DOH Nursing Adult Health Nursing 1 — Questions and Answers
Question 1: A patient with suspected myocardial infarction presents with chest pain. Which ECG finding is most indicative of STEMI?
- ST-segment elevation in two or more contiguous leads (Correct answer)
- ST-segment depression in all leads
- Peaked T waves in precordial leads
- Prolonged PR interval greater than 0.20 seconds
Correct answer: ST-segment elevation in two or more contiguous leads
STEMI (ST-elevation MI) is diagnosed when ST elevation ≥1 mm is present in two or more contiguous leads (or ≥2 mm in V1–V3). This indicates complete coronary occlusion requiring immediate reperfusion therapy.
Question 2: Which medication should be withheld if a patient's apical pulse is below 60 beats per minute?
- Digoxin (Correct answer)
- Metoprolol
- Furosemide
- Lisinopril
Correct answer: Digoxin
Digoxin slows AV conduction and is held if the apical pulse is <60 bpm (in adults) because the drug could cause dangerous bradycardia. Always take a full apical pulse for one full minute before administering digoxin.
Question 3: A patient with COPD has a PaO2 of 55 mmHg and PaCO2 of 58 mmHg. What oxygen delivery device should the nurse use?
- Venturi mask at 24–28% FiO2 (Correct answer)
- Non-rebreather mask at 100% FiO2
- Simple face mask at 40% FiO2
- Nasal cannula at 6 L/min
Correct answer: Venturi mask at 24–28% FiO2
COPD patients may rely on hypoxic drive for respiration. Controlled low-flow oxygen via Venturi mask (24–28%) raises PaO2 to a safe level (55–65 mmHg) without eliminating the hypoxic drive. High-flow oxygen can cause CO2 retention.
Question 4: Which assessment finding is an early sign of hypovolemic shock?
- Anxiety and restlessness with tachycardia (Correct answer)
- Hypotension with systolic <90 mmHg
- Unresponsiveness and absent urine output
- Cyanosis and mottled skin
Correct answer: Anxiety and restlessness with tachycardia
In early (compensated) hypovolemic shock, the body maintains blood pressure through sympathetic compensation, but early signs include anxiety, restlessness, and tachycardia. Hypotension is a late, decompensated sign indicating severe blood loss.
Question 5: A patient is admitted with diabetic ketoacidosis (DKA). Which laboratory finding is most consistent with this diagnosis?
- Blood glucose >250 mg/dL, pH <7.3, bicarbonate <15 mEq/L, positive ketones (Correct answer)
- Blood glucose >126 mg/dL with normal pH and bicarbonate
- Low blood glucose with elevated pH and bicarbonate
- Normal blood glucose with elevated ketones and normal pH
Correct answer: Blood glucose >250 mg/dL, pH <7.3, bicarbonate <15 mEq/L, positive ketones
DKA is characterized by hyperglycemia (>250 mg/dL), metabolic acidosis (pH <7.3), low bicarbonate (<15 mEq/L), and elevated ketones. This triad results from insulin deficiency causing fat breakdown and ketone production.
Question 6: Which intervention is priority for a patient in acute pulmonary edema?
- Sit upright, apply high-flow oxygen, and administer IV furosemide as ordered (Correct answer)
- Lay flat, administer oral furosemide, and monitor every 4 hours
- Administer IV fluids to improve cardiac output
- Place in Trendelenburg position to improve venous return
Correct answer: Sit upright, apply high-flow oxygen, and administer IV furosemide as ordered
Acute pulmonary edema is a medical emergency. Sitting the patient upright reduces venous return and lung congestion. High-flow oxygen corrects hypoxemia. IV furosemide rapidly reduces preload by promoting diuresis. Oral medications act too slowly.
DOH Nursing Adult Health Nursing 1
A patient with suspected myocardial infarction presents with chest pain.
Which ECG finding is most indicative of STEMI?