CHAPTER 6 CEN|VERIFIED QUESTIONS AND
ANSWERS|GRADED A+ |LATEST 2026/2027
A patient presents to the ED with CP and diaphoresis, & denies dyspnea. VS are BP 148/70, HR 72, RR 18,
SPO2 98 RA. BBS clear & equal. The ECG shows inferior wall ST elevation. You anticipate the following
oxygen order.
A. No supplemental O2 @ this time
B. NC 6L
C. PNRB @ 10 L
D. NRB @ 15L - ANSWER✔ A. No supplemental O2 @ this time
A patient c/o CP, dyspnea, & diaphoresis. Which of the following assessment factors would indicate a
possible diagnosis of acute coronary syndrome?
A. Pleuritic CP
B. Positional CP
C. CP that radiates to the shoulders, with pain in the R shoulder worse than pain in the L shoulder
D. Pain reproducible with chest walk palpation - ANSWER✔ C. CP that radiates to the shoulders, with
pain in the R shoulder worse than pain in the L shoulder
Which of the following human compensatory mechanisms to the presence of shock triggers
glycogenolysis?
A. chemoreceptor activation
B. clotting cascade activation
C. cerebral autoregulation stimulation
D. adrenal gland stimulation - ANSWER✔ D. adrenal gland stimulation
causes adrenals to release 2 catecholamines: Epi and Norepi . Epi increases HR and peripheral
vasoconstriction & triggers glycogenolysis
A patient presents to the ED with ABD pain and "ripping" back pain. Which condition places the patient
@ risk for abdominal aortic aneurysm dissection?
,A. Downs syndrome
B. Romano-Ward syndrome
C. Jervell & Lange-Nielsen Syndrome
D. Ehler-Danlos Syndrome - ANSWER✔ D. Ehler-Danlos Syndrome
Patients with Ehler-Danlos Syndrome may be identified by hyper mobile joints & skin that is hyper-
extensible, has a soft velvety-like appearance, is fragile, & tears or bruises easily. Ehler-Danlos Syndrome
is a connective tissue disorder that places patients @ risk for the presence of aortic aneurysm and
dissection.
Romano-Ward syndrome - ANSWER✔ -Congenital long QT syndrome
-may have sudden death resulting from a dysrhythmia
Jervell Lange-Nielsen Syndrome - ANSWER✔ -Congenital long QT syndrome
-profound hearing loss from birth
-may have sudden death resulting from a dysrhythmia
A patient presents via EMS in cardiopulmonary arrest, following 15 minutes of CPR. On completion of
the initial nursing assessment, which of the following findings would indicate that termination of
resuscitation efforts should be considered?
A. Decreased compliance while performing bag-mask device ventilation
B. An end-tidal carbon dioxide level reading less than 10% after 20 minutes of high-quality CPR
C. An initial rhythm of PEA
D. An initial presentation of a shockable rhythm - ANSWER✔ B. A low end-tidal CO2 level indicates a
lack of both end cellular perfusion & adenosine triphosphate production, resulting in cellular death
A 7 y/o suddenly develops VF. The child weighs 66 lbs (30 kg). CPR is started immediately. What is the
correct defibrillation dose for the initial shock to be used by the ER nurse.
A. 60 j
,B. 30 j
C. 120 j
D. 90 j - ANSWER✔ A. The child weighs 30 kg. The correct initial joule dose is 2 j per kg. The correct
dose would be 60 j for the initial shock & increasing to 4 j per kg. This dose can be increased up to max
of 10 j per kg.
The ER nurse is participating in the care of an obtunded patient presumed to have taken an OD of
tricyclic antidepressants. The patient has a palpable pulse, and an ECG is obtained. The nurse would
anticipate the presence of which ECG finding?
A. SB with normal QRS & QT intervals
B. VF
C. Narrow complex SVT
D. ST with both a widened QRS interval & prolonged QT interval - ANSWER✔ D. ST occurs frequently
from the anticholinergic effects of tricyclic antidepressant toxicity. QRS complex widening occurs as a
result of sodium channel blockade, & this delayed conduction may be seen more commonly involving
the R side of the heart, manifesting as R BBB. In addition, QT interval prolongation can occur with these
agents.
During triage, the patient states the pacemaker only fires when the patient's HR slows below a certain
number of beats/minute. The nurse anticipates that the patient has a(an):
A. asynchronous pacemaker
B. demand pacemaker
C. dual-chamber pacemaker
D. fixed-rate pacemaker - ANSWER✔ B. demand pacemaker
Fixed rate pacemaker - ANSWER✔ Pacemaker that continuously discharges at a preset rate
regardless of the patient's intrinsic activity; also known as an asynchronous pacemaker
dual chamber pacemaker - ANSWER✔ Pacemaker that stimulates the atrium and ventricle based on
patient's intrinsic HR
, A patient being evaluated in the ED is noted to have Janeway lesions, Roth spots, and Osler's nodes
along with elevated body temperature & elevated WBC count. Patient assessment reveals the presence
of several recent body piercings. The ER nurse suspects the patient has:
A. endocarditis
B. pericarditis
C. myocarditis
D. leukemia - ANSWER✔ A. endocarditis
The patient's symptoms are classic for endocarditis. Janeway lesions are petechial lesions found on the
palms of the hands or soles of the feet. Osler's nodes are defined as painful fingertip lesions, & Roth's
spots are retinal hemorrhages with the presence of whitish spots in the center. The patient may
experience fevers along with an elevated WBC, and recent body piercings may be a source of infections
leading to endocarditis. The endocarditic infection may also spread to valve structures in the heart,
resulting in permanent valvular dysfunction.
A conscious pulseless patient with a continuous-flow LVAD and a history of end-stage heart failure
presents to the ED because of a "low-flow" alarm. The nurse anticipates performing which intervention
first?
A. Obtain BP using Doppler and sphygmomanometer
B. Auscultate over the pump to ascertain if the device is working
C. administer IVF
D. Begin chest compressions - ANSWER✔ A. Obtain BP using Doppler and sphygmomanometer
the low flow alarm maybe because of decrease preload from hypotension, dehydration, obstruction of
the inflow or outflow ( which would cause an increase in afterload) cannula, or disconnection of
percutaneous leads. mean arterial blood pressure should be obtained by placing a Doppler over the
brachial or radial artery and then inflating the cuff until flow is no longer heard. Once the arterial flow is
heard again, this is the MAP. LVAD patient should have MAPs between 70 and 80. in a conscious patient,
determining the patient's blood pressure will help guide therapy and troubleshooting. the patients LVAD
coordinator should also be contacted as soon as possible
a heart failure patient with profound dyspnea, lung crackles, and pink frothy sputum presents to the
emergency department. The physician orders for the patient to be placed on bi-level positive airway
pressure at an end-expiratory pressure of 10 and an inspiratory pressure of 5. Which of the following
findings demonstrates that the patient's symptoms and work of breathing have been reduced?
ANSWERS|GRADED A+ |LATEST 2026/2027
A patient presents to the ED with CP and diaphoresis, & denies dyspnea. VS are BP 148/70, HR 72, RR 18,
SPO2 98 RA. BBS clear & equal. The ECG shows inferior wall ST elevation. You anticipate the following
oxygen order.
A. No supplemental O2 @ this time
B. NC 6L
C. PNRB @ 10 L
D. NRB @ 15L - ANSWER✔ A. No supplemental O2 @ this time
A patient c/o CP, dyspnea, & diaphoresis. Which of the following assessment factors would indicate a
possible diagnosis of acute coronary syndrome?
A. Pleuritic CP
B. Positional CP
C. CP that radiates to the shoulders, with pain in the R shoulder worse than pain in the L shoulder
D. Pain reproducible with chest walk palpation - ANSWER✔ C. CP that radiates to the shoulders, with
pain in the R shoulder worse than pain in the L shoulder
Which of the following human compensatory mechanisms to the presence of shock triggers
glycogenolysis?
A. chemoreceptor activation
B. clotting cascade activation
C. cerebral autoregulation stimulation
D. adrenal gland stimulation - ANSWER✔ D. adrenal gland stimulation
causes adrenals to release 2 catecholamines: Epi and Norepi . Epi increases HR and peripheral
vasoconstriction & triggers glycogenolysis
A patient presents to the ED with ABD pain and "ripping" back pain. Which condition places the patient
@ risk for abdominal aortic aneurysm dissection?
,A. Downs syndrome
B. Romano-Ward syndrome
C. Jervell & Lange-Nielsen Syndrome
D. Ehler-Danlos Syndrome - ANSWER✔ D. Ehler-Danlos Syndrome
Patients with Ehler-Danlos Syndrome may be identified by hyper mobile joints & skin that is hyper-
extensible, has a soft velvety-like appearance, is fragile, & tears or bruises easily. Ehler-Danlos Syndrome
is a connective tissue disorder that places patients @ risk for the presence of aortic aneurysm and
dissection.
Romano-Ward syndrome - ANSWER✔ -Congenital long QT syndrome
-may have sudden death resulting from a dysrhythmia
Jervell Lange-Nielsen Syndrome - ANSWER✔ -Congenital long QT syndrome
-profound hearing loss from birth
-may have sudden death resulting from a dysrhythmia
A patient presents via EMS in cardiopulmonary arrest, following 15 minutes of CPR. On completion of
the initial nursing assessment, which of the following findings would indicate that termination of
resuscitation efforts should be considered?
A. Decreased compliance while performing bag-mask device ventilation
B. An end-tidal carbon dioxide level reading less than 10% after 20 minutes of high-quality CPR
C. An initial rhythm of PEA
D. An initial presentation of a shockable rhythm - ANSWER✔ B. A low end-tidal CO2 level indicates a
lack of both end cellular perfusion & adenosine triphosphate production, resulting in cellular death
A 7 y/o suddenly develops VF. The child weighs 66 lbs (30 kg). CPR is started immediately. What is the
correct defibrillation dose for the initial shock to be used by the ER nurse.
A. 60 j
,B. 30 j
C. 120 j
D. 90 j - ANSWER✔ A. The child weighs 30 kg. The correct initial joule dose is 2 j per kg. The correct
dose would be 60 j for the initial shock & increasing to 4 j per kg. This dose can be increased up to max
of 10 j per kg.
The ER nurse is participating in the care of an obtunded patient presumed to have taken an OD of
tricyclic antidepressants. The patient has a palpable pulse, and an ECG is obtained. The nurse would
anticipate the presence of which ECG finding?
A. SB with normal QRS & QT intervals
B. VF
C. Narrow complex SVT
D. ST with both a widened QRS interval & prolonged QT interval - ANSWER✔ D. ST occurs frequently
from the anticholinergic effects of tricyclic antidepressant toxicity. QRS complex widening occurs as a
result of sodium channel blockade, & this delayed conduction may be seen more commonly involving
the R side of the heart, manifesting as R BBB. In addition, QT interval prolongation can occur with these
agents.
During triage, the patient states the pacemaker only fires when the patient's HR slows below a certain
number of beats/minute. The nurse anticipates that the patient has a(an):
A. asynchronous pacemaker
B. demand pacemaker
C. dual-chamber pacemaker
D. fixed-rate pacemaker - ANSWER✔ B. demand pacemaker
Fixed rate pacemaker - ANSWER✔ Pacemaker that continuously discharges at a preset rate
regardless of the patient's intrinsic activity; also known as an asynchronous pacemaker
dual chamber pacemaker - ANSWER✔ Pacemaker that stimulates the atrium and ventricle based on
patient's intrinsic HR
, A patient being evaluated in the ED is noted to have Janeway lesions, Roth spots, and Osler's nodes
along with elevated body temperature & elevated WBC count. Patient assessment reveals the presence
of several recent body piercings. The ER nurse suspects the patient has:
A. endocarditis
B. pericarditis
C. myocarditis
D. leukemia - ANSWER✔ A. endocarditis
The patient's symptoms are classic for endocarditis. Janeway lesions are petechial lesions found on the
palms of the hands or soles of the feet. Osler's nodes are defined as painful fingertip lesions, & Roth's
spots are retinal hemorrhages with the presence of whitish spots in the center. The patient may
experience fevers along with an elevated WBC, and recent body piercings may be a source of infections
leading to endocarditis. The endocarditic infection may also spread to valve structures in the heart,
resulting in permanent valvular dysfunction.
A conscious pulseless patient with a continuous-flow LVAD and a history of end-stage heart failure
presents to the ED because of a "low-flow" alarm. The nurse anticipates performing which intervention
first?
A. Obtain BP using Doppler and sphygmomanometer
B. Auscultate over the pump to ascertain if the device is working
C. administer IVF
D. Begin chest compressions - ANSWER✔ A. Obtain BP using Doppler and sphygmomanometer
the low flow alarm maybe because of decrease preload from hypotension, dehydration, obstruction of
the inflow or outflow ( which would cause an increase in afterload) cannula, or disconnection of
percutaneous leads. mean arterial blood pressure should be obtained by placing a Doppler over the
brachial or radial artery and then inflating the cuff until flow is no longer heard. Once the arterial flow is
heard again, this is the MAP. LVAD patient should have MAPs between 70 and 80. in a conscious patient,
determining the patient's blood pressure will help guide therapy and troubleshooting. the patients LVAD
coordinator should also be contacted as soon as possible
a heart failure patient with profound dyspnea, lung crackles, and pink frothy sputum presents to the
emergency department. The physician orders for the patient to be placed on bi-level positive airway
pressure at an end-expiratory pressure of 10 and an inspiratory pressure of 5. Which of the following
findings demonstrates that the patient's symptoms and work of breathing have been reduced?
