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The nurse is managing the care of a patient with an arterial line. Which assessment finding warrants immediate intervention by the nurse?
A. An overdamped waveform on the monitor
B. Tubing disconnected from the arterial line
C. IV medications being infused into an arterial line
D. Redness at the arterial line insertion site
Correct Answer: C. IV medications being infused into an arterial line
Why this needs immediate action:
Arterial lines are NEVER used to give IV medications.
Injecting medications into an artery can cause severe tissue damage, loss of blood flow, ischemia, or even limb loss.
This is a medical emergency and must be stopped right away.
Why the others are not the most urgent:
A. Overdamped waveform → affects accuracy but is not immediately life-threatening.
B. Tubing disconnected → serious, but typically alarms and can be corrected quickly.
D. Redness at the site → could mean infection, but it’s not immediately dangerous.
🩺 NCLEX takeaway:
👉 Anything infused into an arterial line = EMERGENCY
An arterial line (A-line) is placed in a patient for continuous blood pressure monitoring. Which of the following nursing actions is strictly contraindicated for this device?
A.
Assessing the site for signs of bleeding or poor perfusion.
B.
Zeroing the transducer at the level of the phlebostatic axis.
C.
Drawing blood for arterial blood gas (ABG) analysis.
D.
Administering intravenous (IV) maintenance fluids.
D.
Administering intravenous (IV) maintenance fluids.
Right answer
Arterial lines are for monitoring and sampling only; administering fluids or medications into an artery can cause severe tissue damage or necrosis.
Before inserting a radial arterial line, the provider performs an Allen's test. What is the primary purpose of this assessment?
A.To verify the patency of the ulnar artery.
B.To measure the patient's baseline systolic blood pressure.
C.To identify the presence of a deep vein thrombosis (DVT).
D.To determine the correct size of the catheter to be used.
A.
To verify the patency of the ulnar artery.
That's right!
The test ensures that if the radial artery is damaged, the ulnar artery can provide sufficient collateral circulation to the hand.
A patient's Central Venous Pressure (CVP) is measured at 2 mmHg. Which clinical condition is most likely associated with this finding?
A.
Right-sided heart failure
B.
Hypervolemia
C.
Fluid volume deficit
D.
Pulmonary hypertension
C.
Fluid volume deficit
That's right!
Low CVP indicates insufficient preload or fluid volume, such as in dehydration or sepsis.
Calculate the Mean Arterial Pressure (MAP) for a patient with a blood pressure of 90/60 mmHg.
A.
70 mmHg
B.
30 mmHg
C.
75 mmHg
D.
150 mmHg
70
A patient with hypertension has which physical symptom?
A. Decreased resistance, which may increase CO
B. Increased resistance, which may decrease CO
C. Increased resistance, which may increase CO
D. Decreased resistance, which may decrease CO
Correct Answer: B. Increased resistance, which may decrease CO
Explanation (simple):
Hypertension means high blood pressure.
High blood pressure causes blood vessels to tighten, which increases resistance (afterload).
When resistance is high, the heart has to work harder to pump blood out.
This can decrease cardiac output (CO) because it’s harder for the heart to push blood forward.
🩺 NCLEX tip:
👉 Hypertension = ↑ resistance (afterload) → ↓ CO (can happen)
A nurse is providing care for a patient newly diagnosed with heart disease. Which dietary, activity, or lifestyle modification(s) should be included in the plan of care? (Select all that apply.)
A. Stopping smoking
B. Drinking lots of water
C. Limiting sedentary lifestyle
D. Eating a diet rich in red meat and protein
E. Limiting alcohol intake
✅ Correct Answers:
A. Stopping smoking
C. Limiting a sedentary lifestyle (being more active)
E. Limiting alcohol intake
Why these are correct:
Stopping smoking → lowers heart disease risk and improves blood vessel health
Being more active → strengthens the heart and improves circulation
Limiting alcohol → helps control blood pressure and prevents heart damage
Why the others are incorrect:
B. Drinking lots of water → hydration is important, but “lots” is not a specific heart-healthy recommendation and can be harmful in some heart conditions
D. Eating a diet rich in red meat → high in saturated fat, which increases heart disease risk
🩺 NCLEX tip:
👉 Heart-healthy lifestyle = no smoking, regular activity, healthy diet, limit alcohol
A patient presents with chest pain. The nurse notes the Troponin I level is elevated. Why is this marker preferred over Creatinine Kinase (CK−MB) for diagnosing an MI?
A.Troponin is only elevated in cases of GERD.
B.Troponin is only found in skeletal muscle.
C.Troponin levels rise within 30 minutes of injury.
D.Troponin stays elevated for approximately 10 days.
D.Troponin stays elevated for approximately 10 days.That's right!Troponin remains elevated longer than CK−MB, which only stays elevated for about 3 days, making it more reliable for detecting damage over time.1
In cardiac conduction, which EKG component represents the resting state when ions move back to normal and the heart prepares for the next beat?
A.PR interval
B.QRS complex
C.T wave
D.P wave
C.
T wave
That's right!
The T wave represents ventricular repolarization, which is the resting and recovery phase of the ventricles.
7 / 15
When interpreting an EKG, a PR interval of 0.28 seconds is identified. This finding is indicative of which condition?
A.Ventricular Tachycardia
B.A normal conduction rhythm
C.Bundle Branch Block (BBB)
D.Atrioventricular (AV) block
D.
Atrioventricular (AV) block
That's right!
A PR interval greater than 0.20 seconds indicates a delay in conduction, often seen in AV blocks.
A patient's cardiac monitor shows a sinus rhythm with a rate of 45 beats per minute. The patient is symptomatic, complaining of dizziness. Which medication should the nurse anticipate administering?
A. Amiodarone
B. Metoprolol
C. Atropine
D. Adenosine
C.
Atropine
That's right!
Atropine is the indicated treatment for symptomatic bradycardia (heart rate < 60 bpm) to increase the heart rate.
A nurse identifies a 'saw-tooth' pattern on the EKG monitor. Which intervention should the nurse anticipate?
A.Immediate CPR
B.Defibrillation
C.Cardioversion or rate control medications
D.Administration of Atropine
C.
Cardioversion or rate control medications
Right answer
Atrial flutter (saw-tooth) is managed by controlling the heart rate or converting the rhythm.
A patient is in Supraventricular Tachycardia (SVT) with a heart rate of 190 bpm. After vagal maneuvers fail, which medication is the priority?
A.
Amiodarone
B.
Dopamine
C.
Epinephrine
D.
Adenosine
D.
Adenosine
That's right!
Adenosine is the drug of choice for SVT to rapidly slow conduction through the AV node.
A patient's EKG shows a regular rhythm with a PR interval that progressively lengthens until a QRS complex is dropped. Which rhythm is being described?
A.
Third Degree AV Block
B.
Second Degree AV Block (Mobitz Type 2)
C.
Second Degree AV Block (Mobitz Type 1 / Wenckebach)
D.
First Degree AV Block
C.
Second Degree AV Block (Mobitz Type 1 / Wenckebach)
That's right!
This rhythm is characterized by a PR interval that 'prolongs' until a beat is 'dropped'.
A nurse is caring for a patient post-Percutaneous Transluminal Coronary Angioplasty (PTCA) via the femoral approach. Which assessment is the priority?
A.Checking for a friction rub sound.
B.Monitoring the patient for a headache from Nitroglycerin.
C.Performing circulation, motor, and sensory (CMS) checks on the affected leg.
D.Assessing the patient's ability to ambulate immediately.
C.
Performing circulation, motor, and sensory (CMS) checks on the affected leg.
That's right!
CMS checks are vital to ensure the catheter has not compromised blood flow or nerve function in the extremity.
A patient is being monitored with a Central Venous Pressure (CVP) line. The nurse notes the CVP reading is significantly elevated. This finding is most consistent with which condition?
A.
Dehydration
B.
Sepsis
C.
Left ventricular hypertrophy
D.
Right heart failure
D.
Right heart failure
Right answer
High CVP indicates elevated right atrial pressure and preload, which is a sign of right heart failure or fluid volume overload.
A nurse is preparing to level an arterial line transducer. At which anatomical location should the phlebostatic axis be identified to ensure accurate hemodynamic readings?
A.The 2nd intercostal space at the mid-clavicular line.
B.The 4th intercostal space at the mid-clavicular line.
C.The 4th intercostal space at the mid-axillary line.
D.The 5th intercostal space at the mid-axillary line.
C.
The 4th intercostal space at the mid-axillary line.
That's right!
This intersection represents the approximate level of the atria, ensuring that the transducer is at the correct height to measure pressure accurately.
A patient's cardiac monitor shows Ventricular Tachycardia (V-Tach). The nurse assesses the patient and finds they are pulseless and unresponsive. According to the notes, what is the immediate priority intervention?
A.Synchronized Cardioversion
B.Vagal Maneuvers
C.Administer Amiodarone IV push
D.Defibrillation
D.
Defibrillation (Unsynchronized)
That's right!
Pulseless V-Tach is treated identically to V-Fib: immediate defibrillation is required to reset the electrical activity.
A patient is in unstable Supraventricular Tachycardia (SVT) with a pulse, but they are hypotensive and unresponsive to adenosine. The provider orders a procedure. Which setting on the defibrillator is essential for this specific case?
A.Unsynchronized mode
B.AED mode
C.Synchronized mode
D.Pacing mode
C.
Synchronized mode
That's right!
For a patient with a pulse (like unstable SVT), the shock must be synchronized to the R-wave to avoid shocking during the vulnerable T-wave period.
A patient with a history of hypertension is found to have an increased 'Afterload.' How does the nurse best explain this concept to the patient?
A.It is the strength of each individual cardiac contraction.
B.It is how hard the heart has to work to push blood out to the body.
C.It is the total amount of blood pumped by the left ventricle in one minute..
D.It is the amount of blood that fills the heart before it beats.
B.
It is how hard the heart has to work to push blood out to the body.
That's right!
Afterload refers to the pressure or resistance the heart must overcome to eject blood; high blood pressure increases this resistance.
A patient becomes unresponsive and pulseless. The monitor shows ventricular fibrillation. What is the correct priority sequence of actions?
A. Defibrillate → CPR → Epinephrine → Intubate
B. CPR → Epinephrine → Defibrillate → Oxygen
C. Check pulse → CPR → Defibrillate → Medications
D. Oxygen → CPR → Defibrillate → Epinephrine
You: C ✅
👉 Always think:
Pulse → CPR → Shock → Meds
No CPR = no oxygen = no surviva
A nurse notices that a patient’s arterial line BP reading is much higher than the manual cuff. The transducer is positioned below the phlebostatic axis. Why is this causing inaccurate readings?
A. It increases venous return
B. It increases hydrostatic pressure, causing falsely high readings
C. It decreases preload
D. It reduces cardiac output
B. It increases hydrostatic pressure, causing falsely high readings
A patient with cardiogenic shock has an Intra-Aortic Balloon Pump (IABP) inserted via the right femoral artery. Which nursing assessment finding requires immediate intervention?
A.The urine output has decreased from 50 mL/hr to 35 mL/hr.
B.The patient's head of bed is elevated to 45∘.
C.The patient's right leg is maintained in a straight position.
D.The patient reports a mild headache after a dose of Nitroglycerin.
B.
The patient's head of bed is elevated to 45∘.
That's right!
High hip flexion (such as 45∘ elevation) is contraindicated with a femoral IABP as it can displace the catheter or cause vascular injury.
A patient is diagnosed with a 'Stenosis' of the mitral valve. Which heart sound should the nurse expect to auscultate?
A.An S4 atrial gallop.
B.A friction rub.
C.A diastolic murmur or click.
D.A systolic murmur.
C.
A diastolic murmur or click.
Right answer
According to the 'Heart Sounds' table, mitral valve stenosis is specifically associated with clicks and diastolic murmurs.
A patient in the ICU has the following hemodynamic readings: Central Venous Pressure (CVP) of 18 mmHg and a Pulmonary Artery Wedge Pressure (PAWP) of 8 mmHg. Based on the class notes, which condition is most consistent with these findings?
A.
Left Ventricular Failure
B.
Right Ventricular Failure
C.
Mitral Valve Stenosis
D.
Hypovolemia
B.
Right Ventricular Failure
That's right!
CVP reflects Right Atrial Pressure. An elevated CVP (18 mmHg) with a normal PAWP indicates the backup is originating in the right side of the heart, not the left.