: NUR242/ NUR 242 Medical-Surgical
Nursing Exam | Questions and Verified
Answers| 100% Correct and rationals to
explain in a better way to enhance clear
understanding| Grade A- Galen
Section 1: Cardiovascular Assessment, Dysrhythmias, and Cardiac Procedures
1. During cardiac auscultation, where should the nurse listen to best hear the pulmonic
valve?
A) Second intercostal space at the left sternal border
B) Second intercostal space at the right sternal border
C) Fifth intercostal space at the midclavicular line
D) Fourth intercostal space at the left sternal border
Correct Answer: Second intercostal space at the left sternal border
Rationale: The pulmonic area is located at the second left intercostal space along the sternal
border. The aortic area is at the second right intercostal space. The tricuspid area is generally
at the fourth or fifth left sternal border, while the mitral area is near the fifth intercostal
space at the midclavicular line.
2. Which assessment location corresponds to Erb's point?
A) Second intercostal space, right sternal border
B) Third intercostal space, left sternal border
C) Fifth intercostal space, midclavicular line
D) Fourth intercostal space, left sternal border
Correct Answer: Third intercostal space, left sternal border
Rationale: Erb's point is commonly assessed at the third left intercostal space along the
sternal border. It provides an additional location for evaluating cardiac sounds, particularly
S2. Correct identification of auscultation sites helps the nurse distinguish normal and
abnormal heart sounds and murmurs.
,3. A client has a regular rhythm with a heart rate of 110/min and normal P waves
preceding each QRS complex. Which rhythm is most consistent with these findings?
A) Atrial fibrillation
B) Ventricular fibrillation
C) Sinus tachycardia
D) Sinus bradycardia
Correct Answer: Sinus tachycardia
Rationale: Sinus tachycardia originates from the sinoatrial node and is characterized by a
regular rhythm, normal P waves, and a rate above 100/min in adults. Common causes
include pain, fever, anxiety, dehydration, and exercise. Atrial and ventricular fibrillation have
substantially different electrical patterns.
4. A client develops symptomatic sinus bradycardia with dizziness and hypotension. Which
intervention should the nurse anticipate?
A) Encourage ambulation
B) Administer a prescribed treatment for symptomatic bradycardia
C) Place the client flat and delay assessment
D) Encourage coughing to terminate the rhythm
Correct Answer: Administer a prescribed treatment for symptomatic bradycardia
Rationale: Symptomatic bradycardia requires prompt assessment and intervention because
inadequate heart rate can reduce cardiac output. Treatment may include atropine or pacing
depending on the clinical situation and current ACLS guidance. Coughing is not a definitive
treatment for clinically significant bradycardia.
5. Which characteristic is most associated with atrial fibrillation?
A) Regular rhythm with one P wave before every QRS
B) Wide QRS complexes occurring at a fixed rate
C) Completely irregular ventricular rhythm without consistent P waves
D) Absence of ventricular electrical activity
Correct Answer: Completely irregular ventricular rhythm without consistent P waves
Rationale: Atrial fibrillation produces chaotic atrial electrical activity and an irregularly
irregular ventricular response. Distinct P waves are generally absent. Because blood can pool
,in the atria, clients with atrial fibrillation have an increased risk of thromboembolic stroke
and may require anticoagulation based on individualized risk assessment.
6. A client becomes unresponsive and the monitor shows ventricular fibrillation. What is
the priority intervention?
A) Begin CPR and prepare for immediate defibrillation
B) Administer oral anticoagulation
C) Obtain a routine 12-lead ECG before intervention
D) Place the client in a sitting position
Correct Answer: Begin CPR and prepare for immediate defibrillation
Rationale: Ventricular fibrillation is a pulseless cardiac-arrest rhythm that requires
immediate high-quality CPR and defibrillation. Delaying shock delivery while obtaining
routine testing can worsen outcomes. The American Heart Association identifies ventricular
fibrillation and pulseless ventricular tachycardia as shockable cardiac-arrest rhythms.
7. A conscious client has ventricular tachycardia with a pulse and signs of instability. Which
intervention is most appropriate to anticipate?
A) Routine discharge teaching
B) Synchronized cardioversion
C) Oral potassium replacement without assessment
D) Ambulation to improve circulation
Correct Answer: Synchronized cardioversion
Rationale: Unstable tachycardia with a pulse may require synchronized cardioversion. The
synchronized shock is timed with the cardiac cycle to reduce the risk of delivering the shock
during ventricular repolarization. Management depends on whether a pulse is present and
whether the client is stable or unstable.
8. Which finding after pacemaker insertion requires the most immediate follow-up?
A) Mild tenderness at the incision
B) Client asking about the identification card
C) Temporary activity restrictions
D) New dizziness accompanied by an unexpectedly low heart rate
Correct Answer: New dizziness accompanied by an unexpectedly low heart rate
, Rationale: Dizziness associated with a low heart rate can indicate inadequate pacemaker
function or another dysrhythmia. The nurse should assess the rhythm, vital signs, and device
function and notify the appropriate provider. Mild incision discomfort and routine teaching
are expected during recovery unless accompanied by concerning findings.
9. Which teaching is appropriate for a client who has a permanent pacemaker?
A) Report redness, drainage, fever, or swelling at the insertion site
B) Place strong magnets directly over the device
C) Ignore new dizziness because the pacemaker prevents dysrhythmias
D) Avoid carrying identification for the device
Correct Answer: Report redness, drainage, fever, or swelling at the insertion site
Rationale: Redness, swelling, drainage, or fever can indicate infection following pacemaker
implantation. Clients should carry device identification and follow individualized activity and
device precautions. New symptoms such as dizziness, syncope, palpitations, or dyspnea
should also be reported because they may indicate device or rhythm problems.
10. A client is scheduled for cardiac catheterization. Which information should the nurse
verify before the procedure?
A) The client has eaten a full meal immediately before the procedure
B) Baseline peripheral pulses have been assessed
C) The client has discontinued all prescribed medications independently
D) Bed rest is unnecessary afterward
Correct Answer: Baseline peripheral pulses have been assessed
Rationale: Baseline distal pulses provide an important comparison for assessing circulation
after catheterization. The nurse should also verify informed consent, allergies, relevant
laboratory values, and prescribed fasting requirements. Postprocedure monitoring focuses
on bleeding, hematoma, distal circulation, dysrhythmias, and other complications.
11. During contrast administration for cardiac catheterization, which sensation should the
nurse explain may occur?
A) Permanent loss of taste
B) Severe paralysis
C) A brief warm or flushed sensation
D) Immediate hearing loss
Nursing Exam | Questions and Verified
Answers| 100% Correct and rationals to
explain in a better way to enhance clear
understanding| Grade A- Galen
Section 1: Cardiovascular Assessment, Dysrhythmias, and Cardiac Procedures
1. During cardiac auscultation, where should the nurse listen to best hear the pulmonic
valve?
A) Second intercostal space at the left sternal border
B) Second intercostal space at the right sternal border
C) Fifth intercostal space at the midclavicular line
D) Fourth intercostal space at the left sternal border
Correct Answer: Second intercostal space at the left sternal border
Rationale: The pulmonic area is located at the second left intercostal space along the sternal
border. The aortic area is at the second right intercostal space. The tricuspid area is generally
at the fourth or fifth left sternal border, while the mitral area is near the fifth intercostal
space at the midclavicular line.
2. Which assessment location corresponds to Erb's point?
A) Second intercostal space, right sternal border
B) Third intercostal space, left sternal border
C) Fifth intercostal space, midclavicular line
D) Fourth intercostal space, left sternal border
Correct Answer: Third intercostal space, left sternal border
Rationale: Erb's point is commonly assessed at the third left intercostal space along the
sternal border. It provides an additional location for evaluating cardiac sounds, particularly
S2. Correct identification of auscultation sites helps the nurse distinguish normal and
abnormal heart sounds and murmurs.
,3. A client has a regular rhythm with a heart rate of 110/min and normal P waves
preceding each QRS complex. Which rhythm is most consistent with these findings?
A) Atrial fibrillation
B) Ventricular fibrillation
C) Sinus tachycardia
D) Sinus bradycardia
Correct Answer: Sinus tachycardia
Rationale: Sinus tachycardia originates from the sinoatrial node and is characterized by a
regular rhythm, normal P waves, and a rate above 100/min in adults. Common causes
include pain, fever, anxiety, dehydration, and exercise. Atrial and ventricular fibrillation have
substantially different electrical patterns.
4. A client develops symptomatic sinus bradycardia with dizziness and hypotension. Which
intervention should the nurse anticipate?
A) Encourage ambulation
B) Administer a prescribed treatment for symptomatic bradycardia
C) Place the client flat and delay assessment
D) Encourage coughing to terminate the rhythm
Correct Answer: Administer a prescribed treatment for symptomatic bradycardia
Rationale: Symptomatic bradycardia requires prompt assessment and intervention because
inadequate heart rate can reduce cardiac output. Treatment may include atropine or pacing
depending on the clinical situation and current ACLS guidance. Coughing is not a definitive
treatment for clinically significant bradycardia.
5. Which characteristic is most associated with atrial fibrillation?
A) Regular rhythm with one P wave before every QRS
B) Wide QRS complexes occurring at a fixed rate
C) Completely irregular ventricular rhythm without consistent P waves
D) Absence of ventricular electrical activity
Correct Answer: Completely irregular ventricular rhythm without consistent P waves
Rationale: Atrial fibrillation produces chaotic atrial electrical activity and an irregularly
irregular ventricular response. Distinct P waves are generally absent. Because blood can pool
,in the atria, clients with atrial fibrillation have an increased risk of thromboembolic stroke
and may require anticoagulation based on individualized risk assessment.
6. A client becomes unresponsive and the monitor shows ventricular fibrillation. What is
the priority intervention?
A) Begin CPR and prepare for immediate defibrillation
B) Administer oral anticoagulation
C) Obtain a routine 12-lead ECG before intervention
D) Place the client in a sitting position
Correct Answer: Begin CPR and prepare for immediate defibrillation
Rationale: Ventricular fibrillation is a pulseless cardiac-arrest rhythm that requires
immediate high-quality CPR and defibrillation. Delaying shock delivery while obtaining
routine testing can worsen outcomes. The American Heart Association identifies ventricular
fibrillation and pulseless ventricular tachycardia as shockable cardiac-arrest rhythms.
7. A conscious client has ventricular tachycardia with a pulse and signs of instability. Which
intervention is most appropriate to anticipate?
A) Routine discharge teaching
B) Synchronized cardioversion
C) Oral potassium replacement without assessment
D) Ambulation to improve circulation
Correct Answer: Synchronized cardioversion
Rationale: Unstable tachycardia with a pulse may require synchronized cardioversion. The
synchronized shock is timed with the cardiac cycle to reduce the risk of delivering the shock
during ventricular repolarization. Management depends on whether a pulse is present and
whether the client is stable or unstable.
8. Which finding after pacemaker insertion requires the most immediate follow-up?
A) Mild tenderness at the incision
B) Client asking about the identification card
C) Temporary activity restrictions
D) New dizziness accompanied by an unexpectedly low heart rate
Correct Answer: New dizziness accompanied by an unexpectedly low heart rate
, Rationale: Dizziness associated with a low heart rate can indicate inadequate pacemaker
function or another dysrhythmia. The nurse should assess the rhythm, vital signs, and device
function and notify the appropriate provider. Mild incision discomfort and routine teaching
are expected during recovery unless accompanied by concerning findings.
9. Which teaching is appropriate for a client who has a permanent pacemaker?
A) Report redness, drainage, fever, or swelling at the insertion site
B) Place strong magnets directly over the device
C) Ignore new dizziness because the pacemaker prevents dysrhythmias
D) Avoid carrying identification for the device
Correct Answer: Report redness, drainage, fever, or swelling at the insertion site
Rationale: Redness, swelling, drainage, or fever can indicate infection following pacemaker
implantation. Clients should carry device identification and follow individualized activity and
device precautions. New symptoms such as dizziness, syncope, palpitations, or dyspnea
should also be reported because they may indicate device or rhythm problems.
10. A client is scheduled for cardiac catheterization. Which information should the nurse
verify before the procedure?
A) The client has eaten a full meal immediately before the procedure
B) Baseline peripheral pulses have been assessed
C) The client has discontinued all prescribed medications independently
D) Bed rest is unnecessary afterward
Correct Answer: Baseline peripheral pulses have been assessed
Rationale: Baseline distal pulses provide an important comparison for assessing circulation
after catheterization. The nurse should also verify informed consent, allergies, relevant
laboratory values, and prescribed fasting requirements. Postprocedure monitoring focuses
on bleeding, hematoma, distal circulation, dysrhythmias, and other complications.
11. During contrast administration for cardiac catheterization, which sensation should the
nurse explain may occur?
A) Permanent loss of taste
B) Severe paralysis
C) A brief warm or flushed sensation
D) Immediate hearing loss
