NSG 4100
NSG 4100 (AH III) Exam 3
1. The nurse is attending to a client who has orders for central venous pressure (CVP)
monitoring. The nurse understands the catheter attached to a pressure monitoring system
will be placed in the:
A. Left to right ventricle B. Vena cava or Left atrium C. Vena cava or Right atrium D.
Pulmonary artery or vein
Annotation: The preferred site is the SUBCLAVIAN VEIN; physician threads catheter
through the vein into the VENA CAVA just above or within the RIGHT ATRIUM. CVP
measures right ventricular preload (filling pressure), indicating fluid volume status.
Normal CVP is 2-6 mmHg.
2. The nurse preceptor is observing a newly hired nurse care for a client who has a
hemodynamic monitoring catheter in place. Which of the following actions by the newly
hired nurse requires immediate intervention by the nurse preceptor?
A. Refusing to use topical antibiotic ointment & creams on the insertion sites B. Using
alcohol-based hand rub before and after each contact with the catheter C. Replacing
transducer tubing, continuous flush devices and solution every 96 hours D. Informing the
client that this type of catheter allows for total freedom in the bath and shower
Annotation: Showering is permitted ONLY if catheter & tubing are placed in an
impermeable cover. DO NOT SUBMERGE catheter or site in water (NO BATHS). This
prevents infection at the insertion site.
3. The nurse is caring for a client who developed a cardiac rhythm indicated below. Which of
the following findings is commonly associated with this rhythm?
Sinus Bradycardia Strip
Sinus Bradycardia Strip
A. Lower metabolic needs B. Side effects of atropine C. High metabolic demand D.
Physiological stress
Annotation: “Sinus Bradycardia” -> Rhythm strip shows ~40-50 BPM. SLOW
METABOLISM = SLOW HEART. This can be normal in athletes or during sleep, but
symptomatic bradycardia requires intervention.
,NSG 4100
4. The nurse is reviewing newly written prescriptions for a client admitted with sinus
tachycardia. Which of the following prescriptions requires immediate follow up with a
primary health care provider?
A. Amiodarone B. Procainamide C. Atropine D. Sotalol
Annotation: Atropine INCREASES HR. Do not give with sinus tachycardia! (Raises BP
too). Atropine is used for symptomatic bradycardia, not tachycardia.
5. A client presenting with substernal chest discomfort and nausea is placed on a cardiac
monitor. Which of the following findings is consistent with a diagnosis of Myocardial
Infarction (MI)?
A. An irregularly irregular heart rhythm B. QRS interval greater than 0.12 seconds C. Tall,
tented T-waves with unchanged ST segments D. Inverted T-waves with ST elevation
Annotation: STEMI (ST-Elevation MI) is the classic “tombstone” pattern, indicating
acute injury. Inverted T-waves indicate ischemia, and ST elevation signifies
myocardial injury.
6. The nurse is caring for a client who has had chest pain for the past 30 minutes and has
been prescribed an IV thrombolytic. Which question is a priority for the nurse to ask the
client prior to administration?
A. “Are you allergic to aspirin?” B. “Have you had any surgical procedures within the
past 10 days?” C. “Do you have a prescribed beta blocker?” D. “Do you have a history of
smoking?”
Annotation: Thrombolytics (clot busters) are contraindicated in recent surgery due
to massive bleeding risk! Other contraindications include active bleeding, history of
hemorrhagic stroke, and severe uncontrolled hypertension.
7. The nurse is preparing a client for percutaneous transluminal coronary angioplasty (PTCA).
Which of the following actions should the nurse take?
A. Withhold the anti-HTN meds for 4 hours before the procedure B. Obtain the client’s
weight immediately before the procedure C. Assess for allergies to radio-opaque
contrast dye D. Inform the client that the procedure is routinely performed at the bedside
Annotation: Check for SHELLFISH or IODINE allergies! Contrast dye is used to
visualize the vessels during the procedure. Renal function should also be assessed
due to contrast excretion.
, NSG 4100
8. The nurse is caring for a client who had a PTCA 1 hour ago. The nurse should immediately
notify the provider if the client develops:
A. Discomfort at the insertion site B. Small hematoma on the insertion site C. Diminished
pulses in the affected extremity D. Bruising at the site that is soft to the touch
Annotation: Diminished pulses = ARTERIAL OCCLUSION or CLOT. This is a medical
emergency! It indicates potential limb ischemia and requires urgent intervention.
9. The nurse is caring for a client with a history of cardiomyopathy who develops the rhythm
seen below. What is the first action the nurse should take?
Ventricular Fibrillation Strip
Ventricular Fibrillation Strip
A. Have the client perform vagal maneuvers B. Administer the prescribed cardiac
medication C. Begin CPR and prepare for defibrillation D. Elevate the client’s head of
bed
Annotation: V-FIB = DEFIB! This is a lethal rhythm. No pulse, no breathing. Start
CPR immediately. Defibrillation is the definitive treatment for V-fib.
10. A nurse is assessing a patient with a chest tube. The nurse notes constant bubbling in the
water-seal chamber. What does this indicate?
A. The system is functioning normally B. The patient has a pneumothorax C. There is a
leak in the system D. The chest tube is obstructed
Annotation: Intermittent bubbling is normal in pneumothorax (air leaving the
pleural space); CONSTANT bubbling means a LEAK. Check connections from the
patient to the drainage system.
11. Which cardiac enzyme would the nurse expect to elevate first in a patient diagnosed with
an MI?
A. Creatinine kinase (CK-MB) B. Lactate dehydrogenase (LDH) C. Troponin D. White blood
cells (WBCs)
Annotation: Troponin is the most sensitive and specific marker for cardiac muscle
damage, rising within 3-6 hours of MI onset.
NSG 4100 (AH III) Exam 3
1. The nurse is attending to a client who has orders for central venous pressure (CVP)
monitoring. The nurse understands the catheter attached to a pressure monitoring system
will be placed in the:
A. Left to right ventricle B. Vena cava or Left atrium C. Vena cava or Right atrium D.
Pulmonary artery or vein
Annotation: The preferred site is the SUBCLAVIAN VEIN; physician threads catheter
through the vein into the VENA CAVA just above or within the RIGHT ATRIUM. CVP
measures right ventricular preload (filling pressure), indicating fluid volume status.
Normal CVP is 2-6 mmHg.
2. The nurse preceptor is observing a newly hired nurse care for a client who has a
hemodynamic monitoring catheter in place. Which of the following actions by the newly
hired nurse requires immediate intervention by the nurse preceptor?
A. Refusing to use topical antibiotic ointment & creams on the insertion sites B. Using
alcohol-based hand rub before and after each contact with the catheter C. Replacing
transducer tubing, continuous flush devices and solution every 96 hours D. Informing the
client that this type of catheter allows for total freedom in the bath and shower
Annotation: Showering is permitted ONLY if catheter & tubing are placed in an
impermeable cover. DO NOT SUBMERGE catheter or site in water (NO BATHS). This
prevents infection at the insertion site.
3. The nurse is caring for a client who developed a cardiac rhythm indicated below. Which of
the following findings is commonly associated with this rhythm?
Sinus Bradycardia Strip
Sinus Bradycardia Strip
A. Lower metabolic needs B. Side effects of atropine C. High metabolic demand D.
Physiological stress
Annotation: “Sinus Bradycardia” -> Rhythm strip shows ~40-50 BPM. SLOW
METABOLISM = SLOW HEART. This can be normal in athletes or during sleep, but
symptomatic bradycardia requires intervention.
,NSG 4100
4. The nurse is reviewing newly written prescriptions for a client admitted with sinus
tachycardia. Which of the following prescriptions requires immediate follow up with a
primary health care provider?
A. Amiodarone B. Procainamide C. Atropine D. Sotalol
Annotation: Atropine INCREASES HR. Do not give with sinus tachycardia! (Raises BP
too). Atropine is used for symptomatic bradycardia, not tachycardia.
5. A client presenting with substernal chest discomfort and nausea is placed on a cardiac
monitor. Which of the following findings is consistent with a diagnosis of Myocardial
Infarction (MI)?
A. An irregularly irregular heart rhythm B. QRS interval greater than 0.12 seconds C. Tall,
tented T-waves with unchanged ST segments D. Inverted T-waves with ST elevation
Annotation: STEMI (ST-Elevation MI) is the classic “tombstone” pattern, indicating
acute injury. Inverted T-waves indicate ischemia, and ST elevation signifies
myocardial injury.
6. The nurse is caring for a client who has had chest pain for the past 30 minutes and has
been prescribed an IV thrombolytic. Which question is a priority for the nurse to ask the
client prior to administration?
A. “Are you allergic to aspirin?” B. “Have you had any surgical procedures within the
past 10 days?” C. “Do you have a prescribed beta blocker?” D. “Do you have a history of
smoking?”
Annotation: Thrombolytics (clot busters) are contraindicated in recent surgery due
to massive bleeding risk! Other contraindications include active bleeding, history of
hemorrhagic stroke, and severe uncontrolled hypertension.
7. The nurse is preparing a client for percutaneous transluminal coronary angioplasty (PTCA).
Which of the following actions should the nurse take?
A. Withhold the anti-HTN meds for 4 hours before the procedure B. Obtain the client’s
weight immediately before the procedure C. Assess for allergies to radio-opaque
contrast dye D. Inform the client that the procedure is routinely performed at the bedside
Annotation: Check for SHELLFISH or IODINE allergies! Contrast dye is used to
visualize the vessels during the procedure. Renal function should also be assessed
due to contrast excretion.
, NSG 4100
8. The nurse is caring for a client who had a PTCA 1 hour ago. The nurse should immediately
notify the provider if the client develops:
A. Discomfort at the insertion site B. Small hematoma on the insertion site C. Diminished
pulses in the affected extremity D. Bruising at the site that is soft to the touch
Annotation: Diminished pulses = ARTERIAL OCCLUSION or CLOT. This is a medical
emergency! It indicates potential limb ischemia and requires urgent intervention.
9. The nurse is caring for a client with a history of cardiomyopathy who develops the rhythm
seen below. What is the first action the nurse should take?
Ventricular Fibrillation Strip
Ventricular Fibrillation Strip
A. Have the client perform vagal maneuvers B. Administer the prescribed cardiac
medication C. Begin CPR and prepare for defibrillation D. Elevate the client’s head of
bed
Annotation: V-FIB = DEFIB! This is a lethal rhythm. No pulse, no breathing. Start
CPR immediately. Defibrillation is the definitive treatment for V-fib.
10. A nurse is assessing a patient with a chest tube. The nurse notes constant bubbling in the
water-seal chamber. What does this indicate?
A. The system is functioning normally B. The patient has a pneumothorax C. There is a
leak in the system D. The chest tube is obstructed
Annotation: Intermittent bubbling is normal in pneumothorax (air leaving the
pleural space); CONSTANT bubbling means a LEAK. Check connections from the
patient to the drainage system.
11. Which cardiac enzyme would the nurse expect to elevate first in a patient diagnosed with
an MI?
A. Creatinine kinase (CK-MB) B. Lactate dehydrogenase (LDH) C. Troponin D. White blood
cells (WBCs)
Annotation: Troponin is the most sensitive and specific marker for cardiac muscle
damage, rising within 3-6 hours of MI onset.
