NUR 220 | NUR 220 Medical Surgical Nursing Exam
2 Version 2 | Questions with Correct Answers and
Expert Explanation for Each Question | Baltimore
City Community College
1. A patient is admitted with suspected myocardial infarction (MI). Which cardiac
biomarker is most specific for myocardial injury and typically peaks within 24 hours?
A. Creatine Kinase (CK-MB)
B. Myoglobin
C. Troponin I
D. C-reactive protein
Correct Answer: C
Expert Explanation: Troponin I is the gold standard for diagnosing myocardial
infarction due to its high specificity for heart muscle damage. While CK-MB also
rises during an MI, it is not as specific as Troponin I because it can be found in
skeletal muscle. Myoglobin rises quickly but lacks specificity for cardiac tissue alone.
C-reactive protein is an inflammatory marker and does not diagnose acute necrosis.
Measuring Troponin levels allows clinicians to accurately assess the extent of
myocardial damage.
,2. A nurse identifies ventricular fibrillation (VF) on the cardiac monitor of a patient
who has just collapsed. What is the immediate priority intervention?
A. Administering a bolus of Amiodarone
B. Intubating the patient to secure the airway
C. Preparing for synchronized cardioversion
D. Performing immediate defibrillation
Correct Answer: D
Expert Explanation: Ventricular fibrillation is a pulseless rhythm that requires
rapid defibrillation to restore a functional heartbeat. Synchronized cardioversion is
inappropriate here because there is no R-wave to synchronize with in VF.
Pharmacological interventions like Amiodarone are secondary to mechanical
intervention in this lethal rhythm. Delaying defibrillation for even a few minutes
significantly reduces the probability of a successful resuscitation. The primary goal
in VF management is to stop the chaotic electrical activity so the SA node can regain
control.
3. A patient presents with acute respiratory failure and the following ABG results: pH
7.28, PaCO2 55 mmHg, HCO3 26 mEq/L. How should the nurse interpret these
findings?
A. Metabolic Acidosis
,B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Correct Answer: C
Expert Explanation: A pH below 7.35 indicates acidosis, and a PaCO2 above 45
mmHg points to a respiratory cause. The bicarbonate level is within the normal
range, suggesting that the kidneys have not yet compensated for the imbalance. This
condition is commonly seen in patients with hypoventilation or obstructive lung
diseases. The nurse must focus on improving ventilation to blow off excess carbon
dioxide. Early identification of respiratory acidosis is critical to prevent further
clinical deterioration.
4. When administering sublingual Nitroglycerin to a patient with chest pain, which
side effect must the nurse monitor for most closely?
A. Hypertension
B. Bradycardia
C. Hypotension
D. Hypokalemia
Correct Answer: C
, Expert Explanation: Nitroglycerin acts as a potent vasodilator which can lead to a
significant drop in systemic blood pressure. The nurse should always check the
patient’s blood pressure before and after each dose administered. Patients are often
instructed to sit or lie down to prevent falls from orthostatic changes. Headache is a
common side effect, but hypotension is the most dangerous acute hemodynamic
change. Ensuring the patient is stable before subsequent doses is vital for safe
practice.
5. An ECG shows a saw-tooth pattern of P waves with a regular ventricular rate. This
rhythm is most likely:
A. Atrial Fibrillation
B. Atrial Flutter
C. Sinus Tachycardia
D. Ventricular Tachycardia
Correct Answer: B
Expert Explanation: Atrial flutter is characterized by rapid, regular atrial
oscillations that create a distinct saw-tooth appearance on the ECG. This occurs
because of a macro-reentrant circuit within the atria, usually at a rate of 250-350
bpm. Unlike atrial fibrillation, the atrial rhythm in flutter is regular. Treatment often
involves rate control and anticoagulation to prevent thromboembolic events.
2 Version 2 | Questions with Correct Answers and
Expert Explanation for Each Question | Baltimore
City Community College
1. A patient is admitted with suspected myocardial infarction (MI). Which cardiac
biomarker is most specific for myocardial injury and typically peaks within 24 hours?
A. Creatine Kinase (CK-MB)
B. Myoglobin
C. Troponin I
D. C-reactive protein
Correct Answer: C
Expert Explanation: Troponin I is the gold standard for diagnosing myocardial
infarction due to its high specificity for heart muscle damage. While CK-MB also
rises during an MI, it is not as specific as Troponin I because it can be found in
skeletal muscle. Myoglobin rises quickly but lacks specificity for cardiac tissue alone.
C-reactive protein is an inflammatory marker and does not diagnose acute necrosis.
Measuring Troponin levels allows clinicians to accurately assess the extent of
myocardial damage.
,2. A nurse identifies ventricular fibrillation (VF) on the cardiac monitor of a patient
who has just collapsed. What is the immediate priority intervention?
A. Administering a bolus of Amiodarone
B. Intubating the patient to secure the airway
C. Preparing for synchronized cardioversion
D. Performing immediate defibrillation
Correct Answer: D
Expert Explanation: Ventricular fibrillation is a pulseless rhythm that requires
rapid defibrillation to restore a functional heartbeat. Synchronized cardioversion is
inappropriate here because there is no R-wave to synchronize with in VF.
Pharmacological interventions like Amiodarone are secondary to mechanical
intervention in this lethal rhythm. Delaying defibrillation for even a few minutes
significantly reduces the probability of a successful resuscitation. The primary goal
in VF management is to stop the chaotic electrical activity so the SA node can regain
control.
3. A patient presents with acute respiratory failure and the following ABG results: pH
7.28, PaCO2 55 mmHg, HCO3 26 mEq/L. How should the nurse interpret these
findings?
A. Metabolic Acidosis
,B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Correct Answer: C
Expert Explanation: A pH below 7.35 indicates acidosis, and a PaCO2 above 45
mmHg points to a respiratory cause. The bicarbonate level is within the normal
range, suggesting that the kidneys have not yet compensated for the imbalance. This
condition is commonly seen in patients with hypoventilation or obstructive lung
diseases. The nurse must focus on improving ventilation to blow off excess carbon
dioxide. Early identification of respiratory acidosis is critical to prevent further
clinical deterioration.
4. When administering sublingual Nitroglycerin to a patient with chest pain, which
side effect must the nurse monitor for most closely?
A. Hypertension
B. Bradycardia
C. Hypotension
D. Hypokalemia
Correct Answer: C
, Expert Explanation: Nitroglycerin acts as a potent vasodilator which can lead to a
significant drop in systemic blood pressure. The nurse should always check the
patient’s blood pressure before and after each dose administered. Patients are often
instructed to sit or lie down to prevent falls from orthostatic changes. Headache is a
common side effect, but hypotension is the most dangerous acute hemodynamic
change. Ensuring the patient is stable before subsequent doses is vital for safe
practice.
5. An ECG shows a saw-tooth pattern of P waves with a regular ventricular rate. This
rhythm is most likely:
A. Atrial Fibrillation
B. Atrial Flutter
C. Sinus Tachycardia
D. Ventricular Tachycardia
Correct Answer: B
Expert Explanation: Atrial flutter is characterized by rapid, regular atrial
oscillations that create a distinct saw-tooth appearance on the ECG. This occurs
because of a macro-reentrant circuit within the atria, usually at a rate of 250-350
bpm. Unlike atrial fibrillation, the atrial rhythm in flutter is regular. Treatment often
involves rate control and anticoagulation to prevent thromboembolic events.
