NUR 425 EXAM 1 QUESTIONS WITH
CORRECT DETAILED ANSWERS.
Which patient is most at risk for developing delirium?
a. A 50-yr-old woman with cholecystitis
b. A 19-yr-old man with a fractured femur
c. A 42-yr-old woman having an elective hysterectomy
d. A 78-yr-old man admitted to the medical unit with complications related to heart
failure - ANSWER- D
You are caring for a patient who is experiencing delirium due to a lack of sleep. Which
of the following nursing interventions would be *inappropriate* in treating this patients'
condition?
a. You treat the patients' primary diagnosis that is causing the delirium.
b. You turn on the lights and a radio next to the patients' bed to reorient them.
c. You use appropriate touch and verbal communication to help reorient the patient.
d. You put an easy-to-read clock in the patients' room and a calendar close to their bed.
- ANSWER- B (For treating delirium, the nurse should reduce environmental stimuli by
decreasing noise and light levels.)
Normal Potassium level - ANSWER- 3.5-5.0
Normal PR interval length - ANSWER- <0.2 seconds
Normal QRS interval length - ANSWER- <0.12 seconds
Normal CVP (Central venous pressure) in adults - ANSWER- 2-8 mmHg
Normal cardiac output in adults - ANSWER- 4-8 L/min
Normal cardiac index in adults - ANSWER- 2.2-4 L/min/m squared
Normal MAP in adults - ANSWER- 70-105 mmHg
The action of medication is inotropic when it:
A. Decreased afterload
B. Increases heart rate
C. Increases the force of contraction
D. Is used to treat CHF - ANSWER- C (Inotropic drugs increase the force of contraction.
Preload, not afterload, is decreased. Chronotropic drugs increase heart rate. Treatment
of CHF is an indication for use not an action of inotropic drug.)
,Which of the following ECG findings alerts the nurse that the client needs an
antiarrhythmic?
A. Normal sinus rhythm
B. Sinus bradycardia
C. Sinus arrhythmia
D. Frequent ventricular ectopy - ANSWER- D (Ventricular ectopy can be a life-
threatening arrhythmia; therefore, the client needs an arrhythmic. Other choices are not
arrhythmias that need to be treated. An ectopic rhythm is an irregular heart rhythm due
to a premature heartbeat. Ectopic rhythm is also known as premature atrial contraction,
premature ventricular contraction, and extrasystole. When your heart experiences an
early beat, a brief pause usually follows.)
When administering an antiarrhythmic agent, which of the following assessment
parameters is the most important for the nurse to evaluate?
A. ECG
B. Pulse rate
C. Respiratory rate
D. Blood pressure - ANSWER- A (The ECG is the most important parameter to assess.
B, C, and D need to be monitored, but the ECG is the most important.)
Epinephrine is used to treat cardiac arrest and status asthmaticus because of which of
the following actions?
A. Increased speed of conduction and gluconeogenesis
B. Bronchodilation and increased heart rate, contractility, and conduction
C. Increased vasodilation and enhanced myocardial contractility
D. Bronchoconstriction and increased heart rate - ANSWER- B (Bronchodilation results
from stimulated beta receptors, and cardiac effects result from the stimulation of ß1
receptors. Choice A does not address respiratory effects of medication. Choice C is
incorrect because α-stimulating drugs cause vasoconstriction. Bronchodilation, not
bronchoconstriction, results from ß2 activity.)
Following norepinephrine (Levophed) administration, it is essential to the nurse to
assess:
A. electrolyte status
B. color and temperature of toes and fingers
C. capillary refill
D. ventricular arrhythmias - ANSWER- B (Because decreased perfusion is a side effect
of norepinephrine (Levophed), the nurse must check circulation frequently. Capillary
refill is not a reliable indication of perfusion in a shock state. Choices A and D are not
specific for norepinephrine.)
When administering dopamine (Intropin), it is most important for the nurse to know that:
A. the drug's action varies according to the dose.
,B. the drug may be used instead of fluid replacement.
C. the drug cannot be directly mixed in solutions containing bicarbonate or
aminophylline.
D. the lowest dose to produce the desired effect should be used. - ANSWER- C (The
nurse is responsible for knowing compatible solutions before administering dopamine
(Intropin). It is important to know that drug action varies by dose, but the physician is
responsible for determining the dose. Dopamine should not be used instead of fluid
replacement. Choice D is incorrect because, although it is true, it is not the nurse's
primary concern. It is a collaborative action in which the physician is involved in
determining the rate.)
Dobutamine (Dobutrex) improves cardiac output and is indicated for use in all of the
following conditions except:
A. septic shock
B. congestive heart failure
C. arrhythmias
D. pulmonary congestion - ANSWER- C (Dobutamine (Dobutrex) is not used to treat
arrhythmias. Choices A, B, and D are conditions are conditions that respond to
dobutamine.)
Which of the following effects of calcium channel blockers causes a reduction in blood
pressure?
A. Increased cardiac output
B. Decreased peripheral vascular resistance
C. Decreased renal blood flow
D. Calcium influx into cardiac muscles - ANSWER- B
A preoperative patient receives atropine before induction of anesthesia. The nurse
caring for this patient understands that this agent is used to prevent:
A. anxiety.
B. bradycardia.
C. dry mouth.
D. hypertension. - ANSWER- B (Atropine, an anticholinergic drug, is used as an adjunct
to anesthesia to counter the effects of vagal stimulation, which is caused by surgical
manipulations that trigger parasympathetic reflexes, resulting in bradycardia. Atropine is
not an anxiolytic. Atropine causes dry mouth and sometimes is used to minimize
bronchial secretions.)
When titrating an analgesic to manage pain, what is the priority goal?
A. Administer smallest dose that provides relief with the fewest side effects.
B. Titrate upward until the client is pain free.
C. Titrate downwards to prevent toxicity.
D. Ensure that the drug is adequate to meet the client's subjective needs. - ANSWER- A
(The goal is to control pain while minimizing side effects. For severe pain, the
medication can be titrated upward until pain is controlled. Downward titration occurs
, when the pain begins to subside. Adequate dosing is important; however, the concept of
controlled dosing applies more to potent vasoactive drugs.)
For a cognitively impaired client who cannot accurately report pain, what is the first
action that you should take?
A. Closely assess for nonverbal signs such as grimacing or rocking.
B. Obtain baseline behavioral indicators from family members.
C. Look at the MAR and chart, to note the time of the last dose and response.
D. Give the maximum PRS dose within the minimum time frame for relief. - ANSWER- B
(Complete information from the family should be obtained during the initial
comprehensive history and assessment. If this information is not obtained, the nursing
staff will have to rely on observation of nonverbal behavior and careful documentation to
determine pain and relief patterns.)
A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS
complexes are regular. The PR interval is 0.16 second, and QRS complexes measure
0.06 second. The overall heart rate is 64 beats per minute. The nurse assesses the
cardiac rhythm as:
A. Normal sinus rhythm
B. Sinus bradycardia
C. Atrial fibrillation
D. First-degree heart block. - ANSWER- A (This rhythm is NSR. The P waves and QRS
complexes are regular. The PR interval is less than 0.2 seconds. The QRS complex is
less than 0.12 seconds. The heart rate is between 60-100 BPM.)
A nurse notices frequent artifact on the ECG monitor for a client whose leads are
connected by cable to a console at the bedside. The nurse examines the client to
determine the cause. Which of the following items is *unlikely* to be responsible for the
artifact?
A. Frequent movement of the client
B. Tightly secured cable connections
C. Leads applied over hairy areas
D. Leads applied to the limbs - ANSWER- B (Motion artifact, or "noise," can be caused
by frequent client movement, electrode placement on limbs, and insufficient adhesion to
the skin, such as placing electrodes over hairy areas of the skin. Electrode placement
over bony prominences also should be avoided. Signal interference can also occur with
electrode removal and cable disconnection.)
A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes.
There are no P waves, the QRS complexes are wide, and the ventricular rate is regular
but over 100. The nurse determines that the client is experiencing:
A. Premature ventricular contractions
B. Ventricular tachycardia
C. Ventricular fibrillation
CORRECT DETAILED ANSWERS.
Which patient is most at risk for developing delirium?
a. A 50-yr-old woman with cholecystitis
b. A 19-yr-old man with a fractured femur
c. A 42-yr-old woman having an elective hysterectomy
d. A 78-yr-old man admitted to the medical unit with complications related to heart
failure - ANSWER- D
You are caring for a patient who is experiencing delirium due to a lack of sleep. Which
of the following nursing interventions would be *inappropriate* in treating this patients'
condition?
a. You treat the patients' primary diagnosis that is causing the delirium.
b. You turn on the lights and a radio next to the patients' bed to reorient them.
c. You use appropriate touch and verbal communication to help reorient the patient.
d. You put an easy-to-read clock in the patients' room and a calendar close to their bed.
- ANSWER- B (For treating delirium, the nurse should reduce environmental stimuli by
decreasing noise and light levels.)
Normal Potassium level - ANSWER- 3.5-5.0
Normal PR interval length - ANSWER- <0.2 seconds
Normal QRS interval length - ANSWER- <0.12 seconds
Normal CVP (Central venous pressure) in adults - ANSWER- 2-8 mmHg
Normal cardiac output in adults - ANSWER- 4-8 L/min
Normal cardiac index in adults - ANSWER- 2.2-4 L/min/m squared
Normal MAP in adults - ANSWER- 70-105 mmHg
The action of medication is inotropic when it:
A. Decreased afterload
B. Increases heart rate
C. Increases the force of contraction
D. Is used to treat CHF - ANSWER- C (Inotropic drugs increase the force of contraction.
Preload, not afterload, is decreased. Chronotropic drugs increase heart rate. Treatment
of CHF is an indication for use not an action of inotropic drug.)
,Which of the following ECG findings alerts the nurse that the client needs an
antiarrhythmic?
A. Normal sinus rhythm
B. Sinus bradycardia
C. Sinus arrhythmia
D. Frequent ventricular ectopy - ANSWER- D (Ventricular ectopy can be a life-
threatening arrhythmia; therefore, the client needs an arrhythmic. Other choices are not
arrhythmias that need to be treated. An ectopic rhythm is an irregular heart rhythm due
to a premature heartbeat. Ectopic rhythm is also known as premature atrial contraction,
premature ventricular contraction, and extrasystole. When your heart experiences an
early beat, a brief pause usually follows.)
When administering an antiarrhythmic agent, which of the following assessment
parameters is the most important for the nurse to evaluate?
A. ECG
B. Pulse rate
C. Respiratory rate
D. Blood pressure - ANSWER- A (The ECG is the most important parameter to assess.
B, C, and D need to be monitored, but the ECG is the most important.)
Epinephrine is used to treat cardiac arrest and status asthmaticus because of which of
the following actions?
A. Increased speed of conduction and gluconeogenesis
B. Bronchodilation and increased heart rate, contractility, and conduction
C. Increased vasodilation and enhanced myocardial contractility
D. Bronchoconstriction and increased heart rate - ANSWER- B (Bronchodilation results
from stimulated beta receptors, and cardiac effects result from the stimulation of ß1
receptors. Choice A does not address respiratory effects of medication. Choice C is
incorrect because α-stimulating drugs cause vasoconstriction. Bronchodilation, not
bronchoconstriction, results from ß2 activity.)
Following norepinephrine (Levophed) administration, it is essential to the nurse to
assess:
A. electrolyte status
B. color and temperature of toes and fingers
C. capillary refill
D. ventricular arrhythmias - ANSWER- B (Because decreased perfusion is a side effect
of norepinephrine (Levophed), the nurse must check circulation frequently. Capillary
refill is not a reliable indication of perfusion in a shock state. Choices A and D are not
specific for norepinephrine.)
When administering dopamine (Intropin), it is most important for the nurse to know that:
A. the drug's action varies according to the dose.
,B. the drug may be used instead of fluid replacement.
C. the drug cannot be directly mixed in solutions containing bicarbonate or
aminophylline.
D. the lowest dose to produce the desired effect should be used. - ANSWER- C (The
nurse is responsible for knowing compatible solutions before administering dopamine
(Intropin). It is important to know that drug action varies by dose, but the physician is
responsible for determining the dose. Dopamine should not be used instead of fluid
replacement. Choice D is incorrect because, although it is true, it is not the nurse's
primary concern. It is a collaborative action in which the physician is involved in
determining the rate.)
Dobutamine (Dobutrex) improves cardiac output and is indicated for use in all of the
following conditions except:
A. septic shock
B. congestive heart failure
C. arrhythmias
D. pulmonary congestion - ANSWER- C (Dobutamine (Dobutrex) is not used to treat
arrhythmias. Choices A, B, and D are conditions are conditions that respond to
dobutamine.)
Which of the following effects of calcium channel blockers causes a reduction in blood
pressure?
A. Increased cardiac output
B. Decreased peripheral vascular resistance
C. Decreased renal blood flow
D. Calcium influx into cardiac muscles - ANSWER- B
A preoperative patient receives atropine before induction of anesthesia. The nurse
caring for this patient understands that this agent is used to prevent:
A. anxiety.
B. bradycardia.
C. dry mouth.
D. hypertension. - ANSWER- B (Atropine, an anticholinergic drug, is used as an adjunct
to anesthesia to counter the effects of vagal stimulation, which is caused by surgical
manipulations that trigger parasympathetic reflexes, resulting in bradycardia. Atropine is
not an anxiolytic. Atropine causes dry mouth and sometimes is used to minimize
bronchial secretions.)
When titrating an analgesic to manage pain, what is the priority goal?
A. Administer smallest dose that provides relief with the fewest side effects.
B. Titrate upward until the client is pain free.
C. Titrate downwards to prevent toxicity.
D. Ensure that the drug is adequate to meet the client's subjective needs. - ANSWER- A
(The goal is to control pain while minimizing side effects. For severe pain, the
medication can be titrated upward until pain is controlled. Downward titration occurs
, when the pain begins to subside. Adequate dosing is important; however, the concept of
controlled dosing applies more to potent vasoactive drugs.)
For a cognitively impaired client who cannot accurately report pain, what is the first
action that you should take?
A. Closely assess for nonverbal signs such as grimacing or rocking.
B. Obtain baseline behavioral indicators from family members.
C. Look at the MAR and chart, to note the time of the last dose and response.
D. Give the maximum PRS dose within the minimum time frame for relief. - ANSWER- B
(Complete information from the family should be obtained during the initial
comprehensive history and assessment. If this information is not obtained, the nursing
staff will have to rely on observation of nonverbal behavior and careful documentation to
determine pain and relief patterns.)
A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS
complexes are regular. The PR interval is 0.16 second, and QRS complexes measure
0.06 second. The overall heart rate is 64 beats per minute. The nurse assesses the
cardiac rhythm as:
A. Normal sinus rhythm
B. Sinus bradycardia
C. Atrial fibrillation
D. First-degree heart block. - ANSWER- A (This rhythm is NSR. The P waves and QRS
complexes are regular. The PR interval is less than 0.2 seconds. The QRS complex is
less than 0.12 seconds. The heart rate is between 60-100 BPM.)
A nurse notices frequent artifact on the ECG monitor for a client whose leads are
connected by cable to a console at the bedside. The nurse examines the client to
determine the cause. Which of the following items is *unlikely* to be responsible for the
artifact?
A. Frequent movement of the client
B. Tightly secured cable connections
C. Leads applied over hairy areas
D. Leads applied to the limbs - ANSWER- B (Motion artifact, or "noise," can be caused
by frequent client movement, electrode placement on limbs, and insufficient adhesion to
the skin, such as placing electrodes over hairy areas of the skin. Electrode placement
over bony prominences also should be avoided. Signal interference can also occur with
electrode removal and cable disconnection.)
A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes.
There are no P waves, the QRS complexes are wide, and the ventricular rate is regular
but over 100. The nurse determines that the client is experiencing:
A. Premature ventricular contractions
B. Ventricular tachycardia
C. Ventricular fibrillation
