NSG 3800 Exam 1 V1 | NSG 3800 Nursing Practice – Adult Health II |
Actual Q&A with Rationale (NSG3800 Exam 1) | Galen
1. A nurse is caring for a client with sinus bradycardia who is symptomatic with a heart rate of
42 bpm and blood pressure of 86/48 mmHg. Which medication should the nurse anticipate
administering first?
A. Amiodarone
B. Atropine sulfate
C. Epinephrine
D. Dopamine
Answer: B
Rationale: Atropine is the first-line medication for symptomatic bradycardia because it
increases the heart rate by inhibiting vagal stimulation. The client’s low blood pressure
indicates hemodynamic instability, making immediate intervention necessary. If atropine is
ineffective, other treatments like transcutaneous pacing or dopamine infusions may be
considered next.
2. When interpreting an EKG strip, the nurse notes that there are no visible P waves and the
QRS complexes are irregularly spaced. Which rhythm does this describe?
A. Atrial Flutter
B. Sinus Arrhythmia
C. Ventricular Tachycardia
D. Atrial Fibrillation
Answer: D
Rationale: Atrial fibrillation is characterized by a lack of discernible P waves and an
‘irregularly irregular’ ventricular response. This occurs because the atria are quivering
rather than contracting effectively. Nurses must monitor these patients closely for potential
thromboembolic events due to blood stasis in the atria.
3. A client is in Ventricular Fibrillation (VF). After calling for help and initiating CPR, what is
the next priority action?
A. Defibrillating the patient
B. Preparing for synchronized cardioversion
C. Performing endotracheal intubation
D. Administering an IV bolus of Lidocaine
,Answer: A
Rationale: Defibrillation is the definitive treatment for Ventricular Fibrillation and
pulseless Ventricular Tachycardia. The goal is to stop the chaotic electrical activity so the
heart’s natural pacemaker can resume control. Delaying defibrillation significantly
decreases the patient’s chances of survival and successful resuscitation.
4. A nurse is monitoring a client’s CVP (Central Venous Pressure) and notes a reading of 1
mmHg. Which condition should the nurse suspect?
A. Right-sided heart failure
B. Hypovolemia
C. Hypervolemia
D. Pulmonary hypertension
Answer: B
Rationale: A normal CVP range is typically 2 to 8 mmHg, and a low reading indicates
reduced preload. Hypovolemia, caused by dehydration or hemorrhage, leads to decreased
venous return and low CVP. The nurse should assess the patient for signs of dehydration
and anticipate a fluid bolus order.
5. A client with a chest tube has continuous bubbling in the water-seal chamber. How should
the nurse interpret this finding?
A. This is a normal finding during the first 24 hours.
B. The client has a pneumothorax that is resolving.
C. The suction pressure is set too high.
D. There is an air leak somewhere in the system.
E. The chest tube is occluded.
Answer: D
Rationale: Continuous bubbling in the water-seal chamber indicates that air is entering the
system from a leak, either in the patient’s pleura or the tubing connections. Intermittent
bubbling is normal if the patient has a pneumothorax, especially during coughing or
expiration. The nurse should immediately check all connections and use a padded clamp
briefly to locate the source of the leak.
6. Which arterial blood gas (ABG) result is consistent with a client experiencing early stages of
acute respiratory distress syndrome (ARDS)?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.25, PaCO2 35, HCO3 18
, C. pH 7.35, PaCO2 40, HCO3 25
D. pH 7.48, PaCO2 30, HCO3 22
Answer: D
Rationale: In the early stages of ARDS, the patient often hyperventilates due to hypoxemia,
which leads to respiratory alkalosis. This is characterized by an elevated pH and a low
PaCO2 level. As the condition progresses and the patient tires, they may shift into
respiratory acidosis as gas exchange worsens.
7. A client is admitted with a diagnosis of left-sided heart failure. Which clinical manifestation
should the nurse expect to find?
A. Peripheral edema
B. Crackles in the lungs
C. Jugular venous distention
D. Hepatomegaly
Answer: B
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
leading to pulmonary congestion and crackles. Symptoms like peripheral edema and
jugular venous distention are more commonly associated with right-sided heart failure.
Monitoring lung sounds is a critical assessment for evaluating the severity of left-sided
heart failure.
8. The nurse is caring for a patient on a mechanical ventilator. The high-pressure alarm begins
to sound. What is the priority nursing action?
A. Increase the oxygen concentration setting.
B. Manually ventilate the patient with an Ambu bag.
C. Silence the alarm and call the physician.
D. Check for kinks in the ventilator tubing.
Answer: D
Rationale: High-pressure alarms are often caused by obstructions such as tubing kinks,
secretions, or the patient biting the ETT. The nurse should first check for these common
mechanical issues to resolve the alarm. If the cause cannot be found and the patient is in
distress, manual ventilation is the next step.
9. What is the primary purpose of Positive End-Expiratory Pressure (PEEP) in a patient with
ARDS?
A. To decrease the work of breathing.
Actual Q&A with Rationale (NSG3800 Exam 1) | Galen
1. A nurse is caring for a client with sinus bradycardia who is symptomatic with a heart rate of
42 bpm and blood pressure of 86/48 mmHg. Which medication should the nurse anticipate
administering first?
A. Amiodarone
B. Atropine sulfate
C. Epinephrine
D. Dopamine
Answer: B
Rationale: Atropine is the first-line medication for symptomatic bradycardia because it
increases the heart rate by inhibiting vagal stimulation. The client’s low blood pressure
indicates hemodynamic instability, making immediate intervention necessary. If atropine is
ineffective, other treatments like transcutaneous pacing or dopamine infusions may be
considered next.
2. When interpreting an EKG strip, the nurse notes that there are no visible P waves and the
QRS complexes are irregularly spaced. Which rhythm does this describe?
A. Atrial Flutter
B. Sinus Arrhythmia
C. Ventricular Tachycardia
D. Atrial Fibrillation
Answer: D
Rationale: Atrial fibrillation is characterized by a lack of discernible P waves and an
‘irregularly irregular’ ventricular response. This occurs because the atria are quivering
rather than contracting effectively. Nurses must monitor these patients closely for potential
thromboembolic events due to blood stasis in the atria.
3. A client is in Ventricular Fibrillation (VF). After calling for help and initiating CPR, what is
the next priority action?
A. Defibrillating the patient
B. Preparing for synchronized cardioversion
C. Performing endotracheal intubation
D. Administering an IV bolus of Lidocaine
,Answer: A
Rationale: Defibrillation is the definitive treatment for Ventricular Fibrillation and
pulseless Ventricular Tachycardia. The goal is to stop the chaotic electrical activity so the
heart’s natural pacemaker can resume control. Delaying defibrillation significantly
decreases the patient’s chances of survival and successful resuscitation.
4. A nurse is monitoring a client’s CVP (Central Venous Pressure) and notes a reading of 1
mmHg. Which condition should the nurse suspect?
A. Right-sided heart failure
B. Hypovolemia
C. Hypervolemia
D. Pulmonary hypertension
Answer: B
Rationale: A normal CVP range is typically 2 to 8 mmHg, and a low reading indicates
reduced preload. Hypovolemia, caused by dehydration or hemorrhage, leads to decreased
venous return and low CVP. The nurse should assess the patient for signs of dehydration
and anticipate a fluid bolus order.
5. A client with a chest tube has continuous bubbling in the water-seal chamber. How should
the nurse interpret this finding?
A. This is a normal finding during the first 24 hours.
B. The client has a pneumothorax that is resolving.
C. The suction pressure is set too high.
D. There is an air leak somewhere in the system.
E. The chest tube is occluded.
Answer: D
Rationale: Continuous bubbling in the water-seal chamber indicates that air is entering the
system from a leak, either in the patient’s pleura or the tubing connections. Intermittent
bubbling is normal if the patient has a pneumothorax, especially during coughing or
expiration. The nurse should immediately check all connections and use a padded clamp
briefly to locate the source of the leak.
6. Which arterial blood gas (ABG) result is consistent with a client experiencing early stages of
acute respiratory distress syndrome (ARDS)?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.25, PaCO2 35, HCO3 18
, C. pH 7.35, PaCO2 40, HCO3 25
D. pH 7.48, PaCO2 30, HCO3 22
Answer: D
Rationale: In the early stages of ARDS, the patient often hyperventilates due to hypoxemia,
which leads to respiratory alkalosis. This is characterized by an elevated pH and a low
PaCO2 level. As the condition progresses and the patient tires, they may shift into
respiratory acidosis as gas exchange worsens.
7. A client is admitted with a diagnosis of left-sided heart failure. Which clinical manifestation
should the nurse expect to find?
A. Peripheral edema
B. Crackles in the lungs
C. Jugular venous distention
D. Hepatomegaly
Answer: B
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
leading to pulmonary congestion and crackles. Symptoms like peripheral edema and
jugular venous distention are more commonly associated with right-sided heart failure.
Monitoring lung sounds is a critical assessment for evaluating the severity of left-sided
heart failure.
8. The nurse is caring for a patient on a mechanical ventilator. The high-pressure alarm begins
to sound. What is the priority nursing action?
A. Increase the oxygen concentration setting.
B. Manually ventilate the patient with an Ambu bag.
C. Silence the alarm and call the physician.
D. Check for kinks in the ventilator tubing.
Answer: D
Rationale: High-pressure alarms are often caused by obstructions such as tubing kinks,
secretions, or the patient biting the ETT. The nurse should first check for these common
mechanical issues to resolve the alarm. If the cause cannot be found and the patient is in
distress, manual ventilation is the next step.
9. What is the primary purpose of Positive End-Expiratory Pressure (PEEP) in a patient with
ARDS?
A. To decrease the work of breathing.
