NSG 4100 EXAM 3| 50 ACTUAL QUESTIONS AND
ANSWERS | 2026 UPDATE |100% CORRECT.
Unit 5: Complex Perfusion Problems (Part I)
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 35 bpm with a consistent P
wave before each QRS complex. The patient is alert but his blood pressure is 88/50
mmHg. What is the priority nursing intervention?
a) Administer atropine as prescribed.
b) Prepare for transcutaneous pacing.
c) Obtain an order for a 12-lead ECG.
d) Elevate the head of the bed to improve breathing.
« Correct Answer: b) Prepare for transcutaneous pacing.
« Rationale: The patient is experiencing symptomatic sinus bradycardia (HR < 60
bpm with signs of poor perfusion like dizziness and hypotension). While atropine
is a first-line medication, a heart rate of 35 bpm is severely low, and the patient is
hypotensive. Preparing for transcutaneous pacing is the priority as it can
immediately increase the heart rate and improve cardiac output, while waiting for
atropine to take effect or if atropine is ineffective.
Question 2
A nurse is caring for a patient who is post-cardiac catheterization. The patient's
telemetry monitor suddenly shows a rapid, irregular rhythm with a heart rate of 150 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
, « Correct Answer: b) Atrial fibrillation
« Rationale: Atrial fibrillation is characterized by a rapid and irregular heart rhythm
with no identifiable P waves. The loss of atrial kick and rapid ventricular response
can lead to a decrease in cardiac output, causing symptoms like
lightheadedness.
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) "l need to avoid lifting heavy objects for a few weeks."
b) "If | feel a shock, | should call my doctor immediately.”
c) "My family needs to learn CPR in case the device doesn't work."
d) "l can use my cell phone and microwave without any problems."
« Correct Answer: b) "If| feel a shock, | should call my doctor immediately.”
« Rationale: The patient should be taught to call their doctor after receiving a
shock. If they receive multiple shocks or feel unwell, they should seek
emergency medical attention. Feeling a single shock indicates the device is
working as intended to correct a life-threatening arrhythmia.
Question 4
A patient with a history of coronary artery disease is admitted with chest pain. The ECG
shows ST elevation in leads I, Ill, and aVF. The nurse knows this finding is indicative of
an infarction in which area of the heart?
a) Anterior wall
b) Lateral wall
c) Inferior wall
d) Septal wall
¢ Correct Answer: c) Inferior wall
, . Rationale: ST elevation in leads II, lll, and aVF is a classic finding for an inferior
wall myocardial infarction. These leads look at the inferior surface of the heart.
Question 5
Anurse is preparing to administer adenosine to a patient in supraventricular tachycardia
(SVT). The patient's heart rate is 180 bpm and regular. Which action is most critical for
the nurse to take?
a) Administer the drug over 2 minutes to prevent side effects.
b) Have a defibrillator and crash cart at the bedside.
c) Instruct the patient to perform the Valsalva maneuver.
d) Administer the medication through an oral syringe.
« Correct Answer: b) Have a defibrillator and crash cart at the bedside.
« Rationale: Adenosine is a very short-acting drug that can cause a brief period of
asystole. Because of this risk, it is critical to have a defibrillator and crash cart
immediately available in case of a sustained rhythm disturbance. The drug
should be administered rapidly via a large-bore IV.
Unit 6: Complex Perfusion Problems (Part Il)
Question 6
A 55-year-old male with a history of uncontrolled hypertension presents with severe,
tearing back pain. He is diaphoretic, and his blood pressure is 210/110 mmHg. The
nurse suspects an aortic dissection. What is the priority nursing action?
a) Administer analgesics to relieve the pain.
b) Lower the head of the bed to a flat position.
c) Administer IV antihypertensives to lower the blood pressure.
d) Prepare the patient for an emergency abdominal aortic aneurysm repair.
« Correct Answer: c) Administer IV antihypertensives to lower the blood pressure.
« Rationale: An aortic dissection is a medical emergency where the inner layer of
the aorta tears. The priority is to lower the blood pressure to reduce the stress
on the weakened aortic wall and prevent further tearing or rupture.
ANSWERS | 2026 UPDATE |100% CORRECT.
Unit 5: Complex Perfusion Problems (Part I)
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 35 bpm with a consistent P
wave before each QRS complex. The patient is alert but his blood pressure is 88/50
mmHg. What is the priority nursing intervention?
a) Administer atropine as prescribed.
b) Prepare for transcutaneous pacing.
c) Obtain an order for a 12-lead ECG.
d) Elevate the head of the bed to improve breathing.
« Correct Answer: b) Prepare for transcutaneous pacing.
« Rationale: The patient is experiencing symptomatic sinus bradycardia (HR < 60
bpm with signs of poor perfusion like dizziness and hypotension). While atropine
is a first-line medication, a heart rate of 35 bpm is severely low, and the patient is
hypotensive. Preparing for transcutaneous pacing is the priority as it can
immediately increase the heart rate and improve cardiac output, while waiting for
atropine to take effect or if atropine is ineffective.
Question 2
A nurse is caring for a patient who is post-cardiac catheterization. The patient's
telemetry monitor suddenly shows a rapid, irregular rhythm with a heart rate of 150 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
, « Correct Answer: b) Atrial fibrillation
« Rationale: Atrial fibrillation is characterized by a rapid and irregular heart rhythm
with no identifiable P waves. The loss of atrial kick and rapid ventricular response
can lead to a decrease in cardiac output, causing symptoms like
lightheadedness.
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) "l need to avoid lifting heavy objects for a few weeks."
b) "If | feel a shock, | should call my doctor immediately.”
c) "My family needs to learn CPR in case the device doesn't work."
d) "l can use my cell phone and microwave without any problems."
« Correct Answer: b) "If| feel a shock, | should call my doctor immediately.”
« Rationale: The patient should be taught to call their doctor after receiving a
shock. If they receive multiple shocks or feel unwell, they should seek
emergency medical attention. Feeling a single shock indicates the device is
working as intended to correct a life-threatening arrhythmia.
Question 4
A patient with a history of coronary artery disease is admitted with chest pain. The ECG
shows ST elevation in leads I, Ill, and aVF. The nurse knows this finding is indicative of
an infarction in which area of the heart?
a) Anterior wall
b) Lateral wall
c) Inferior wall
d) Septal wall
¢ Correct Answer: c) Inferior wall
, . Rationale: ST elevation in leads II, lll, and aVF is a classic finding for an inferior
wall myocardial infarction. These leads look at the inferior surface of the heart.
Question 5
Anurse is preparing to administer adenosine to a patient in supraventricular tachycardia
(SVT). The patient's heart rate is 180 bpm and regular. Which action is most critical for
the nurse to take?
a) Administer the drug over 2 minutes to prevent side effects.
b) Have a defibrillator and crash cart at the bedside.
c) Instruct the patient to perform the Valsalva maneuver.
d) Administer the medication through an oral syringe.
« Correct Answer: b) Have a defibrillator and crash cart at the bedside.
« Rationale: Adenosine is a very short-acting drug that can cause a brief period of
asystole. Because of this risk, it is critical to have a defibrillator and crash cart
immediately available in case of a sustained rhythm disturbance. The drug
should be administered rapidly via a large-bore IV.
Unit 6: Complex Perfusion Problems (Part Il)
Question 6
A 55-year-old male with a history of uncontrolled hypertension presents with severe,
tearing back pain. He is diaphoretic, and his blood pressure is 210/110 mmHg. The
nurse suspects an aortic dissection. What is the priority nursing action?
a) Administer analgesics to relieve the pain.
b) Lower the head of the bed to a flat position.
c) Administer IV antihypertensives to lower the blood pressure.
d) Prepare the patient for an emergency abdominal aortic aneurysm repair.
« Correct Answer: c) Administer IV antihypertensives to lower the blood pressure.
« Rationale: An aortic dissection is a medical emergency where the inner layer of
the aorta tears. The priority is to lower the blood pressure to reduce the stress
on the weakened aortic wall and prevent further tearing or rupture.
