NR341/NR 341 Exam 2 V3 | Complex Adult Health
Q&A with Rationale | Chamberlain University
1. A patient’s cardiac monitor displays a rhythm with a PR interval of 0.24 seconds, a QRS
complex of 0.08 seconds, and a heart rate of 72 beats/min. Which action should the nurse
take first?
A. Document the finding and continue to monitor the patient.
B. Administer atropine 0.5 mg intravenously.
C. Prepare for immediate synchronized cardioversion.
D. Notify the rapid response team for a possible heart block.
Correct Answer: A
Explanation: A PR interval greater than 0.20 seconds indicates a first-degree AV block. In
this scenario, the heart rate is within normal limits and the QRS complex is normal,
suggesting the patient is likely asymptomatic. The nurse should document the finding as it
is a common benign occurrence in stable patients, though monitoring for progression to
higher-level blocks is necessary.
2. A patient is admitted with septic shock. Which hemodynamic parameter would the nurse
expect to find during the early (hyperdynamic) phase?
A. Increased systemic vascular resistance (SVR)
B. Decreased systemic vascular resistance (SVR)
,C. Decreased cardiac output (CO)
D. Increased pulmonary capillary wedge pressure (PCWP)
Correct Answer: B
Explanation: In the early or hyperdynamic phase of septic shock, massive vasodilation
occurs due to inflammatory mediators. This leads to a significantly decreased systemic
vascular resistance (SVR) and a compensatory increase in cardiac output. Recognizing
these early signs is critical for initiating timely fluid resuscitation and antibiotic therapy to
prevent progression to the hypodynamic phase.
3. The nurse is caring for a patient on mechanical ventilation who begins to fight the
ventilator. The high-pressure alarm is sounding. What is the most appropriate initial action?
A. Increase the sedation level immediately.
B. Disconnect the patient and manually ventilate with a bag-valve-mask.
C. Check the tubing for kinks or the patient for the need to suction.
D. Silence the alarm and reassess the patient in 10 minutes.
Correct Answer: C
Explanation: A high-pressure alarm indicates that the ventilator is meeting resistance
while trying to deliver a breath. Common causes include the patient biting the ET tube,
secretions in the airway, or kinks in the ventilator tubing. The nurse should prioritize
assessing the patient’s airway and the integrity of the equipment before considering
sedation or manual ventilation.
,4. A patient with Acute Respiratory Distress Syndrome (ARDS) is being treated with prone
positioning. Which outcome indicates the treatment is effective?
A. A decrease in the PaO2/FiO2 ratio.
B. A reduction in the respiratory rate to 12 breaths/min.
C. An increase in PaO2 and improved oxygen saturation.
D. Increased sputum production during suctioning.
Correct Answer: C
Explanation: Prone positioning is utilized in ARDS to improve oxygenation by recruiting
collapsed alveoli in the posterior lung fields and improving ventilation-perfusion matching.
A successful response is evidenced by an increase in the partial pressure of arterial oxygen
(PaO2) and overall oxygen saturation (SpO2). This intervention helps reduce the risk of
ventilator-induced lung injury by allowing for lower FiO2 and PEEP settings.
5. A patient presents to the emergency department with a heart rate of 160 beats/min, a
blood pressure of 88/50 mmHg, and reports of chest pain. The EKG shows a narrow-complex
supraventricular tachycardia (SVT). What is the priority intervention?
A. Administer Adenosine 6 mg rapid IV push.
B. Start a Diltiazem drip at 5 mg/hr.
C. Instruct the patient to perform the Valsalva maneuver.
D. Perform immediate synchronized cardioversion.
, Correct Answer: D
Explanation: When a patient is symptomatic (chest pain, hypotension) and unstable due to
a tachydysrhythmia, immediate synchronized cardioversion is the treatment of choice.
While Adenosine and Valsalva maneuvers are used for stable SVT, they should not delay
definitive treatment in an unstable patient. The synchronization ensures the shock is
delivered during the R wave to avoid inducing ventricular fibrillation.
6. Which assessment finding in a patient with a chest tube requires immediate intervention
by the nurse?
A. Intermittent bubbling in the water-seal chamber.
B. Continuous bubbling in the water-seal chamber.
C. Tidaling of fluid in the water-seal chamber with respirations.
D. Drainage of 50 mL of serosanguinous fluid over 4 hours.
Correct Answer: B
Explanation: Continuous bubbling in the water-seal chamber usually indicates an air leak
in the system or the patient’s chest. Intermittent bubbling is normal if the patient has a
pneumothorax, and tidaling is an expected finding indicating the system is patent. The
nurse must locate the leak by briefly clamping the tube to determine if the leak is at the
insertion site or within the tubing/drainage unit.
Q&A with Rationale | Chamberlain University
1. A patient’s cardiac monitor displays a rhythm with a PR interval of 0.24 seconds, a QRS
complex of 0.08 seconds, and a heart rate of 72 beats/min. Which action should the nurse
take first?
A. Document the finding and continue to monitor the patient.
B. Administer atropine 0.5 mg intravenously.
C. Prepare for immediate synchronized cardioversion.
D. Notify the rapid response team for a possible heart block.
Correct Answer: A
Explanation: A PR interval greater than 0.20 seconds indicates a first-degree AV block. In
this scenario, the heart rate is within normal limits and the QRS complex is normal,
suggesting the patient is likely asymptomatic. The nurse should document the finding as it
is a common benign occurrence in stable patients, though monitoring for progression to
higher-level blocks is necessary.
2. A patient is admitted with septic shock. Which hemodynamic parameter would the nurse
expect to find during the early (hyperdynamic) phase?
A. Increased systemic vascular resistance (SVR)
B. Decreased systemic vascular resistance (SVR)
,C. Decreased cardiac output (CO)
D. Increased pulmonary capillary wedge pressure (PCWP)
Correct Answer: B
Explanation: In the early or hyperdynamic phase of septic shock, massive vasodilation
occurs due to inflammatory mediators. This leads to a significantly decreased systemic
vascular resistance (SVR) and a compensatory increase in cardiac output. Recognizing
these early signs is critical for initiating timely fluid resuscitation and antibiotic therapy to
prevent progression to the hypodynamic phase.
3. The nurse is caring for a patient on mechanical ventilation who begins to fight the
ventilator. The high-pressure alarm is sounding. What is the most appropriate initial action?
A. Increase the sedation level immediately.
B. Disconnect the patient and manually ventilate with a bag-valve-mask.
C. Check the tubing for kinks or the patient for the need to suction.
D. Silence the alarm and reassess the patient in 10 minutes.
Correct Answer: C
Explanation: A high-pressure alarm indicates that the ventilator is meeting resistance
while trying to deliver a breath. Common causes include the patient biting the ET tube,
secretions in the airway, or kinks in the ventilator tubing. The nurse should prioritize
assessing the patient’s airway and the integrity of the equipment before considering
sedation or manual ventilation.
,4. A patient with Acute Respiratory Distress Syndrome (ARDS) is being treated with prone
positioning. Which outcome indicates the treatment is effective?
A. A decrease in the PaO2/FiO2 ratio.
B. A reduction in the respiratory rate to 12 breaths/min.
C. An increase in PaO2 and improved oxygen saturation.
D. Increased sputum production during suctioning.
Correct Answer: C
Explanation: Prone positioning is utilized in ARDS to improve oxygenation by recruiting
collapsed alveoli in the posterior lung fields and improving ventilation-perfusion matching.
A successful response is evidenced by an increase in the partial pressure of arterial oxygen
(PaO2) and overall oxygen saturation (SpO2). This intervention helps reduce the risk of
ventilator-induced lung injury by allowing for lower FiO2 and PEEP settings.
5. A patient presents to the emergency department with a heart rate of 160 beats/min, a
blood pressure of 88/50 mmHg, and reports of chest pain. The EKG shows a narrow-complex
supraventricular tachycardia (SVT). What is the priority intervention?
A. Administer Adenosine 6 mg rapid IV push.
B. Start a Diltiazem drip at 5 mg/hr.
C. Instruct the patient to perform the Valsalva maneuver.
D. Perform immediate synchronized cardioversion.
, Correct Answer: D
Explanation: When a patient is symptomatic (chest pain, hypotension) and unstable due to
a tachydysrhythmia, immediate synchronized cardioversion is the treatment of choice.
While Adenosine and Valsalva maneuvers are used for stable SVT, they should not delay
definitive treatment in an unstable patient. The synchronization ensures the shock is
delivered during the R wave to avoid inducing ventricular fibrillation.
6. Which assessment finding in a patient with a chest tube requires immediate intervention
by the nurse?
A. Intermittent bubbling in the water-seal chamber.
B. Continuous bubbling in the water-seal chamber.
C. Tidaling of fluid in the water-seal chamber with respirations.
D. Drainage of 50 mL of serosanguinous fluid over 4 hours.
Correct Answer: B
Explanation: Continuous bubbling in the water-seal chamber usually indicates an air leak
in the system or the patient’s chest. Intermittent bubbling is normal if the patient has a
pneumothorax, and tidaling is an expected finding indicating the system is patent. The
nurse must locate the leak by briefly clamping the tube to determine if the leak is at the
insertion site or within the tubing/drainage unit.
