (120 to 200 J biphasic), resume CPR for 2
minutes, establish IV/IO access, and administer Epinephrine 1 mg IV every 3 to 5 minutes,
followed by Amiodarone 300 mg IV bolus for refractory V-fib
Rationale: Ventricular Fibrillation (V-fib) and Pulseless Ventricular Tachycardia (pVT) are shockable
lethal cardiac arrest rhythms. The immediate priority is initiating high-quality chest compressions and
delivering an immediate unsynchronized defibrillation shock (120-200 J biphasic). CPR is resumed
immediately for 2 minutes before the next rhythm check. Vasopressor therapy with Epinephrine 1 mg
, IV/IO is administered every 3-5 minutes, and for shock-refractory V-fib/pVT, Amiodarone 300 mg IV
bolus (second dose 150 mg) or Lidocaine (1-1.5 mg/kg) is administered.
Question 6: A client on a telemetry unit develops a 3rd-Degree (Complete) Atrioventricular (AV) Block
with a ventricular escape rate of 28 bpm. The client is dizzy, pale, and has a blood pressure of 74/42
mmHg. What is the immediate definitive emergency nursing intervention?
A) Instruct the client to perform repeated Valsalva maneuvers and cough vigorously
B) Prepare for immediate Transcutaneous Pacing (TCP) while administering Atropine 1 mg IV push as a
temporary bridge, and notify the cardiac catheterization team for transvenous/permanent pacemaker
placement
C) Administer Adenosine 6 mg rapid IV push through a central line followed by an ice pack to the face
D) Perform synchronized electrical cardioversion at 100 J biphasic
Correct Answer: B) Prepare for immediate Transcutaneous Pacing (TCP) while administering
Atropine 1 mg IV push as a temporary bridge, and notify the cardiac catheterization team for
transvenous/permanent pacemaker placement
Rationale: In 3rd-degree (complete) AV block, there is total dissociation between atrial P waves and
ventricular QRS complexes; impulses from the SA node do not conduct to the ventricles. In an unstable,
symptomatic client (hypotension, altered perfusion), Atropine 1 mg IV may be attempted (though often
ineffective for infranodal blocks), and immediate Transcutaneous Pacing (TCP) must be initiated to
maintain adequate ventricular rate and cardiac output until a temporary transvenous or permanent
transvenous pacemaker can be placed.
Question 7: A client with a history of Wolf-Parkinson-White syndrome suddenly develops narrow-
complex Supraventricular Tachycardia (SVT) at a regular rate of 210 bpm. The client is alert and
hemodynamically stable with a blood pressure of 118/76 mmHg. What is the appropriate initial
pharmacological intervention?
A) Administer Digoxin 0.5 mg slow IV push over 20 minutes
B) Infuse Dopamine at 20 mcg/kg/min continuous IV infusion
C) Instruct the client to perform vagal maneuvers (such as a modified Valsalva maneuver), and if
unsuccessful, administer Adenosine 6 mg rapid IV push over 1 to 2 seconds followed immediately by a 20
mL rapid normal saline flush
D) Deliver an unsynchronized 200 J defibrillation shock immediately
Correct Answer: C) Instruct the client to perform vagal maneuvers (such as a modified
Valsalva maneuver), and if unsuccessful, administer Adenosine 6 mg rapid IV push over 1 to 2
seconds followed immediately by a 20 mL rapid normal saline flush
Rationale: For stable, narrow-complex Supraventricular Tachycardia (SVT), non-pharmacological vagal
maneuvers (e.g., modified Valsalva with passive leg raise or carotid sinus massage) are attempted first. If
SVT persists, the first-line medication is Adenosine 6 mg administered as a rapid IV push over 1-2
seconds through an antecubital or central vein, immediately followed by a rapid 20 mL 0.9% normal
saline flush and limb elevation. Adenosine temporarily blocks AV node conduction. If unsuccessful, a
second dose of 12 mg may be administered.
Question 8: A 54-year-old client is admitted to the intensive care unit in a Hypertensive Emergency
with a blood pressure of 230/135 mmHg, severe occipital headache, and bilateral papilledema. An
intravenous infusion of Nicardipine is initiated. What is the therapeutic goal for blood pressure
reduction over the initial hour of therapy?
University St. Paul (PDF), Exams of Nursing Comprehensive
Assessment
2026-2027 | 100 Questions | 100% VERIFIED
Introduction
This comprehensive assessment is designed in strict alignment with the NUR 417 Care of Adult II
curriculum standards and advanced medical-surgical critical care nursing competencies at Concordia
University St. Paul. The question bank provides rigorous, in-depth evaluation across eight core
foundational domains: Complex Cardiovascular and Hemodynamic Disorders (acute coronary
syndromes, invasive arterial and pulmonary artery catheter monitoring, cardiogenic shock, lethal
ventricular arrhythmias, advanced heart blocks, hypertensive crisis, aortic dissection, and tamponade),
Advanced Respiratory and Pulmonary Pathophysiology (ARDS lung-protective ventilation, prone
positioning, VAP prevention bundle, massive pulmonary embolism, tension pneumothorax, status
asthmaticus, and advanced acid-base analysis), Neurological and Neurosurgical Care (intracranial
pressure dynamics, Monro-Kellie hypothesis, Cushing's triad, ischemic stroke thrombolytic protocols,
subarachnoid hemorrhage vasospasm, spinal cord injury, autonomic dysreflexia, and brain death
determination), Endocrine and Metabolic Alterations (diabetic ketoacidosis resuscitation, hyperosmolar
hyperglycemic state, SIADH, diabetes insipidus, thyroid storm, myxedema coma, and adrenal crisis),
Gastrointestinal and Hepatic Disorders (acute liver failure, esophageal varices, hepatic encephalopathy,
acute necrotizing pancreatitis, small bowel obstruction, mesenteric ischemia, and abdominal
compartment syndrome), Renal and Urological Dysfunction (KDIGO acute kidney injury staging,
rhabdomyolysis, severe hyperkalemia management stacks, hemodialysis vascular access, continuous
renal replacement therapy, peritoneal dialysis peritonitis, and renal transplantation), Oncology and
Palliative Care (tumor lysis syndrome, superior vena cava syndrome, spinal cord compression,
hypercalcemia of malignancy, neutropenic fever, vesicant extravasation, radiation safety, and hospice
end-of-life symptom control), and Multisystem Complications and Critical Care Nursing (Surviving
Sepsis Campaign Hour-1 bundle, massive transfusion protocols, anaphylactic shock, disseminated
intravascular coagulation, multiple organ dysfunction syndrome, Parkland burn resuscitation, carbon
monoxide poisoning, targeted temperature management, and critical care delirium bundles). Mastering
these advanced clinical competencies is essential for achieving academic progression, NCLEX-RN
mastery, and delivering superior adult health nursing clinical execution.
Question 1: A 62-year-old client presents to the emergency department with severe crushing
substernal chest pain radiating to the left jaw. The 12-lead ECG demonstrates ST-segment elevation of 3
mm in leads V1, V2, V3, and V4. Which coronary artery is occluded, and what is the target door-to-
balloon time for emergent percutaneous coronary intervention (PCI)?
A) Left anterior descending (LAD) artery; target door-to-balloon time is within 90 minutes of hospital
arrival
, B) Posterior descending artery (PDA); target door-to-balloon time is within 12 hours of hospital arrival
C) Right coronary artery (RCA); target door-to-balloon time is within 180 minutes of hospital arrival
D) Left circumflex (LCx) artery; target door-to-balloon time is within 24 hours of hospital arrival
Correct Answer: A) Left anterior descending (LAD) artery; target door-to-balloon time is
within 90 minutes of hospital arrival
Rationale: ST-segment elevation in precordial leads V1 through V4 indicates an acute anterior wall
myocardial infarction, which is caused by occlusion of the Left Anterior Descending (LAD) coronary
artery ('the widow maker'). According to American College of Cardiology (ACC) and American Heart
Association (AHA) emergency clinical guidelines, the benchmark standard for emergent reperfusion
therapy via primary Percutaneous Coronary Intervention (PCI) is a door-to-balloon time of ≤ 90 minutes
from hospital arrival.
Question 2: A nurse is caring for a critically ill client who has a left radial arterial line in place for
continuous blood pressure monitoring. To ensure accurate hemodynamic pressure readings, at which
anatomical landmark must the pressure transducer be leveled and zeroed?
A) The 6th intercostal space at the anterior axillary line (representing the left ventricular apex)
B) The 2nd intercostal space at the right sternal border (representing the aortic arch)
C) The sternal notch at the base of the neck
D) The phlebostatic axis, located at the 4th intercostal space at the mid-axillary line (representing the
level of the right atrium)
Correct Answer: D) The phlebostatic axis, located at the 4th intercostal space at the mid-
axillary line (representing the level of the right atrium)
Rationale: Accurate invasive arterial and central venous pressure monitoring requires zeroing and
leveling the transducer to the phlebostatic axis. The phlebostatic axis is anatomically located at the
intersection of the 4th intercostal space and the mid-axillary line (or midway between anterior and
posterior chest surfaces), corresponding to the level of the right and left atria. Leveling above this point
produces falsely low readings; leveling below produces falsely high readings.
Question 3: A nurse is interpreting hemodynamic parameters from a pulmonary artery (Swan-Ganz)
catheter in a client in acute cardiogenic shock. Which set of hemodynamic values is characteristic of
cardiogenic shock?
A) Decreased CVP (< 2 mmHg), decreased PAOP (< 6 mmHg), elevated CI (> 4.5 L/min/m²), and
profoundly decreased SVR (< 500 dynes·s/cm⁵)
B) Decreased CVP (< 2 mmHg), decreased PAOP (< 6 mmHg), decreased CI (< 2.0 L/min/m²), and
elevated SVR (> 1,600 dynes·s/cm⁵)
C) Elevated Central Venous Pressure (CVP > 12 mmHg), elevated Pulmonary Artery Occlusion Pressure
(PAOP/PCWP > 18 mmHg), markedly decreased Cardiac Index (CI < 2.0 L/min/m²), and elevated
Systemic Vascular Resistance (SVR > 1,600 dynes·s/cm⁵)
D) Normal CVP (4 mmHg), normal PAOP (8 mmHg), normal CI (3.0 L/min/m²), and decreased SVR (<
600 dynes·s/cm⁵)
Correct Answer: C) Elevated Central Venous Pressure (CVP > 12 mmHg), elevated Pulmonary
Artery Occlusion Pressure (PAOP/PCWP > 18 mmHg), markedly decreased Cardiac Index (CI
< 2.0 L/min/m²), and elevated Systemic Vascular Resistance (SVR > 1,600 dynes·s/cm⁵)
Rationale: Cardiogenic shock results from severe primary pump failure (often secondary to massive
myocardial infarction). Because the left and right ventricles fail to eject blood forward, filling pressures
back up, causing elevated Central Venous Pressure (CVP > 12 mmHg, normal 2-6) and elevated
, Pulmonary Artery Occlusion Pressure (PAOP > 18 mmHg, normal 6-12). Cardiac Output/Index falls
precipitously (CI < 2.0 L/min/m², normal 2.5-4.0), and compensatory systemic vasoconstriction causes
elevated Systemic Vascular Resistance (SVR > 1,600 dynes·s/cm⁵, normal 800-1,200).
Question 4: An Intra-Aortic Balloon Pump (IABP) is inserted via the femoral artery for a client
experiencing refractory cardiogenic shock. During which phase of the cardiac cycle does the balloon
inflate, and what is the primary therapeutic mechanism achieved?
A) The balloon inflates during systole, forcing blood through the stenotic aortic valve, and deflates
during diastole
B) The balloon remains continuously inflated to create permanent retrograde flow into the pulmonary
veins
C) The balloon inflates during diastole (at the dicrotic notch on the arterial waveform), augmenting
coronary artery perfusion pressure, and deflates immediately prior to systole, reducing left ventricular
afterload and myocardial oxygen consumption
D) The balloon inflates during the P wave to stimulate atrial contraction, and deflates during the T wave
Correct Answer: C) The balloon inflates during diastole (at the dicrotic notch on the arterial
waveform), augmenting coronary artery perfusion pressure, and deflates immediately prior
to systole, reducing left ventricular afterload and myocardial oxygen consumption
Rationale: The Intra-Aortic Balloon Pump (IABP) operates through counterpulsation. Balloon inflation
occurs precisely at the onset of diastole (marked by the dicrotic notch on the arterial pressure trace),
displacing blood retrograde into the aortic root to augment coronary and cerebral artery perfusion.
Balloon deflation occurs immediately before ventricular systole (just prior to aortic valve opening),
creating a sudden vacuum effect that drastically reduces left ventricular afterload, cardiac workload, and
myocardial oxygen demand.
Question 5: A nurse monitors a telemetry rhythm strip showing coarse Ventricular Fibrillation (V-fib).
The client is unresponsive, pulseless, and apneic. According to current Advanced Cardiovascular Life
Support (ACLS) guidelines, which sequence of emergency interventions is correct?
A) Infuse a 1-liter bolus of 0.9% normal saline over 5 minutes and obtain a 12-lead ECG before initiating
compressions
B) Call for help and initiate high-quality CPR immediately, deliver an immediate unsynchronized
defibrillation shock (120 to 200 J biphasic), resume CPR for 2 minutes, establish IV/IO access, and
administer Epinephrine 1 mg IV every 3 to 5 minutes, followed by Amiodarone 300 mg IV bolus for
refractory V-fib
C) Perform transcutaneous pacing immediately at 80 mA, administer Adenosine 6 mg rapid IV push, and
withhold chest compressions
D) Administer synchronized cardioversion at 50 J, deliver Atropine 1 mg IV push, and check the carotid
pulse for 60 seconds
Correct Answer: B) Call for help and initiate high-quality CPR immediately, deliver an
immediate unsynchronized defibrillation shock (120 to 200 J biphasic), resume CPR for 2
minutes, establish IV/IO access, and administer Epinephrine 1 mg IV every 3 to 5 minutes,
followed by Amiodarone 300 mg IV bolus for refractory V-fib
Rationale: Ventricular Fibrillation (V-fib) and Pulseless Ventricular Tachycardia (pVT) are shockable
lethal cardiac arrest rhythms. The immediate priority is initiating high-quality chest compressions and
delivering an immediate unsynchronized defibrillation shock (120-200 J biphasic). CPR is resumed
immediately for 2 minutes before the next rhythm check. Vasopressor therapy with Epinephrine 1 mg
, IV/IO is administered every 3-5 minutes, and for shock-refractory V-fib/pVT, Amiodarone 300 mg IV
bolus (second dose 150 mg) or Lidocaine (1-1.5 mg/kg) is administered.
Question 6: A client on a telemetry unit develops a 3rd-Degree (Complete) Atrioventricular (AV) Block
with a ventricular escape rate of 28 bpm. The client is dizzy, pale, and has a blood pressure of 74/42
mmHg. What is the immediate definitive emergency nursing intervention?
A) Instruct the client to perform repeated Valsalva maneuvers and cough vigorously
B) Prepare for immediate Transcutaneous Pacing (TCP) while administering Atropine 1 mg IV push as a
temporary bridge, and notify the cardiac catheterization team for transvenous/permanent pacemaker
placement
C) Administer Adenosine 6 mg rapid IV push through a central line followed by an ice pack to the face
D) Perform synchronized electrical cardioversion at 100 J biphasic
Correct Answer: B) Prepare for immediate Transcutaneous Pacing (TCP) while administering
Atropine 1 mg IV push as a temporary bridge, and notify the cardiac catheterization team for
transvenous/permanent pacemaker placement
Rationale: In 3rd-degree (complete) AV block, there is total dissociation between atrial P waves and
ventricular QRS complexes; impulses from the SA node do not conduct to the ventricles. In an unstable,
symptomatic client (hypotension, altered perfusion), Atropine 1 mg IV may be attempted (though often
ineffective for infranodal blocks), and immediate Transcutaneous Pacing (TCP) must be initiated to
maintain adequate ventricular rate and cardiac output until a temporary transvenous or permanent
transvenous pacemaker can be placed.
Question 7: A client with a history of Wolf-Parkinson-White syndrome suddenly develops narrow-
complex Supraventricular Tachycardia (SVT) at a regular rate of 210 bpm. The client is alert and
hemodynamically stable with a blood pressure of 118/76 mmHg. What is the appropriate initial
pharmacological intervention?
A) Administer Digoxin 0.5 mg slow IV push over 20 minutes
B) Infuse Dopamine at 20 mcg/kg/min continuous IV infusion
C) Instruct the client to perform vagal maneuvers (such as a modified Valsalva maneuver), and if
unsuccessful, administer Adenosine 6 mg rapid IV push over 1 to 2 seconds followed immediately by a 20
mL rapid normal saline flush
D) Deliver an unsynchronized 200 J defibrillation shock immediately
Correct Answer: C) Instruct the client to perform vagal maneuvers (such as a modified
Valsalva maneuver), and if unsuccessful, administer Adenosine 6 mg rapid IV push over 1 to 2
seconds followed immediately by a 20 mL rapid normal saline flush
Rationale: For stable, narrow-complex Supraventricular Tachycardia (SVT), non-pharmacological vagal
maneuvers (e.g., modified Valsalva with passive leg raise or carotid sinus massage) are attempted first. If
SVT persists, the first-line medication is Adenosine 6 mg administered as a rapid IV push over 1-2
seconds through an antecubital or central vein, immediately followed by a rapid 20 mL 0.9% normal
saline flush and limb elevation. Adenosine temporarily blocks AV node conduction. If unsuccessful, a
second dose of 12 mg may be administered.
Question 8: A 54-year-old client is admitted to the intensive care unit in a Hypertensive Emergency
with a blood pressure of 230/135 mmHg, severe occipital headache, and bilateral papilledema. An
intravenous infusion of Nicardipine is initiated. What is the therapeutic goal for blood pressure
reduction over the initial hour of therapy?
