Your Duties As A Nurse- MCQ Test
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What is the first action a nurse should take when they see VT[tachy] on monitor?
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Check patients urine output
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Check pulse
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Prepare for defibrillation
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Prepare for cardioversion
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Are you preparing or aspiring to be a nurse? Or have your nursing exam coming up soon? In that case, you need to have clarity about your duties as a nurse. Do you know enough about it? Well, this MCQ test will clear that out in minutes. All the best!
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- 2.
A patients cardiac monitor frequently sounds false rate alarms. Which nursing intervention is indicated?
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Ask the patient to lie still
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Adjust the high and low rates on the alarm
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Shut the room door so the alarm will not disturb the other patients
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Set the alarms on silent
Correct Answer
A. Adjust the high and low rates on the alarmExplanation
from articleRate this question:
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- 3.
Which of the following is true of the QT interval
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Measures atrial and ventricular depolarization
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Measures ventricular depolarization and repolarization. it should be corrected for HR
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It is an unimportant measure and rarely considered
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Measurement of resting membrane potential
Correct Answer
A. Measures ventricular depolarization and repolarization. it should be corrected for HRExplanation
The QT interval is a measurement on an electrocardiogram (ECG) that represents the time it takes for the ventricles of the heart to both depolarize and repolarize. It is an important measure as it provides information about the electrical activity of the heart and can help identify certain cardiac conditions. However, the QT interval should be corrected for heart rate (HR) because the duration of the interval can vary depending on the individual's heart rate. This correction is done using formulas such as the QTc (corrected QT) interval, which takes into account the heart rate to provide a more accurate assessment of ventricular depolarization and repolarization.Rate this question:
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- 4.
A patient with a moderate diffuse head injury is demonstrating a variety of neruo symptoms. What is the priority when caring for this patient?
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Supporting nutritional needs
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Maintaining stable CPP
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Electrolyte replacements
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Maintaining adequate fluid volume
Correct Answer
A. Maintaining stable CPPExplanation
This is the pressure needed to ensure blood flow to the brain and is the MOST IMPORTANT SINGLE FACTOR IN MAINTAINING BRAIN HEALTH
increased CPP (by increasing MAP and decreasing ICP)Rate this question:
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- 5.
A patient arrives in the ICU with an altered LOC. After an initial assessment of ABCs[including VS and spo2] and GCS, the next test should be...
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Non contrast head CT
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ETOH level
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CXR
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Finger stick glucose
Correct Answer
A. Finger stick glucoseExplanation
remember, in the brain it is 30 percent less than the regular BG. want above 120 for finger stick glucose for stroke patientsRate this question:
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- 6.
The nurse is reviewing pharm management for HA patient diagnosed with unstable angina[UA]. Which collaborative therapy should the nurse expect to see in a plan of care?
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Hydrochlorothiazide
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Metoprolol
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Mannitol
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Furosemide
Correct Answer
A. MetoprololExplanation
beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.Rate this question:
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- 7.
A pt is admitted to the ED for a suspected MI. Which lab test should the nurse anticipate being performed for this PT[ which is most accurate]
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Serum potassium
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Troponin
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C-reactive protein
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Lipid profile
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CK-MB
Correct Answer
A. TroponinExplanation
CKMB is good, but troponin is gold standard for MIRate this question:
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- 8.
An adult patient with a heart rate of 50bpm should be?
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Worked up for possible bradycardic cardiomyopathy
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Assessed for his perfusion response to this HR[ this may be perfectly normal in a healthy adult]
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Given 0.5mg atropine and repeated to a total of 3mg
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Placed on transcutaneous pacing until HR is at least 60
Correct Answer
A. Assessed for his perfusion response to this HR[ this may be perfectly normal in a healthy adult]Explanation
An adult patient with a heart rate of 50bpm should be assessed for his perfusion response to this heart rate as it may be perfectly normal in a healthy adult. This means that the patient's blood flow and oxygen delivery to the tissues should be evaluated to determine if there are any signs of inadequate perfusion. It is important to consider that a heart rate of 50bpm may be within the normal range for some individuals, especially athletes or those with a naturally lower heart rate. Therefore, further investigation is needed to ensure that the patient's cardiovascular system is functioning properly and there are no underlying issues causing the bradycardia.Rate this question:
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- 9.
A patients admission VS were BP 128/64, HR 86, RR 16, Temp 98.6F. The patient has a spiked temp of 101.6. Which change in heart rate would the nurse anticipate?
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Increased to 116 bpm
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Increase 100 bpm
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Decrease 75 bpm
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Increase or decrease no more than 5bmp
Correct Answer
A. Increased to 116 bpmExplanation
high temp indicates feverRate this question:
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- 10.
Your patient has a HR of 108. The rhythm is regular, patient has a p wave before each QRS complex, PR interval is .20 seconds and the QRS that follows each p is narrow. How would you label this rhythm?
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Normal sinus rhythm
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First degree heart block
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SVT
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Sinus tachycardia
Correct Answer
A. Sinus tachycardiaExplanation
Based on the given information, the patient's heart rate is elevated (HR of 108), but the rhythm is regular. There is a P wave before each QRS complex, indicating that the atria are depolarizing normally. The PR interval is within normal range (.20 seconds), and the QRS complexes are narrow, suggesting that the ventricles are also depolarizing normally. These characteristics are consistent with sinus tachycardia, which is a normal rhythm that occurs when the heart rate is faster than usual due to factors such as exercise, stress, or fever.Rate this question:
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- 11.
Which of the following is the priority in treating a patient with pulseless electrical activity [PEA]
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Immediate defibrillation
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Good CPR, epinephrine q 5minutes, assess H's and T's
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Check rhythm in another lead before assuming this is PEA
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Treatment is transcutaneous pacing
Correct Answer
A. Good CPR, epinephrine q 5minutes, assess H's and T'sExplanation
The H’s and T’s are 12 reversible conditions, 7 that start with H and 5 that start with T.
Hypovolemia
Hypoxia
Hydrogen ion excess (acidosis)
Hypoglycemia
Hypokalemia
Hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade – Cardiac
Toxins
Thrombosis (pulmonary embolus)
Thrombosis (myocardial infarction)Rate this question:
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- 12.
Which assessment finding increases the concern that a patient with cerebral vascular accident would aspirate?
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Absence of interest in eating or drinking
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Continuous clearing of the throat
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Eating only foods on one side of the tray
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Refusal to allow the nurse to assist with feeding
Correct Answer
A. Continuous clearing of the throatExplanation
Continuous clearing of the throat increases the concern that a patient with a cerebral vascular accident would aspirate. Clearing the throat frequently can be a sign of difficulty swallowing or a weak gag reflex, which increases the risk of food or liquid entering the airway instead of going to the stomach. Aspiration can lead to pneumonia or other respiratory complications. Therefore, this assessment finding raises concerns about the patient's ability to safely swallow and increases the risk of aspiration.Rate this question:
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- 13.
You have a patient dx with CAD, and is started on simvastatin. What baseline lab test is required prior to initiation of therapy.
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CBC
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Sedimentation rate
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Liver function test
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Triglycerides
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PTT
Correct Answer
A. Liver function testExplanation
Occasionally, statin use could cause an increase in the level of enzymes that signal liver inflammation.Rate this question:
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- 14.
The nurse has administered thrombolytic therapy to a 65 yr old female patient diagnosed with STEMI. Ten hours following administration of the thrombolytic, the patient is uncharacteristically irritable and somnolent. Which complication should the nurse suspect?
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Allergic reaction
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Cardiac tampondae
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Intracranial hemorrhage
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Reocclusion
Correct Answer
A. Intracranial hemorrhageExplanation
The nurse should suspect intracranial hemorrhage as a complication in this case. Thrombolytic therapy can increase the risk of bleeding, and the patient's symptoms of irritability and somnolence could be indicative of a bleed in the brain. This is a serious complication that requires immediate medical attention.Rate this question:
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- 15.
An ICU nurse is documenting a high- acuity patient's clinical response following administration of morphine sulfate for anginal pain using PQRST. What data should the nurse expect to document as "s"
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Patient reports burning in the chest area
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Patient states that the pain subsided after 10 mins
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Patient reports pain has decreased from a 9 to a 6 on pain scale
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Patient reports that the majority of pain is located in left jaw
Correct Answer
A. Patient reports pain has decreased from a 9 to a 6 on pain scaleExplanation
The nurse should expect to document that the patient reports a decrease in pain from a 9 to a 6 on the pain scale. This information indicates a positive response to the administration of morphine sulfate for anginal pain. It shows that the medication has effectively reduced the intensity of the patient's pain.Rate this question:
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- 16.
The nurse is preparing to administer tPA thearpy to a HA patient with an acute ischemic stroke. which findings should cause the nurse to abort procedure
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Stroke symptoms suddenly appearing an hour ago
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Lumbar puncture 2 months ago
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Current use of warfarin
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Evidence of embolic stroke on a ct scan
Correct Answer
A. Current use of warfarinExplanation
since you are completely getting rid of a clot with tPA, one must not be on an anticoagulantRate this question:
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- 17.
HA patient has a suspected acute stoke. Which patient condition may result in impaired airway clearance
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Hemiplegia
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Nausea
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Aphasia
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Loss of vision
Correct Answer
A. HemiplegiaExplanation
half of side of body not workingRate this question:
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- 18.
The nurse is performing an assessment on a HA patient with severe right sided heart failure. Which finding should indicate to the nurse an exacerbation of this condition?
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Movement at the fifth intercostal space at the precordium
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Lower extremity edema
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Increased urine output
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The presence of an s2 sound
Correct Answer
A. Lower extremity edemaExplanation
congesitive HF=edemaRate this question:
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- 19.
A patient with a.flutter with a 4:1 block is to be started on medications to convert this new rhythm. Which of the following meds would be appropriate?
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Calcium channel blocker [like diltiazem] or an antiarrhythmic[amiodrane]
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A beta blocker [lopressor or digoxin]
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A magnesium salt to buffer the effects of calcium in the atria
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An ace inhibitor to affect afterload- addressing cause of rhythm
Correct Answer
A. Calcium channel blocker [like diltiazem] or an antiarrhythmic[amiodrane]Explanation
(diltiazem) for ventricular rate control.
[ACE) inhibitors help relax your veins and arteries to lower your blood pressure. doesnt matter here]Rate this question:
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- 20.
The nurse is providing post procedure care for HA patient after a carotid endarterectomy. Which action should the nurse take to facilltate carotid blood flow?
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Elevate the head of the bed 30 degrees
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Position patient on the non operative side
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Maintain head and neck alignment
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Support the head during position change
Correct Answer
A. Maintain head and neck alignmentExplanation
To facilitate carotid blood flow after a carotid endarterectomy, it is important for the nurse to maintain head and neck alignment. This helps to ensure that the carotid arteries are not compressed or restricted in any way, allowing for optimal blood flow. By keeping the head and neck in a neutral position, the nurse can help prevent any potential complications or disruptions to the blood flow in the carotid arteries.Rate this question:
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- 21.
A patient with a TBI continues to have increased ICP despite conventional therapeutic interventions. The nurse would anticipate which tier three intervention?
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Hyperosmolar thearpy
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Hyperbaric oxygen thearpy
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High-dose barbiturate thearpy
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High volume intravenous fluids
Correct Answer
A. High-dose barbiturate thearpyExplanation
reasons you give barbiturate, to stop shivering before tier 3 coolingRate this question:
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- 22.
You are caring for a patient who arrived from the cath lab post PCI. They have an angioseal device to the L femoral artery. Which is your priority nursing action?
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Maintain head of the bed at 30 degrees
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Maintain manual pressure to affected area for at least 2 hours
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Maintain patient flat for at least 30 minutes
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Early ambulation
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Lay patient on good side
Correct Answer
A. Maintain patient flat for at least 30 minutesExplanation
The priority nursing action in this situation is to maintain the patient flat for at least 30 minutes. This is because after a percutaneous coronary intervention (PCI) with an angioseal device, it is important to keep the patient in a supine position to prevent bleeding and promote hemostasis at the femoral artery site. This allows the device to properly seal the artery and reduces the risk of complications such as hematoma or bleeding. Once the recommended time has passed, the patient can be gradually mobilized and ambulated.Rate this question:
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- 23.
A client who experienced a minor hemorrhagic stroke from an aneurysm 1 week ago[aneurysm was not repaired] reports a severe headache accompanied by nausea and vomiting. What is your immediate concert.
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The client may be re-bleeding
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The clients warfarin dose is inadequate
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The client is experiencing stroke related pyschological stress
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The client is experiencing increased ICP
Correct Answer
A. The client may be re-bleedingExplanation
always major risk for rebleed with HEMORRHAGIC stroke.Rate this question:
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- 24.
Your head injury patient develops decreased urinary output 20-30ml/hour, his serum NA+ is < 130mg/dl and they have +3 generalized edema. What is the treatment of this pathology in the head injured patient?
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DI may be treated with hypotonic fluids [ the only time hypotonic fluid is given in a neuro patient) and vasopressin
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SIADH is treated with administration of vasopressin and rapid replacement of sodium
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Although DI is generally treated with hypotonic fluids, this is inappropriate in head injury and therefore the fluid of choice is NS
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SIADH is best treated with fluid restriction and strict I&O
Correct Answer
A. SIADH is best treated with fluid restriction and strict I&OExplanation
Syndrome of inappropriate anti-diuretic hormone (SIADH) the opposite of DI. excessive ADH causes water intoxication and hyponatremia treated with fluid restriction, electrolyte replacement, and Lithium or Phenytoin to increase free water lossRate this question:
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- 25.
When developing a teaching plan for a patient who had an embolic stroke, the nurse considers which history as a significant risk factor?
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Hx of atherosclerosis of cerebral arteries
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A.fib
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Hypertension
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Use of anticoagulants
Correct Answer
A. A.fibExplanation
embolic means from somewhere else.. a-fib can cause that somewhere else clot.Rate this question:
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- 26.
The nurse has determined that the patients has a bundle branch block. Which condition likely exists?
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PR interval longer than .20 seconds
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An elevated ST segment
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A QRS segment longer than 0.12 seconds
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A PR interval that lengthens with each beat
Correct Answer
A. A QRS segment longer than 0.12 secondsExplanation
A bundle branch block is a condition in which there is a delay or blockage in the electrical conduction through the bundle branches of the heart. This causes a delay in the activation of one of the ventricles, resulting in a widened QRS complex on the electrocardiogram (ECG). Therefore, a QRS segment longer than 0.12 seconds is likely to be indicative of a bundle branch block.Rate this question:
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- 27.
A client who is s/p clipping for an aneurysm in the past 48 hours reports severe intermittent headache. He is notably less alert while he is experiencing the headache. As a nurse, what is your immediate concern?
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These are expected post clipping symptoms, continue to monitor and record progress.
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The client may be experiencing transient vasospams and may need his Nimodipine dose increased - call provider who may wish to order a transcranial Doppler study.
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The client may be re-bleeding and should be sent for a CT scan to determine this- call neuro PA or NP.
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The client is probably experiencing a post bleed- ischemic injury d/t reperfusion, and altered free oxygen radical release- call PA who may wish to increase antioxidant thearpy.
Correct Answer
A. The client may be experiencing transient vasospams and may need his Nimodipine dose increased - call provider who may wish to order a transcranial Doppler study.Explanation
transcranial Doppler study is used to detect vasospasms
Nimodipine gold standard for vasospasmsRate this question:
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Quiz Review Timeline (Updated): Mar 22, 2023 +
Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.
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Current Version
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Mar 22, 2023Quiz Edited by
ProProfs Editorial Team -
Feb 22, 2021Quiz Created by
Catherine Halcomb
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