Review Practice Exercise 2

Emergency Nursing Principles and Management > Adult Health

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Practice Exercise 2

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Total Questions : 5

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Question 1:

A patient is experiencing crushing chest pain that radiates to their left arm and jaw. The EKG shows ST-segment elevation. Which of the following is the most likely diagnosis?

A. Pericarditis B. Aortic dissection C. Acute myocardial infarction (STEMI) D. Unstable angina

Answer and Explanation

Choice A:

Pericarditis: Can cause chest pain and diffuse ST elevation, but the pain is usually sharp, pleuritic, and relieved by sitting forward, not crushing or radiating to the arm/jaw.

Choice B:

Aortic dissection: Causes sudden, tearing chest or back pain, often with pulse differences between limbs, not ST elevation from coronary occlusion.

Choice C:

Acute myocardial infarction (STEMI): Classic presentation includes severe, persistent chest pain, radiation to the arm or jaw, and ST-segment elevation on EKG, indicating full-thickness myocardial injury.Rationale for incorrect answers:

Choice D:

Unstable angina: Presents with similar chest pain, but EKG changes do not show persistent ST elevation, and there is no complete coronary occlusion.

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Question 2:

A nurse is assessing a patient with a suspected cardiac emergency. Which of the following are classic signs and symptoms of a myocardial infarction? Select all that apply

A. Sudden, sharp, stabbing pain that worsens with deep breath. B. Cool, clammy skin. C. Shortness of breath (dyspnea). D. Palpitations. E. Nausea and vomiting.

Answer and Explanation

Choice A:

Sudden, sharp, stabbing pain that worsens with deep breath: This type of pain is usually pleuritic or musculoskeletal, not typical of MI.

Choice B:

Cool, clammy skin: Caused by vasoconstriction and activation of the sympathetic nervous system.

Choice C:

Shortness of breath (dyspnea): Results from reduced cardiac output and possible pulmonary congestion.

Choice D:

Palpitations: May occur from arrhythmias triggered by ischemia.

Choice E:

Nausea and vomiting: Often due to vagal stimulation or inferior wall MI.Rationale for incorrect answer:

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Question 3:

A patient in the emergency department suddenly becomes unresponsive, apneic, and pulseless. A nurse should immediately initiate which of the following interventions?

A. Administering a bolus of intravenous fluids. B. Beginning chest compressions and calling for the defibrillator. C. Obtaining a 12-lead EKG. D. Preparing for endotracheal intubation.

Answer and Explanation

Choice A:

Administering a bolus of intravenous fluids: Fluids may be helpful later depending on the cause, but circulation must be initiated first.

Choice B:

Beginning chest compressions and calling for the defibrillator: Early CPR and rapid defibrillation are the most critical interventions for cardiac arrest, significantly improving survival rates.Rationale for incorrect answers:

Choice C:

Obtaining a 12-lead EKG: This is performed after return of spontaneous circulation (ROSC), not during active arrest.

Choice D:

Preparing for endotracheal intubation: Airway management is important but should not delay initiation of chest compressions.

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Question 4:

Which of the following are considered modifiable risk factors for coronary artery disease (CAD)? Select all that apply

A. Family history of CAD. B. Male gender. C. Hypertension. D. Hyperlipidemia. E. Smoking.

Answer and Explanation

Choice A:

Family history of CAD: Non-modifiable; genetic predisposition cannot be changed.

Choice B:

Male gender: Non-modifiable; although men are at higher risk, gender itself cannot be altered as a risk factor.

Choice C:

Hypertension: Can be managed with medications, diet, exercise, and stress reduction.

Choice D:

Hyperlipidemia: Can be controlled with diet, exercise, and lipid-lowering drugs.

Choice E:

Smoking: Stopping smoking greatly reduces CAD risk.Rationale for incorrect answers:

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Question 5:

A patient presents with a rapid, irregular heart rate. The EKG shows no discernable P waves and a chaotic baseline with a variable ventricular response. This is a classic finding for which type of arrhythmia?

A. Atrial fibrillation. B. Ventricular tachycardia. C. Supraventricular tachycardia. D. Sinus tachycardia.

Answer and Explanation

Choice A:

Atrial fibrillation: Results from disorganized atrial electrical activity, leading to fibrillatory waves instead of normal P waves, and an unpredictable ventricular rhythm.Rationale for incorrect answers:

Choice B:

Ventricular tachycardia: Shows wide QRS complexes and a regular rhythm, often without visible P waves.

Choice C:

Supraventricular tachycardia: Usually presents with a rapid, regular rhythm, often with narrow QRS complexes, and sometimes hidden P waves.

Choice D:

Sinus tachycardia: Has a regular rhythm with identifiable P waves before each QRS complex.

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Practice Exercise 2

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