NSG 4100 Exam 3: Complex Perfusion &
Oxygenation Problems Adult Health III | Galen
College of Nursing 80+ Practice Questions with
Answers and Rationales Updated 2025
SECTION 1: COMPLEX PERFUSION PROBLEMS (CARDIOVASCULAR)
Questions 1-45
Question 1
A 68-year-old male presents to the emergency department with complaints of dizziness and shortness of
breath. The ECG shows a heart rate of 38 bpm with a consistent P wave before each QRS complex. The
patient is alert but his blood pressure is 84/48 mmHg. What is the priority nursing intervention?
a) Administer atropine 0.5 mg IV push
b) Prepare for transcutaneous pacing
c) Obtain a stat 12-lead ECG
d) Place the patient in Trendelenburg position
Correct Answer: b) Prepare for transcutaneous pacing
*Rationale: The patient is experiencing symptomatic bradycardia (HR < 60 with signs of poor perfusion
including hypotension and dizziness). While atropine is a first-line medication, a heart rate of 38 with BP
84/48 indicates severe hemodynamic compromise. According to ACLS guidelines, transcutaneous pacing
is the priority intervention for symptomatic bradycardia unresponsive to atropine or when the patient is
unstable. Pacing provides immediate increase in heart rate and cardiac output .*
Question 2
A nurse is caring for a patient post-cardiac catheterization. The telemetry monitor suddenly shows a
rapid, irregular rhythm with a heart rate of 168 bpm and no discernible P waves. The patient reports
feeling lightheaded. What is the most likely rhythm?
a) Sinus tachycardia
b) Atrial fibrillation
c) Ventricular tachycardia
d) Atrial flutter with variable block
,Correct Answer: b) Atrial fibrillation
*Rationale: Atrial fibrillation is characterized by a rapid, irregularly irregular ventricular rhythm with
absent P waves and an undulating baseline. The loss of atrial kick reduces cardiac output by 10-20%,
causing symptoms like lightheadedness. The ventricular rate in untreated A-fib typically ranges from
120-200 bpm .*
Question 3
A 75-year-old patient with a history of heart failure and recurrent ventricular tachycardia is being
discharged with a newly implanted cardioverter-defibrillator (ICD). Which statement by the patient
indicates a need for further teaching?
a) "I need to avoid lifting heavy objects on the side of the incision for several weeks."
b) "If I feel a shock, I should call my doctor immediately to report it."
c) "My family needs to learn CPR in case the device doesn't work."
d) "I can use my cell phone on the opposite side of my ICD."
Correct Answer: b) "If I feel a single shock, I should call my doctor immediately."
*Rationale: Patients should be taught to call their doctor after receiving a single shock, but this is not an
emergency. A single shock indicates the device is working appropriately to terminate a life-threatening
arrhythmia. Emergency care is needed if the patient receives multiple shocks in 24 hours, feels unwell
after a shock, or loses consciousness. The other statements are correct: activity restriction, family CPR
training, and cell phone use on the opposite side are appropriate teaching points .*
Question 4
A patient with coronary artery disease is admitted with chest pain. The ECG shows ST elevation in leads
II, III, and aVF. The nurse knows this finding indicates infarction in which area?
a) Anterior wall
b) Lateral wall
c) Inferior wall
d) Septal wall
Correct Answer: c) Inferior wall
*Rationale: Leads II, III, and aVF are inferior leads that view the inferior wall of the heart. ST elevation in
these leads indicates an inferior wall myocardial infarction (IWMI). Anterior wall infarctions show
changes in V1-V4, lateral wall in I, aVL, V5-V6, and septal in V1-V2 .*
Question 5
, A nurse is caring for a patient with a pulmonary embolism who suddenly becomes more dyspneic and
hypoxic. The nurse notes new onset of JVD and muffled heart sounds. What is the priority action?
a) Increase oxygen flow rate
b) Prepare for emergency pericardiocentesis
c) Administer IV heparin bolus
d) Reposition the patient on the left side
Correct Answer: b) Prepare for emergency pericardiocentesis
Rationale: The patient is exhibiting Beck's triad (JVD, muffled heart sounds, hypotension), which indicates
cardiac tamponade. In a patient with PE, this could result from hemorrhagic pericardial effusion or right
ventricular strain. Pericardiocentesis is the emergency treatment to remove fluid from the pericardial sac
and restore cardiac output .
Question 6
A patient with disseminated intravascular coagulation (DIC) is being monitored. Which laboratory finding
is most consistent with this diagnosis?
a) Elevated platelet count
b) Decreased fibrin degradation products
c) Prolonged PT and aPTT with elevated D-dimer
d) Increased fibrinogen level
Correct Answer: c) Prolonged PT and aPTT with elevated D-dimer
Rationale: DIC involves widespread coagulation followed by hemorrhage. The initial clotting phase
consumes clotting factors and platelets, prolonging PT and aPTT. Fibrin degradation products and D-
dimer are elevated due to fibrinolysis. Platelets are decreased, not elevated .
Question 7
A patient with a recent MI suddenly develops severe dyspnea, tachycardia, and crackles in all lung fields.
The patient is pale and diaphoretic. These findings are most consistent with:
a) Pulmonary embolism
b) Cardiogenic shock
c) Cardiac tamponade
d) Pneumothorax
Correct Answer: b) Cardiogenic shock
*Rationale: Cardiogenic shock results from severe left ventricular failure with inadequate cardiac
output. Pulmonary edema (crackles), poor peripheral perfusion (pale, diaphoretic), and compensatory
tachycardia are classic findings. This occurs in 5-10% of MI patients and carries high mortality .*
Oxygenation Problems Adult Health III | Galen
College of Nursing 80+ Practice Questions with
Answers and Rationales Updated 2025
SECTION 1: COMPLEX PERFUSION PROBLEMS (CARDIOVASCULAR)
Questions 1-45
Question 1
A 68-year-old male presents to the emergency department with complaints of dizziness and shortness of
breath. The ECG shows a heart rate of 38 bpm with a consistent P wave before each QRS complex. The
patient is alert but his blood pressure is 84/48 mmHg. What is the priority nursing intervention?
a) Administer atropine 0.5 mg IV push
b) Prepare for transcutaneous pacing
c) Obtain a stat 12-lead ECG
d) Place the patient in Trendelenburg position
Correct Answer: b) Prepare for transcutaneous pacing
*Rationale: The patient is experiencing symptomatic bradycardia (HR < 60 with signs of poor perfusion
including hypotension and dizziness). While atropine is a first-line medication, a heart rate of 38 with BP
84/48 indicates severe hemodynamic compromise. According to ACLS guidelines, transcutaneous pacing
is the priority intervention for symptomatic bradycardia unresponsive to atropine or when the patient is
unstable. Pacing provides immediate increase in heart rate and cardiac output .*
Question 2
A nurse is caring for a patient post-cardiac catheterization. The telemetry monitor suddenly shows a
rapid, irregular rhythm with a heart rate of 168 bpm and no discernible P waves. The patient reports
feeling lightheaded. What is the most likely rhythm?
a) Sinus tachycardia
b) Atrial fibrillation
c) Ventricular tachycardia
d) Atrial flutter with variable block
,Correct Answer: b) Atrial fibrillation
*Rationale: Atrial fibrillation is characterized by a rapid, irregularly irregular ventricular rhythm with
absent P waves and an undulating baseline. The loss of atrial kick reduces cardiac output by 10-20%,
causing symptoms like lightheadedness. The ventricular rate in untreated A-fib typically ranges from
120-200 bpm .*
Question 3
A 75-year-old patient with a history of heart failure and recurrent ventricular tachycardia is being
discharged with a newly implanted cardioverter-defibrillator (ICD). Which statement by the patient
indicates a need for further teaching?
a) "I need to avoid lifting heavy objects on the side of the incision for several weeks."
b) "If I feel a shock, I should call my doctor immediately to report it."
c) "My family needs to learn CPR in case the device doesn't work."
d) "I can use my cell phone on the opposite side of my ICD."
Correct Answer: b) "If I feel a single shock, I should call my doctor immediately."
*Rationale: Patients should be taught to call their doctor after receiving a single shock, but this is not an
emergency. A single shock indicates the device is working appropriately to terminate a life-threatening
arrhythmia. Emergency care is needed if the patient receives multiple shocks in 24 hours, feels unwell
after a shock, or loses consciousness. The other statements are correct: activity restriction, family CPR
training, and cell phone use on the opposite side are appropriate teaching points .*
Question 4
A patient with coronary artery disease is admitted with chest pain. The ECG shows ST elevation in leads
II, III, and aVF. The nurse knows this finding indicates infarction in which area?
a) Anterior wall
b) Lateral wall
c) Inferior wall
d) Septal wall
Correct Answer: c) Inferior wall
*Rationale: Leads II, III, and aVF are inferior leads that view the inferior wall of the heart. ST elevation in
these leads indicates an inferior wall myocardial infarction (IWMI). Anterior wall infarctions show
changes in V1-V4, lateral wall in I, aVL, V5-V6, and septal in V1-V2 .*
Question 5
, A nurse is caring for a patient with a pulmonary embolism who suddenly becomes more dyspneic and
hypoxic. The nurse notes new onset of JVD and muffled heart sounds. What is the priority action?
a) Increase oxygen flow rate
b) Prepare for emergency pericardiocentesis
c) Administer IV heparin bolus
d) Reposition the patient on the left side
Correct Answer: b) Prepare for emergency pericardiocentesis
Rationale: The patient is exhibiting Beck's triad (JVD, muffled heart sounds, hypotension), which indicates
cardiac tamponade. In a patient with PE, this could result from hemorrhagic pericardial effusion or right
ventricular strain. Pericardiocentesis is the emergency treatment to remove fluid from the pericardial sac
and restore cardiac output .
Question 6
A patient with disseminated intravascular coagulation (DIC) is being monitored. Which laboratory finding
is most consistent with this diagnosis?
a) Elevated platelet count
b) Decreased fibrin degradation products
c) Prolonged PT and aPTT with elevated D-dimer
d) Increased fibrinogen level
Correct Answer: c) Prolonged PT and aPTT with elevated D-dimer
Rationale: DIC involves widespread coagulation followed by hemorrhage. The initial clotting phase
consumes clotting factors and platelets, prolonging PT and aPTT. Fibrin degradation products and D-
dimer are elevated due to fibrinolysis. Platelets are decreased, not elevated .
Question 7
A patient with a recent MI suddenly develops severe dyspnea, tachycardia, and crackles in all lung fields.
The patient is pale and diaphoretic. These findings are most consistent with:
a) Pulmonary embolism
b) Cardiogenic shock
c) Cardiac tamponade
d) Pneumothorax
Correct Answer: b) Cardiogenic shock
*Rationale: Cardiogenic shock results from severe left ventricular failure with inadequate cardiac
output. Pulmonary edema (crackles), poor peripheral perfusion (pale, diaphoretic), and compensatory
tachycardia are classic findings. This occurs in 5-10% of MI patients and carries high mortality .*
