HEALTHSTREAM TEST NEWEST ACTUAL EXAM 100 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES/GRADE A+ ASSURED
Question 1
A patient assessment reveals distended neck veins, pulsus paradoxus, and decreased systolic
pressure. This assessment is most consistent with:
A) Pulmonary embolism
B) Myocardial infarction
C) Cardiac tamponade
D) Tension pneumothorax
E) Aortic dissection
Correct Answer: C) cardiac tamponade.
Rationale: Cardiac tamponade occurs when fluid (blood or effusion) accumulates in the
pericardial sac, exerting pressure on the heart and preventing the ventricles from filling
adequately. The classic assessment findings are known as Beck's Triad (hypotension,
jugular venous distention, and muffled heart sounds). Pulsus paradoxus—a drop in systolic
blood pressure of more than 10 mmHg during inspiration—is a hallmark sign of the
restricted cardiac filling and decreased stroke volume associated with this life-threatening
condition.
Question 2
The nurse is caring for a patient with severe sepsis and third-degree heart block. The patient is
currently hypotensive. The most appropriate treatment for this life-threatening rhythm change
includes:
A) Atropine 0.5 mg IV push
B) Synchronized cardioversion
C) Transcutaneous pacing
D) Amiodarone infusion
E) Defibrillation at 200 Joules
Correct Answer: C) transcutaneous pacing.
Rationale: Third-degree heart block (complete heart block) occurs when no electrical
impulses from the atria reach the ventricles, leading to a slow ventricular escape rhythm
and hemodynamic instability. In the context of sepsis and hypotension, Atropine is rarely
, 2
effective because it acts on the SA node, which is already disconnected from the ventricles.
Transcutaneous pacing (TCP) is the immediate treatment of choice to provide an external
electrical stimulus to maintain a heart rate sufficient to support cardiac output until a
permanent pacemaker can be placed.
Question 3
A patient is admitted to the ICU with a suspected cervical spinal cord injury following a motor
vehicle accident. The most important nursing intervention for this patient is to:
A) Initiate high-dose steroid therapy
B) Immobilize his head
C) Assess for autonomic dysreflexia
D) Insert a foley catheter
E) Obtain a stat CT scan
Correct Answer: B) immobilize his head.
Rationale: The priority in managing a suspected spinal cord injury (SCI) is to prevent
secondary injury caused by mechanical movement of unstable vertebral fractures.
Immobilizing the head and neck in a neutral position (typically using a cervical collar and
log-rolling techniques) prevents further compression or transection of the spinal cord.
While imaging and medications are important, stabilization of the spine is the absolute first
step in the "ABC" (Airway, Breathing, Circulation/Stability) of trauma nursing.
Question 4
The nurse assesses a patient's chest tube drainage 2 hours following thoracic surgery. The total
drainage in the system is 200 mL. The nurse recognizes that:
A) This is a normal amount for the first few hours
B) The suction is likely set too high
C) This is an excessive amount of drainage
D) The patient should be placed in Trendelenburg
E) The chest tube is likely occluded
Correct Answer: C) this is an excessive amount of drainage
Rationale: Following thoracic surgery, drainage greater than 100 mL/hr (or 200 mL in a 2-
, 3
hour window) is generally considered excessive and may indicate active internal
hemorrhage. The nurse must notify the surgeon immediately, monitor the patient's
hemodynamic status (blood pressure and heart rate), and prepare for potential surgical re-
exploration. Normal drainage should gradually decrease over time and transition from
sanguineous to serosanguineous.
Question 5
A patient requires CRRT (Continuous Renal Replacement Therapy). The charge nurse assigns the
patient to a nurse with 3 years of CRRT experience rather than the admitting nurse who has not
been educated on the therapy. This is an example of:
A) The Nursing Process
B) The Synergy Model for Patient Care
C) Evidence-Based Practice
D) Shared Governance
E) Relationship-Based Care
Correct Answer: B) the synergy model for patient care.
Rationale: The AACN Synergy Model for Patient Care suggests that the needs or
characteristics of patients and families influence and drive the characteristics or
competencies of nurses. Synergy occurs when the needs of the patient (in this case, the high
complexity of CRRT) are matched with the specific competencies of the nurse (3 years of
experience in that specific therapy). This alignment optimizes patient outcomes.
Question 6
A patient with acute tubular necrosis (ATN) is experiencing severe dehydration and sepsis. The
patient has now entered the polyuric stage of ATN. The most important nursing action is to:
A) Limit fluid intake to 1000 mL daily
B) Administer high-dose diuretics
C) Monitor electrolyte levels and signs of fluid depletion
D) Assess for periorbital edema
E) Prepare the patient for immediate dialysis
, 4
Correct Answer: C) monitor electrolyte levels and signs of fluid depletion.
Rationale: The polyuric (diuretic) stage of ATN is characterized by a gradual increase in
urine output (often 1–5 liters per day) because the kidneys have regained the ability to
excrete waste but cannot yet concentrate urine. This puts the patient at extreme risk for
hypovolemia, dehydration, and severe electrolyte imbalances (especially hyponatremia and
hypokalemia). Nursing care must focus on aggressive fluid replacement and laboratory
monitoring.
Question 7
A patient has an elevated central venous pressure (CVP) measurement. The most likely clinical
reason for this finding is:
A) Hypovolemic shock
B) Systemic vasodilation
C) Right heart failure
D) Internal hemorrhage
E) Excessive diuretic use
Correct Answer: C) right heart failure.
Rationale: Central Venous Pressure (CVP) measures the pressure in the right atrium and
reflects right ventricular end-diastolic pressure. An elevated CVP (normal is 2-6 mmHg)
indicates fluid volume overload or the inability of the right heart to pump blood forward.
In right heart failure, blood backs up into the systemic venous circulation, increasing the
pressure measured by the CVP catheter. Conversely, low CVP would indicate dehydration
or hypovolemia.
Question 8
Diabetes insipidus (DI) is a condition characterized by a deficiency of antidiuretic hormone
(ADH), and it is usually treated with:
A) Insulin regular
B) Furosemide
C) Vasopressin
DETAILED ANSWERS WITH RATIONALES/GRADE A+ ASSURED
Question 1
A patient assessment reveals distended neck veins, pulsus paradoxus, and decreased systolic
pressure. This assessment is most consistent with:
A) Pulmonary embolism
B) Myocardial infarction
C) Cardiac tamponade
D) Tension pneumothorax
E) Aortic dissection
Correct Answer: C) cardiac tamponade.
Rationale: Cardiac tamponade occurs when fluid (blood or effusion) accumulates in the
pericardial sac, exerting pressure on the heart and preventing the ventricles from filling
adequately. The classic assessment findings are known as Beck's Triad (hypotension,
jugular venous distention, and muffled heart sounds). Pulsus paradoxus—a drop in systolic
blood pressure of more than 10 mmHg during inspiration—is a hallmark sign of the
restricted cardiac filling and decreased stroke volume associated with this life-threatening
condition.
Question 2
The nurse is caring for a patient with severe sepsis and third-degree heart block. The patient is
currently hypotensive. The most appropriate treatment for this life-threatening rhythm change
includes:
A) Atropine 0.5 mg IV push
B) Synchronized cardioversion
C) Transcutaneous pacing
D) Amiodarone infusion
E) Defibrillation at 200 Joules
Correct Answer: C) transcutaneous pacing.
Rationale: Third-degree heart block (complete heart block) occurs when no electrical
impulses from the atria reach the ventricles, leading to a slow ventricular escape rhythm
and hemodynamic instability. In the context of sepsis and hypotension, Atropine is rarely
, 2
effective because it acts on the SA node, which is already disconnected from the ventricles.
Transcutaneous pacing (TCP) is the immediate treatment of choice to provide an external
electrical stimulus to maintain a heart rate sufficient to support cardiac output until a
permanent pacemaker can be placed.
Question 3
A patient is admitted to the ICU with a suspected cervical spinal cord injury following a motor
vehicle accident. The most important nursing intervention for this patient is to:
A) Initiate high-dose steroid therapy
B) Immobilize his head
C) Assess for autonomic dysreflexia
D) Insert a foley catheter
E) Obtain a stat CT scan
Correct Answer: B) immobilize his head.
Rationale: The priority in managing a suspected spinal cord injury (SCI) is to prevent
secondary injury caused by mechanical movement of unstable vertebral fractures.
Immobilizing the head and neck in a neutral position (typically using a cervical collar and
log-rolling techniques) prevents further compression or transection of the spinal cord.
While imaging and medications are important, stabilization of the spine is the absolute first
step in the "ABC" (Airway, Breathing, Circulation/Stability) of trauma nursing.
Question 4
The nurse assesses a patient's chest tube drainage 2 hours following thoracic surgery. The total
drainage in the system is 200 mL. The nurse recognizes that:
A) This is a normal amount for the first few hours
B) The suction is likely set too high
C) This is an excessive amount of drainage
D) The patient should be placed in Trendelenburg
E) The chest tube is likely occluded
Correct Answer: C) this is an excessive amount of drainage
Rationale: Following thoracic surgery, drainage greater than 100 mL/hr (or 200 mL in a 2-
, 3
hour window) is generally considered excessive and may indicate active internal
hemorrhage. The nurse must notify the surgeon immediately, monitor the patient's
hemodynamic status (blood pressure and heart rate), and prepare for potential surgical re-
exploration. Normal drainage should gradually decrease over time and transition from
sanguineous to serosanguineous.
Question 5
A patient requires CRRT (Continuous Renal Replacement Therapy). The charge nurse assigns the
patient to a nurse with 3 years of CRRT experience rather than the admitting nurse who has not
been educated on the therapy. This is an example of:
A) The Nursing Process
B) The Synergy Model for Patient Care
C) Evidence-Based Practice
D) Shared Governance
E) Relationship-Based Care
Correct Answer: B) the synergy model for patient care.
Rationale: The AACN Synergy Model for Patient Care suggests that the needs or
characteristics of patients and families influence and drive the characteristics or
competencies of nurses. Synergy occurs when the needs of the patient (in this case, the high
complexity of CRRT) are matched with the specific competencies of the nurse (3 years of
experience in that specific therapy). This alignment optimizes patient outcomes.
Question 6
A patient with acute tubular necrosis (ATN) is experiencing severe dehydration and sepsis. The
patient has now entered the polyuric stage of ATN. The most important nursing action is to:
A) Limit fluid intake to 1000 mL daily
B) Administer high-dose diuretics
C) Monitor electrolyte levels and signs of fluid depletion
D) Assess for periorbital edema
E) Prepare the patient for immediate dialysis
, 4
Correct Answer: C) monitor electrolyte levels and signs of fluid depletion.
Rationale: The polyuric (diuretic) stage of ATN is characterized by a gradual increase in
urine output (often 1–5 liters per day) because the kidneys have regained the ability to
excrete waste but cannot yet concentrate urine. This puts the patient at extreme risk for
hypovolemia, dehydration, and severe electrolyte imbalances (especially hyponatremia and
hypokalemia). Nursing care must focus on aggressive fluid replacement and laboratory
monitoring.
Question 7
A patient has an elevated central venous pressure (CVP) measurement. The most likely clinical
reason for this finding is:
A) Hypovolemic shock
B) Systemic vasodilation
C) Right heart failure
D) Internal hemorrhage
E) Excessive diuretic use
Correct Answer: C) right heart failure.
Rationale: Central Venous Pressure (CVP) measures the pressure in the right atrium and
reflects right ventricular end-diastolic pressure. An elevated CVP (normal is 2-6 mmHg)
indicates fluid volume overload or the inability of the right heart to pump blood forward.
In right heart failure, blood backs up into the systemic venous circulation, increasing the
pressure measured by the CVP catheter. Conversely, low CVP would indicate dehydration
or hypovolemia.
Question 8
Diabetes insipidus (DI) is a condition characterized by a deficiency of antidiuretic hormone
(ADH), and it is usually treated with:
A) Insulin regular
B) Furosemide
C) Vasopressin
