GALEN NUR 242 EXAM 3: ADVANCED
MED-SURG NURSING
COMPREHENSIVE REVIEW
1. A patient’s ECG monitor shows a lack of P waves, an irregularly irregular rhythm, and a
narrow QRS complex. The nurse should anticipate which primary risk for this patient?
A. Cardiac tamponade
B. Hypovolemic shock
C. Ventricular fibrillation
D. Embolic stroke
Answer: D
Conceptual Explanation: The description matches Atrial Fibrillation (AFib). The loss of
effective atrial contraction leads to blood stasis in the atria, significantly increasing the risk
of thrombus formation and subsequent embolic stroke.
2. Which intervention is the priority for a patient experiencing symptomatic sinus bradycardia
with a heart rate of 38 bpm and a blood pressure of 82/50 mmHg?
A. Administering IV Atropine 1 mg
B. Preparing for immediate synchronized cardioversion
,C. Administering a 500 mL bolus of Normal Saline
D. Instructing the patient to perform the Valsalva maneuver
Answer: A
Conceptual Explanation: Per ACLS guidelines, IV Atropine is the first-line medication for
symptomatic bradycardia. Cardioversion is for tachyarrhythmias, and the Valsalva
maneuver would further slow the heart rate.
3. A patient with a history of heart failure presents with a sudden onset of severe dyspnea,
pink frothy sputum, and a pulse oximetry reading of 84%. Which condition is most likely
occurring?
A. Pulmonary embolism
B. Acute pulmonary edema
C. Bacterial pneumonia
D. Pneumothorax
Answer: B
Conceptual Explanation: Pink frothy sputum is a classic hallmark sign of acute pulmonary
edema, often resulting from left-sided heart failure exacerbation.
4. In the interpretation of ABGs, a patient has pH 7.28, PaCO2 55, and HCO3 26. How should
the nurse classify this acid-base imbalance?
A. Partially compensated respiratory acidosis
, B. Fully compensated metabolic acidosis
C. Uncompensated respiratory acidosis
D. Uncompensated metabolic alkalosis
Answer: C
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory cause),
and the HCO3 is normal, meaning the kidneys have not yet begun to compensate.
5. A patient in the ICU has a Central Venous Pressure (CVP) of 1 mmHg. What does this
finding most likely indicate?
A. Fluid volume excess
B. Hypovolemia
C. Right-sided heart failure
D. Cardiac tamponade
Answer: B
Conceptual Explanation: Normal CVP is generally 2-8 mmHg. A low CVP (1 mmHg)
indicates reduced preload, which is typical of hypovolemia or dehydration.
6. Which cardiac rhythm is characterized by a ‘sawtooth’ pattern of P waves?
A. Atrial Fibrillation
B. Atrial Flutter
MED-SURG NURSING
COMPREHENSIVE REVIEW
1. A patient’s ECG monitor shows a lack of P waves, an irregularly irregular rhythm, and a
narrow QRS complex. The nurse should anticipate which primary risk for this patient?
A. Cardiac tamponade
B. Hypovolemic shock
C. Ventricular fibrillation
D. Embolic stroke
Answer: D
Conceptual Explanation: The description matches Atrial Fibrillation (AFib). The loss of
effective atrial contraction leads to blood stasis in the atria, significantly increasing the risk
of thrombus formation and subsequent embolic stroke.
2. Which intervention is the priority for a patient experiencing symptomatic sinus bradycardia
with a heart rate of 38 bpm and a blood pressure of 82/50 mmHg?
A. Administering IV Atropine 1 mg
B. Preparing for immediate synchronized cardioversion
,C. Administering a 500 mL bolus of Normal Saline
D. Instructing the patient to perform the Valsalva maneuver
Answer: A
Conceptual Explanation: Per ACLS guidelines, IV Atropine is the first-line medication for
symptomatic bradycardia. Cardioversion is for tachyarrhythmias, and the Valsalva
maneuver would further slow the heart rate.
3. A patient with a history of heart failure presents with a sudden onset of severe dyspnea,
pink frothy sputum, and a pulse oximetry reading of 84%. Which condition is most likely
occurring?
A. Pulmonary embolism
B. Acute pulmonary edema
C. Bacterial pneumonia
D. Pneumothorax
Answer: B
Conceptual Explanation: Pink frothy sputum is a classic hallmark sign of acute pulmonary
edema, often resulting from left-sided heart failure exacerbation.
4. In the interpretation of ABGs, a patient has pH 7.28, PaCO2 55, and HCO3 26. How should
the nurse classify this acid-base imbalance?
A. Partially compensated respiratory acidosis
, B. Fully compensated metabolic acidosis
C. Uncompensated respiratory acidosis
D. Uncompensated metabolic alkalosis
Answer: C
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory cause),
and the HCO3 is normal, meaning the kidneys have not yet begun to compensate.
5. A patient in the ICU has a Central Venous Pressure (CVP) of 1 mmHg. What does this
finding most likely indicate?
A. Fluid volume excess
B. Hypovolemia
C. Right-sided heart failure
D. Cardiac tamponade
Answer: B
Conceptual Explanation: Normal CVP is generally 2-8 mmHg. A low CVP (1 mmHg)
indicates reduced preload, which is typical of hypovolemia or dehydration.
6. Which cardiac rhythm is characterized by a ‘sawtooth’ pattern of P waves?
A. Atrial Fibrillation
B. Atrial Flutter
