NR 341: Complex Adult Health Exam 1 — Comprehensive
Critical Care Practice Exam with Detailed Rationales
(2026/2027 Edition)
Section 1: Emergency & Trauma Nursing
Question 1: An emergency room nurse assesses a client who has been raped. With which health
care team member should the nurse collaborate when planning this client's care?
• A. Emergency medicine physician
• B. Case manager
• C. Forensic nurse examiner
• D. Psychiatric crisis nurse
Correct Answer: C. Forensic nurse examiner
Rationale: The forensic nurse examiner is specifically educated to obtain client histories and
collect evidence dealing with sexual assault. This specialist can offer the counseling and follow-
up needed when dealing with victims of assault.
Question 2: The emergency department team is performing cardiopulmonary resuscitation on a
client when the client's spouse arrives. Which action should the nurse take first?
• A. Request that the spouse sit in the waiting room
• B. Ask the spouse if he wishes to be present during the resuscitation
• C. Suggest that the spouse begin to pray for the client
• D. Refer the spouse to the hospital's crisis team
Correct Answer: B. Ask the spouse if he wishes to be present during the resuscitation
Rationale: If resuscitation efforts are still under way when the family arrives, one or two family
members may be given the opportunity to be present during lifesaving procedures. This
supports family-centered care and allows for closure.
,Question 3: An emergency room nurse is triaging victims of a multi-casualty event. Which client
should receive care first?
• A. A 30-year-old distraught mother holding her crying child
• B. A 65-year-old conscious male with a head laceration
• C. A 26-year-old male who has pale, cool, clammy skin
• D. A 48-year-old with a simple fracture of the lower leg
Correct Answer: C. A 26-year-old male who has pale, cool, clammy skin
Rationale: The client with pale, cool, clammy skin is in shock and needs immediate medical
attention. This represents an emergent (life-threatening) condition. The mother has no injuries
(lowest priority), and the others need attention but not at the expense of a person in shock.
Section 2: Cardiovascular Emergencies & Dysrhythmias
Question 4: A nurse is preparing to administer diltiazem to a patient with atrial fibrillation.
Which of the following best describes the primary action of this medication?
• A. Increases myocardial contractility and heart rate
• B. Relaxes blood vessels and decreases heart rate
• C. Stimulates beta-adrenergic receptors to lower blood pressure
• D. Constricts coronary arteries to improve perfusion
Correct Answer: B. Relaxes blood vessels and decreases heart rate
Rationales:
• A. Incorrect — diltiazem is not an inotrope; it decreases contractility and slows
conduction.
• B. Correct — calcium channel blockers like diltiazem relax vascular smooth muscle and
reduce heart rate.
• C. Incorrect — this describes beta-blockers, not calcium channel blockers.
• D. Incorrect — vasoconstriction would worsen angina, opposite of diltiazem's action.
Test-Taking Tip: If you see "calcium channel blocker," think relaxation of vessels and
slowing the heart.
Question 5: The provider prescribes metoprolol for a patient experiencing supraventricular
tachycardia (SVT). What type of medication is metoprolol?
• A. Calcium channel blocker
, • B. Nitrate
• C. Beta blocker
• D. ACE inhibitor
Correct Answer: C. Beta blocker
Rationales:
• A. Incorrect — diltiazem/verapamil are calcium channel blockers.
• B. Incorrect — nitrates (like nitroglycerin) dilate veins and arteries.
• C. Correct — metoprolol is a beta-1 selective blocker that slows AV node conduction,
useful in SVT.
• D. Incorrect — ACE inhibitors lower BP but are not used acutely for SVT.
Test-Taking Tip: Beta blockers = "-lol" medications that slow the heart.
Question 6: A patient with acute chest pain is prescribed aspirin. What is the rationale for this
medication?
• A. To relieve pain
• B. To inhibit platelet aggregation and reduce infarct size
• C. To lower blood pressure
• D. To prevent arrhythmias
Correct Answer: B. To inhibit platelet aggregation and reduce infarct size
Rationale: Aspirin should be administered immediately to inhibit platelet aggregation and
reduce infarct size in acute coronary syndrome.
Question 7: The QT interval is the total time taken for ventricular depolarization and
repolarization. Prolongation of the QT interval:
• A. decreases the risk of lethal dysrhythmias.
• B. usually occurs when heart rate increases.
• C. increases the risk of lethal dysrhythmias.
• D. can only be measured with irregular rhythms.
Correct Answer: C. increases the risk of lethal dysrhythmias.
Rationale: A prolonged QT interval increases the risk of lethal dysrhythmias, such as torsades de
pointes.
, Question 8: The patient has an irregular heart rhythm. To determine an accurate heart rate, the
nurse first:
• A. identifies the markers on the ECG paper that indicate a 6-second strip.
• B. counts the number of large boxes between two consecutive P waves.
• C. counts the number of small boxes between two consecutive QRS complexes.
• D. divides the number of complexes in a 6-second strip by 10.
Correct Answer: A. identifies the markers on the ECG paper that indicate a 6-second strip.
Rationale: For an irregular rhythm, the most accurate method is to count the number of R
waves in a 6-second strip and multiply by 10.
Question 9: The patient is admitted with a fever and rapid heart rate. The patient’s temperature
is 103° F (39.4° C). The nurse places the patient on a cardiac monitor and finds the patient’s
atrial and ventricular rates are above 105 beats per minute. P waves are clearly seen and appear
normal in configuration. QRS complexes are normal in appearance and 0.08 seconds wide. The
rhythm is regular, and blood pressure is normal. The nurse should focus on providing:
• A. medications to lower heart rate.
• B. treatment to lower temperature.
• C. treatment to lower cardiac output.
• D. treatment to reduce heart rate.
Correct Answer: B. treatment to lower temperature.
Rationale: The patient is exhibiting sinus tachycardia, likely due to fever. The underlying cause
(fever) should be treated first.
Question 10: The nurse is working on the night shift when she notices sinus bradycardia on the
patient’s cardiac monitor. The nurse should:
• A. give atropine to increase heart rate.
• B. begin transcutaneous pacing of the patient.
• C. start a dopamine infusion to stimulate heart function.
• D. assess for hemodynamic instability.
Correct Answer: D. assess for hemodynamic instability.
Rationale: Sinus bradycardia may be a normal finding in some patients. The nurse should first
assess the patient for signs of hemodynamic instability (e.g., hypotension, dizziness, syncope)
before initiating treatment.
Critical Care Practice Exam with Detailed Rationales
(2026/2027 Edition)
Section 1: Emergency & Trauma Nursing
Question 1: An emergency room nurse assesses a client who has been raped. With which health
care team member should the nurse collaborate when planning this client's care?
• A. Emergency medicine physician
• B. Case manager
• C. Forensic nurse examiner
• D. Psychiatric crisis nurse
Correct Answer: C. Forensic nurse examiner
Rationale: The forensic nurse examiner is specifically educated to obtain client histories and
collect evidence dealing with sexual assault. This specialist can offer the counseling and follow-
up needed when dealing with victims of assault.
Question 2: The emergency department team is performing cardiopulmonary resuscitation on a
client when the client's spouse arrives. Which action should the nurse take first?
• A. Request that the spouse sit in the waiting room
• B. Ask the spouse if he wishes to be present during the resuscitation
• C. Suggest that the spouse begin to pray for the client
• D. Refer the spouse to the hospital's crisis team
Correct Answer: B. Ask the spouse if he wishes to be present during the resuscitation
Rationale: If resuscitation efforts are still under way when the family arrives, one or two family
members may be given the opportunity to be present during lifesaving procedures. This
supports family-centered care and allows for closure.
,Question 3: An emergency room nurse is triaging victims of a multi-casualty event. Which client
should receive care first?
• A. A 30-year-old distraught mother holding her crying child
• B. A 65-year-old conscious male with a head laceration
• C. A 26-year-old male who has pale, cool, clammy skin
• D. A 48-year-old with a simple fracture of the lower leg
Correct Answer: C. A 26-year-old male who has pale, cool, clammy skin
Rationale: The client with pale, cool, clammy skin is in shock and needs immediate medical
attention. This represents an emergent (life-threatening) condition. The mother has no injuries
(lowest priority), and the others need attention but not at the expense of a person in shock.
Section 2: Cardiovascular Emergencies & Dysrhythmias
Question 4: A nurse is preparing to administer diltiazem to a patient with atrial fibrillation.
Which of the following best describes the primary action of this medication?
• A. Increases myocardial contractility and heart rate
• B. Relaxes blood vessels and decreases heart rate
• C. Stimulates beta-adrenergic receptors to lower blood pressure
• D. Constricts coronary arteries to improve perfusion
Correct Answer: B. Relaxes blood vessels and decreases heart rate
Rationales:
• A. Incorrect — diltiazem is not an inotrope; it decreases contractility and slows
conduction.
• B. Correct — calcium channel blockers like diltiazem relax vascular smooth muscle and
reduce heart rate.
• C. Incorrect — this describes beta-blockers, not calcium channel blockers.
• D. Incorrect — vasoconstriction would worsen angina, opposite of diltiazem's action.
Test-Taking Tip: If you see "calcium channel blocker," think relaxation of vessels and
slowing the heart.
Question 5: The provider prescribes metoprolol for a patient experiencing supraventricular
tachycardia (SVT). What type of medication is metoprolol?
• A. Calcium channel blocker
, • B. Nitrate
• C. Beta blocker
• D. ACE inhibitor
Correct Answer: C. Beta blocker
Rationales:
• A. Incorrect — diltiazem/verapamil are calcium channel blockers.
• B. Incorrect — nitrates (like nitroglycerin) dilate veins and arteries.
• C. Correct — metoprolol is a beta-1 selective blocker that slows AV node conduction,
useful in SVT.
• D. Incorrect — ACE inhibitors lower BP but are not used acutely for SVT.
Test-Taking Tip: Beta blockers = "-lol" medications that slow the heart.
Question 6: A patient with acute chest pain is prescribed aspirin. What is the rationale for this
medication?
• A. To relieve pain
• B. To inhibit platelet aggregation and reduce infarct size
• C. To lower blood pressure
• D. To prevent arrhythmias
Correct Answer: B. To inhibit platelet aggregation and reduce infarct size
Rationale: Aspirin should be administered immediately to inhibit platelet aggregation and
reduce infarct size in acute coronary syndrome.
Question 7: The QT interval is the total time taken for ventricular depolarization and
repolarization. Prolongation of the QT interval:
• A. decreases the risk of lethal dysrhythmias.
• B. usually occurs when heart rate increases.
• C. increases the risk of lethal dysrhythmias.
• D. can only be measured with irregular rhythms.
Correct Answer: C. increases the risk of lethal dysrhythmias.
Rationale: A prolonged QT interval increases the risk of lethal dysrhythmias, such as torsades de
pointes.
, Question 8: The patient has an irregular heart rhythm. To determine an accurate heart rate, the
nurse first:
• A. identifies the markers on the ECG paper that indicate a 6-second strip.
• B. counts the number of large boxes between two consecutive P waves.
• C. counts the number of small boxes between two consecutive QRS complexes.
• D. divides the number of complexes in a 6-second strip by 10.
Correct Answer: A. identifies the markers on the ECG paper that indicate a 6-second strip.
Rationale: For an irregular rhythm, the most accurate method is to count the number of R
waves in a 6-second strip and multiply by 10.
Question 9: The patient is admitted with a fever and rapid heart rate. The patient’s temperature
is 103° F (39.4° C). The nurse places the patient on a cardiac monitor and finds the patient’s
atrial and ventricular rates are above 105 beats per minute. P waves are clearly seen and appear
normal in configuration. QRS complexes are normal in appearance and 0.08 seconds wide. The
rhythm is regular, and blood pressure is normal. The nurse should focus on providing:
• A. medications to lower heart rate.
• B. treatment to lower temperature.
• C. treatment to lower cardiac output.
• D. treatment to reduce heart rate.
Correct Answer: B. treatment to lower temperature.
Rationale: The patient is exhibiting sinus tachycardia, likely due to fever. The underlying cause
(fever) should be treated first.
Question 10: The nurse is working on the night shift when she notices sinus bradycardia on the
patient’s cardiac monitor. The nurse should:
• A. give atropine to increase heart rate.
• B. begin transcutaneous pacing of the patient.
• C. start a dopamine infusion to stimulate heart function.
• D. assess for hemodynamic instability.
Correct Answer: D. assess for hemodynamic instability.
Rationale: Sinus bradycardia may be a normal finding in some patients. The nurse should first
assess the patient for signs of hemodynamic instability (e.g., hypotension, dizziness, syncope)
before initiating treatment.
