Practice

Q: A patient's ECG shows normal sinus rhythm with an occasional early beat that has a normal-looking QRS. What is this most consistent with?
A. PVC
B. PAC
C. Vtach
D. Vfib

B. PAC

Q: A premature ventricular contraction (PVC) is best described as:
A. Early beat with narrow QRS and visible P-wave
B. Early, wide, bizarre QRS with no P-wave
C. Late beat with normal QRS and inverted P-wave
D. Early beat with ST elevation

B. Early, wide, bizarre QRS with no P-wave

Q: The pattern where every other beat is a PVC is called:
A. Trigeminy
B. Quadrigeminy
C. Bigeminy
D. Couplets

C. Bigeminy

Q: Three PVCs in a row are called:
A. Triplets
B. Couplets
C. Bigeminy
D. Trigeminy

A. Triplets

Q: Four or more PVCs in a row at a rate greater than 100 bpm is defined as:
A. Atrial flutter
B. Ventricular fibrillation
C. Ventricular tachycardia
D. Supraventricular tachycardia

C. Ventricular tachycardia

Q: Polymorphic Vtach that appears as a "twisting of the points" is usually associated with which electrolyte abnormality?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypomagnesemia

D. Hypomagnesemia

Q: A patient in ventricular fibrillation will most likely present with:
A. Palpitations and chest pain
B. No pulse and unresponsiveness
C. Bradycardia and hypotension
D. Hypertension and bounding pulses

B. No pulse and unresponsiveness

Q: Which ECG finding is most consistent with atrial fibrillation?
A. Regular R-R intervals with sawtooth waves
B. No P-waves and irregularly irregular R-R intervals
C. Wide QRS complexes with P-waves
D. ST elevation in contiguous leads

B. No P-waves and irregularly irregular R-R intervals

Q: Atrial fibrillation with rapid ventricular response (RVR) is defined as:
A. Atrial rate >100 bpm
B. Ventricular rate >100 bpm
C. PR interval >0.20 seconds
D. QRS duration >0.12 seconds

B. Ventricular rate >100 bpm

Q: In first-degree heart block, which ECG characteristic is present?
A. Dropped QRS complexes
B. PR interval progressively lengthens
C. PR interval >0.20 seconds, all P-waves conducted
D. No relationship between P-waves and QRS

C. PR interval >0.20 seconds, all P-waves conducted

Q: In second-degree Type I (Wenckebach) block, the nurse expects to see:
A. Constant PR interval with random dropped QRS
B. PR interval progressively lengthens until a QRS is dropped
C. No P-waves before QRS complexes
D. Wide QRS complexes with no P-waves

B. PR interval progressively lengthens until a QRS is dropped

Q: Second-degree Type II heart block is considered dangerous because it:
A. Is always benign
B. Often converts to sinus tachycardia
C. May progress to third-degree block
D. Always resolves spontaneously

C. May progress to third-degree block

Q: In third-degree (complete) heart block, which finding is expected?
A. Atria and ventricles beat independently
B. PR interval gradually lengthens
C. All P-waves are conducted
D. No QRS complexes are present

A. Atria and ventricles beat independently

Q: Which heart block typically requires pacing?
A. First-degree
B. Second-degree Type I
C. Second-degree Type II
D. Third-degree

D. Third-degree

Q: A patient with frequent PVCs in bigeminy is most concerning because this pattern:
A. Is always benign
B. Can deteriorate into Vtach or Vfib
C. Indicates atrial fibrillation
D. Indicates sinus bradycardia

B. Can deteriorate into Vtach or Vfib

Q: The nurse identifies an "irregularly irregular" rhythm with no visible P-waves. What is the priority assessment?
A. Check for ST elevation
B. Assess for a pulse deficit and signs of decreased cardiac output
C. Check for U-waves
D. Assess for peaked T-waves

B. Assess for a pulse deficit and signs of decreased cardiac output

Q: Which rhythm is most likely to require immediate defibrillation?
A. Sinus tachycardia
B. Atrial flutter
C. Pulseless Vtach
D. First-degree heart block

C. Pulseless Vtach

Q: The nurse sees a chaotic rhythm with no identifiable P-waves or QRS complexes. The patient is pulseless. What is the rhythm?
A. Atrial fibrillation
B. Ventricular fibrillation
C. Supraventricular tachycardia
D. Junctional rhythm

B. Ventricular fibrillation

Q: A patient with Torsades de Pointes is being treated. Which medication is expected?
A. Amiodarone IV push
B. Magnesium drip
C. Digoxin IV push
D. Adenosine IV slam

B. Magnesium drip

Q: A patient has a PR interval of 0.24 seconds, but all P-waves are followed by QRS complexes. The nurse should:
A. Prepare for immediate pacing
B. Notify the provider but continue to monitor
C. Start CPR
D. Administer adenosine

B. Notify the provider but continue to monitor

Q: Which rhythm is most associated with "no P-waves, irregularly irregular R-R intervals"?
A. Atrial flutter
B. Atrial fibrillation
C. Sinus tachycardia
D. Junctional rhythm

B. Atrial fibrillation

Q: A patient in monomorphic Vtach with a pulse and hypotension is best treated with:
A. Defibrillation
B. Synchronized cardioversion
C. Vagal maneuvers
D. Atropine

B. Synchronized cardioversion

Q: A patient in stable supraventricular tachycardia (SVT) is alert and oriented. What is the first-line intervention?
A. Defibrillation
B. Synchronized cardioversion
C. Vagal maneuvers
D. Atropine

C. Vagal maneuvers

Q: Which of the following is true regarding polymorphic Vtach (Torsades)?
A. It is treated with adenosine
B. It is usually due to low magnesium
C. It is always benign
D. It is treated with digoxin

B. It is usually due to low magnesium

Q: A patient with a heart block should generally avoid which medications?
A. Beta-blockers and ACE inhibitors
B. Amiodarone, lidocaine, digoxin
C. Aspirin and statins
D. Nitrates and morphine

B. Amiodarone, lidocaine, digoxin

Q: The nurse recognizes that amiodarone is primarily used to treat:
A. Sinus bradycardia
B. Vtach and Vfib
C. First-degree heart block
D. Atrial flutter only

B. Vtach and Vfib

Q: A patient with symptomatic bradycardia is most likely to receive which medication?
A. Atropine
B. Adenosine
C. Amiodarone
D. Cardizem

A. Atropine

Q: Atropine is ineffective in which conduction disturbances?
A. Sinus bradycardia
B. First-degree block
C. Second-degree Type II and third-degree block
D. Sinus tachycardia

C. Second-degree Type II and third-degree block

Q: A patient with SVT is given adenosine. The nurse explains that this drug:
A. Gradually slows the heart over several minutes
B. Temporarily stops the heart to break the rhythm
C. Increases contractility and heart rate
D. Decreases preload and afterload

B. Temporarily stops the heart to break the rhythm

Q: Cardizem (diltiazem) is considered first-line for which condition?
A. Vfib
B. Afib with RVR
C. Sinus bradycardia
D. Torsades de Pointes

B. Afib with RVR

Q: An inferior wall MI is most commonly associated with occlusion of which artery?
A. LAD
B. Left main
C. RCA
D. Left circumflex

C. RCA

Q: Which lab is the most definitive marker of myocardial injury?
A. CK-MB
B. Troponin
C. BNP
D. Myoglobin

B. Troponin

Q: A normal ejection fraction (EF) is:
A. 20-30%
B. 30-40%
C. 40-50%
D. 50-70%

D. 50-70%

Q: Heart failure is generally indicated when EF is:
A. >60%
B. 50-70%
C. <40%
D. 40-50%

C. <40%

Q: Which diagnostic test directly visualizes coronary artery blockages?
A. Echocardiogram
B. 12-lead EKG
C. Cardiac catheterization/PCI
D. Chest X-ray

C. Cardiac catheterization/PCI

Q: STEMI is best described as:
A. ST depression with reversible injury
B. ST elevation with tissue death
C. No ST changes with tissue death
D. T-wave inversion only

B. ST elevation with tissue death

Q: NSTEMI is characterized by:
A. ST elevation and tissue death
B. No ST elevation and reversible injury
C. ST depression and tissue death
D. ST elevation and reversible injury

B. No ST elevation and reversible injury

Q: The components of MONA for acute MI include:
A. Morphine, Oxygen, Nitroglycerin, Aspirin
B. Metoprolol, Oxygen, Nitrates, Atropine
C. Morphine, Ondansetron, Nitrates, ACE inhibitor
D. Magnesium, Oxygen, Nitrates, Aspirin

A. Morphine, Oxygen, Nitroglycerin, Aspirin

Q: Stable angina is best described as chest pain that:
A. Occurs at rest and is not relieved by nitro
B. Is relieved by rest and/or nitroglycerin
C. Is associated with ST elevation
D. Is always accompanied by syncope

B. Is relieved by rest and/or nitroglycerin

Q: Unstable angina is characterized by chest pain that:
A. Is relieved by rest
B. Is relieved by nitroglycerin
C. Is not relieved by rest or nitroglycerin
D. Occurs only with exertion

C. Is not relieved by rest or nitroglycerin

Q: After a cardiac catheterization, which nursing action is a priority?
A. Encourage ambulation
B. Keep the patient flat and monitor the insertion site
C. Remove the dressing within 1 hour
D. Restrict fluids

B. Keep the patient flat and monitor the insertion site

Q: Post-cath, the nurse should monitor:
A. Distal pulses and temperature
B. Only blood pressure
C. Only heart rate
D. Only respiratory rate

A. Distal pulses and temperature

Q: A patient with left-sided heart failure is most likely to exhibit:
A. JVD and peripheral edema
B. Hepatosplenomegaly
C. Dyspnea and crackles
D. Ascites

C. Dyspnea and crackles

Q: Pink frothy sputum is most associated with:
A. Right-sided HF
B. Left-sided HF and pulmonary edema
C. COPD
D. Pneumonia

B. Left-sided HF and pulmonary edema

Q: Right-sided heart failure typically presents with:
A. Dyspnea and orthopnea
B. Crackles and pink frothy sputum
C. JVD and peripheral edema
D. Hemoptysis

C. JVD and peripheral edema

Q: Cor pulmonale is best described as:
A. Left HF due to MI
B. Right HF caused by chronic lung disease
C. HF due to valvular disease
D. HF due to renal failure

B. Right HF caused by chronic lung disease

Q: BNP is elevated when:
A. The liver is failing
B. The kidneys are failing
C. The heart muscle is stretched
D. The lungs are hyperinflated

C. The heart muscle is stretched

Q: A Swan-Ganz catheter wedge pressure primarily reflects:
A. Right heart function
B. Left heart pressure
C. Pulmonary function only
D. Systemic vascular resistance

B. Left heart pressure

Q: Pulmonary artery pressure (PAP) is most useful to assess:
A. Liver function
B. Lung condition
C. Renal perfusion
D. Cerebral perfusion

B. Lung condition

Q: DIC is most commonly caused by:
A. Trauma
B. Sepsis
C. Liver failure
D. Renal failure

B. Sepsis

Q: In DIC, the body:
A. Only clots
B. Only bleeds
C. Clots and bleeds simultaneously
D. Neither clots nor bleeds

C. Clots and bleeds simultaneously

Q: Which lab pattern is most consistent with DIC?
A. ↓ D-dimer, ↑ platelets, ↓ PT/PTT
B. ↑ D-dimer, ↓ platelets, ↑ PT/PTT/INR, ↓ fibrinogen
C. Normal D-dimer, normal platelets
D. ↑ fibrinogen, ↓ PT/PTT

B. ↑ D-dimer, ↓ platelets, ↑ PT/PTT/INR, ↓ fibrinogen

Q: Treatment of DIC may include:
A. Heparin and replacement of blood products
B. Only platelets
C. Only FFP
D. Only vitamin K

A. Heparin and replacement of blood products

Q: Vasopressors such as Levophed and dopamine primarily:
A. Decrease blood pressure
B. Shunt blood to vital organs
C. Increase urine output
D. Dilate peripheral vessels

B. Shunt blood to vital organs

Q: A major risk of vasopressor therapy is:
A. Hyperglycemia
B. Peripheral ischemia and gangrene
C. Hyperkalemia
D. Pulmonary edema

B. Peripheral ischemia and gangrene

Q: Vasopressors should ideally be administered via:
A. Peripheral IV
B. Central line
C. IM injection
D. Subcutaneous injection

B. Central line

Q: Inotropes such as dobutamine and digoxin primarily:
A. Decrease heart rate
B. Increase contractility
C. Decrease contractility
D. Decrease preload

B. Increase contractility

Q: An intra-aortic balloon pump (IABP) is used primarily for:
A. Septic shock
B. Cardiogenic shock
C. Neurogenic shock
D. Hypovolemic shock

B. Cardiogenic shock

Q: The IABP inflates during:
A. Systole to increase afterload
B. Diastole to increase coronary perfusion
C. Systole to decrease preload
D. Diastole to decrease coronary perfusion

B. Diastole to increase coronary perfusion

Q: The IABP helps by:
A. Increasing afterload
B. Reducing afterload and improving coronary perfusion
C. Increasing preload
D. Decreasing heart rate

B. Reducing afterload and improving coronary perfusion

Q: Normal potassium range is:
A. 2.0–3.0
B. 3.5–5.0
C. 5.5–6.5
D. 1.5–2.5

B. 3.5–5.0

Q: High potassium levels are most associated with which ECG change?
A. Peaked T-waves
B. U-waves
C. ST depression
D. Prolonged QT

A. Peaked T-waves

Q: Low potassium is most likely to cause:
A. Muscle cramps
B. Hemoptysis
C. JVD
D. Pink frothy sputum

A. Muscle cramps

Q: Statins are best taken:
A. In the morning
B. At night
C. With grapefruit juice
D. Only with antacids

B. At night

Q: A patient on statins should be instructed to report:
A. Dry cough
B. Muscle pain
C. Increased appetite
D. Constipation

B. Muscle pain

Q: Grapefruit should be avoided with which medication class?
A. ACE inhibitors
B. Statins
C. Beta-blockers
D. Diuretics

B. Statins

Q: Nitroprusside should be protected from light to prevent:
A. Renal toxicity
B. Hepatotoxicity
C. Cyanide toxicity
D. Ototoxicity

C. Cyanide toxicity

Q: Low SvO₂ is most likely caused by:
A. Septic shock with high cardiac output
B. Heart failure or cardiogenic shock
C. Over-supply of oxygen
D. Hyperthyroidism only

B. Heart failure or cardiogenic shock

Q: High SvO₂ is most associated with:
A. Septic shock or inability of tissues to extract oxygen
B. Cardiogenic shock
C. Anemia only
D. Hypovolemia

A. Septic shock or inability of tissues to extract oxygen

Q: Which condition is most likely to cause low SvO₂?
A. Fever and hyperthyroid
B. Septic shock with high output
C. Heart failure and anemia
D. Over-sedation

A. Fever and hyperthyroid

Q: Hypoxemia refers to:
A. Low tissue oxygen
B. Low PaO₂ in the blood
C. Low hemoglobin
D. Low cardiac output

B. Low PaO₂ in the blood

Q: Hypoxia refers to:
A. Low PaO₂
B. Low tissue oxygen
C. Low hemoglobin
D. Low respiratory rate

B. Low tissue oxygen

Q: The primary site of gas exchange in the lungs is the:
A. Bronchi
B. Trachea
C. Alveoli
D. Pleura

C. Alveoli

Q: Surfactant’s main function is to:
A. Increase mucus production
B. Prevent alveolar collapse
C. Increase airway resistance
D. Decrease oxygen diffusion

B. Prevent alveolar collapse

Q: Common symptoms of tuberculosis include (Select all that apply):
A. Fatigue
B. Night sweats
C. High-grade fever
D. Low-grade fever
E. Hemoptysis (late sign)

A, B, D, E

Q: The PPD test for TB is interpreted by measuring:
A. Redness
B. Induration
C. Bruising
D. Pain

B. Induration

Q: The definitive diagnosis of TB is made by:
A. Chest X-ray
B. One sputum culture
C. Three morning sputum AFB cultures
D. Blood culture

C. Three morning sputum AFB cultures

Q: Rifampin is associated with which side effect?
A. Blue urine
B. Orange urine
C. Green sputum
D. Black stools

B. Orange urine

Q: Isoniazid (INH) is most associated with:
A. Ototoxicity
B. Hepatotoxicity
C. Nephrotoxicity
D. Cardiotoxicity

B. Hepatotoxicity

Q: Pyrazinamide and isoniazid share which major risk?
A. Hepatotoxicity
B. Ototoxicity
C. Nephrotoxicity
D. Pancreatitis

A. Hepatotoxicity

Q: Ethambutol is most associated with:
A. Ototoxicity
B. Hepatotoxicity
C. Visual changes/optic neuritis
D. Nephrotoxicity

C. Visual changes/optic neuritis

Q: In chronic bronchitis, the primary site of pathology is the:
A. Alveoli
B. Bronchioles
C. Pleura
D. Trachea

B. Bronchioles

Q: In emphysema, the primary pathology involves:
A. Inflammation and mucus
B. Loss of alveolar elasticity and CO₂ trapping
C. Bronchospasm only
D. Pleural effusion

B. Loss of alveolar elasticity and CO₂ trapping

Q: Chronic bronchitis is best described as:
A. Loss of alveolar surface area
B. Inflammation and mucus in the bronchioles
C. Fluid in the pleural space
D. Collapse of the trachea

B. Inflammation and mucus in the bronchioles

Q: Emphysema’s main issue is:
A. Airway narrowing only
B. CO₂ trapping due to loss of elasticity
C. Excess surfactant
D. Pulmonary emboli

B. CO₂ trapping due to loss of elasticity

Q: Patients with COPD often present with:
A. Cyanosis and productive cough
B. Pink frothy sputum
C. Hemoptysis only
D. Stridor

A. Cyanosis and productive cough

Q: Treatments for COPD may include (Select all that apply):
A. Bronchodilators (Albuterol)
B. Anticholinergics (Atrovent)
C. Corticosteroids
D. Mucolytics and fluids
E. Pursed-lip breathing

A, B, C, D, E

Q: Oxygen should be used cautiously in COPD patients because:
A. It always worsens hypoxia
B. It can suppress the respiratory drive in CO₂ retainers
C. It causes bronchospasm
D. It increases mucus production

B. It can suppress the respiratory drive in CO₂ retainers

Q: Pursed-lip breathing is especially helpful in emphysema because it:
A. Increases respiratory rate
B. Creates back-pressure to prevent airway collapse and expel CO₂
C. Decreases tidal volume
D. Increases mucus production

B. Creates back-pressure to prevent airway collapse and expel CO₂

Q: ARDS is most commonly caused by:
A. Asthma
B. Sepsis
C. Heart failure
D. Pulmonary embolism

B. Sepsis

Q: Early signs of ARDS include:
A. Respiratory acidosis and ALOC
B. Tachypnea, respiratory alkalosis, restlessness
C. Bradycardia and hypotension
D. Cyanosis and coma

B. Tachypnea, respiratory alkalosis, restlessness

Q: Late signs of ARDS include:
A. Respiratory alkalosis
B. Respiratory acidosis and ALOC
C. Hyperventilation
D. Normal ABGs

B. Respiratory acidosis and ALOC

Q. The hallmark of ARDS is:
A. Productive cough
B. Refractory hypoxemia
C. Hemoptysis
D. Stridor

B. Refractory hypoxemia

Q: A chest X-ray in ARDS typically shows:
A. Hyperinflation
B. White-out infiltrates
C. Pleural effusion
D. Normal findings

B. White-out infiltrates

Q: MODS (multiple organ dysfunction syndrome) in ARDS may affect which organs? (Select all that apply):
A. Heart (hypotension, dysrhythmias)
B. Lungs (ventilation required)
C. Kidneys (low urine output, dialysis)
D. Brain (ALOC)
E. Liver (jaundice)

A, B, C, D, E

Q: Management of ARDS often includes:
A. Decreasing PEEP
B. Proning and increasing PEEP
C. Avoiding mechanical ventilation
D. Restricting oxygen

B. Proning and increasing PEEP

Q0: Common assessment findings in pneumonia include (Select all that apply):
A. Crackles
B. Rhonchi
C. Fever
D. Green or rust-colored sputum
E. JVD

A, B, C, D

Q: Diagnosis of pneumonia may include:
A. CXR, pulse ox, ABGs, sputum culture
B. Only ABGs
C. Only pulse ox
D. Only sputum culture

A. CXR, pulse ox, ABGs, sputum culture

Q: Treatment of pneumonia typically includes (Select all that apply):
A. Empiric antibiotics (Azithromycin, Levaquin)
B. Oxygen
C. Fluids
D. Analgesics
E. Vasopressors

A, B, C, D

Q: Ventilator-associated pneumonia (VAP) prevention includes:
A. HOB flat
B. HOB 30–45°
C. Oral care every 4 hours with chlorhexidine
D. Avoiding hand hygiene
E. Frequent suctioning with no hyperoxygenation

B. HOB 30–45°