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CNA Emergency Nursing (ENC(C)) study materials
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CNA Emergency Nursing (ENC(C)) practice questions

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Question 1Assessment, Triage, and Clinical Decision-Making

During the initial assessment of a patient arriving by ambulance, which action should the emergency nurse take first?

  1. Assess airway, breathing, and circulation Correct answer.
  2. Obtain a full medical history from the family
  3. Measure the patient's weight and height
  4. Collect a urine specimen for analysis

Explanation

The primary survey follows an ABCDE sequence in which airway, breathing, and circulation are evaluated before any secondary data collection. Life-threatening problems found during this rapid assessment must be addressed immediately, so history taking and specimen collection are deferred until the patient is stabilized.

Question 2Assessment, Triage, and Clinical Decision-Making

A patient reports chest pressure. Which finding during the primary survey most strongly suggests inadequate tissue perfusion?

  1. Urine output of 50 mL per hour
  2. Warm, dry skin
  3. Altered mental status Correct answer.
  4. Capillary refill of 2 seconds

Explanation

Mental status is a sensitive indicator of cerebral perfusion, so new confusion or drowsiness signals inadequate oxygen delivery to the brain. Capillary refill under 3 seconds, warm dry skin, and adequate hourly urine output all suggest perfusion is being maintained.

Question 3Assessment, Triage, and Clinical Decision-Making

Which triage category is assigned to a patient who is breathing spontaneously but has a Glasgow Coma Scale score of 9 and requires immediate airway protection?

  1. Semi-urgent, requiring care within 2 hours
  2. Urgent, requiring care within 30 minutes
  3. Non-urgent, able to wait several hours
  4. Emergent, requiring immediate intervention Correct answer.

Explanation

A Glasgow Coma Scale score of 9 or below indicates a compromised airway that needs immediate protection, placing the patient in the highest acuity category. Delaying intervention in this group risks aspiration, hypoxia, and death, so the patient must be seen without delay.

Question 4Assessment, Triage, and Clinical Decision-Making

Which single question is most useful when screening an older adult for fall risk in the emergency department?

  1. Have you ever had a blood transfusion?
  2. Have you fallen in the past year? Correct answer.
  3. Do you take any vitamins?
  4. Do you own a pet at home?

Explanation

A history of falling in the previous year is one of the strongest predictors of future falls and is recommended as a rapid screening question. It identifies patients who need gait assessment, medication review, and fall-prevention teaching before discharge.

Question 5Assessment, Triage, and Clinical Decision-Making

A patient with a suspected opioid overdose presents with a respiratory rate of 6 breaths per minute and pinpoint pupils. Which action should the nurse anticipate first?

  1. Administering a bolus of intravenous fluids
  2. Preparing to give naloxone Correct answer.
  3. Obtaining an abdominal ultrasound
  4. Applying supplemental oxygen by nasal cannula

Explanation

The presentation of slow breathing, pinpoint pupils, and depressed consciousness is classic for opioid toxicity, and naloxone is the specific antidote that reverses opioid-induced respiratory depression. Oxygen alone does not restore adequate ventilation, so antidote administration is the priority.

Question 6Assessment, Triage, and Clinical Decision-Making

Which finding best distinguishes a stroke from a hypoglycemic episode in a patient with sudden hemiparesis?

  1. Patient's age
  2. Presence of a headache
  3. Pupil size
  4. Blood glucose measurement Correct answer.

Explanation

Hypoglycemia can mimic stroke with focal deficits, so a point-of-care glucose measurement must be obtained immediately and corrected if low. Once glucose is normalized, persistent focal deficits strongly support a stroke diagnosis and activation of the stroke pathway.

Question 7Assessment, Triage, and Clinical Decision-Making

A patient arrives with a deep laceration and spurting bright red blood from the forearm. Which initial intervention is most appropriate?

  1. Obtain a complete blood count before acting
  2. Elevate the arm and wait for the provider
  3. Apply direct pressure to the wound Correct answer.
  4. Apply a tourniquet as the first step

Explanation

Direct pressure over the bleeding site is the fastest, most effective first-line method to control external hemorrhage. Tourniquets, elevation, and laboratory testing are secondary measures that should not delay immediate pressure.

Question 8Assessment, Triage, and Clinical Decision-Making

Which parameter is most important to reassess repeatedly in a patient receiving large-volume fluid resuscitation?

  1. Respiratory effort and lung sounds Correct answer.
  2. Patient's stated pain score
  3. Skin color of the extremities
  4. Number of visitors present

Explanation

Aggressive fluid resuscitation can precipitate pulmonary edema, so lung sounds and work of breathing must be monitored frequently to detect fluid overload early. Changes such as crackles or increasing dyspnea warrant slowing the infusion and notifying the provider.

Question 9Assessment, Triage, and Clinical Decision-Making

A patient with severe abdominal pain is pale, diaphoretic, and has a heart rate of 128 beats per minute with a blood pressure of 88/54 mm Hg. How should the nurse interpret these findings?

  1. Signs of compensated shock requiring urgent evaluation Correct answer.
  2. A normal response to pain alone
  3. Findings consistent with a chronic condition
  4. A stable presentation suitable for routine triage

Explanation

Tachycardia with hypotension and signs of poor perfusion indicates shock that is progressing beyond compensation and requires immediate resuscitation. Pain alone can raise heart rate but does not typically produce hypotension with diaphoresis and pallor.

Question 10Assessment, Triage, and Clinical Decision-Making

Which statement about the purpose of triage is most accurate?

  1. Triage ranks patients by urgency so limited resources go to those who need them most Correct answer.
  2. Triage determines the order in which patients are discharged
  3. Triage establishes a definitive diagnosis for each patient
  4. Triage replaces the need for ongoing reassessment

Explanation

Triage is a sorting process that prioritizes care according to clinical urgency when demand exceeds available resources. It does not diagnose, does not replace reassessment, and must be repeated as patients' conditions change.

Question 11Assessment, Triage, and Clinical Decision-Making

An adult patient reports a sudden severe headache described as the worst of their life. Which action reflects appropriate clinical decision-making?

  1. Reassure the patient that headaches are usually benign
  2. Schedule a routine outpatient follow-up in one week
  3. Discharge the patient with oral analgesics
  4. Escalate for urgent evaluation of a possible intracranial hemorrhage Correct answer.

Explanation

A thunderclap headache that reaches maximum intensity within seconds to minutes raises concern for subarachnoid hemorrhage and requires urgent imaging and specialist evaluation. Dismissing the symptom or delaying workup risks missing a life-threatening diagnosis.

Question 12Assessment, Triage, and Clinical Decision-Making

Which finding indicates that a patient's condition has deteriorated and should prompt immediate reassessment?

  1. A rising respiratory rate and new confusion Correct answer.
  2. A pain score that has decreased
  3. A temperature of 37.0 degrees Celsius
  4. A stable heart rate over the past hour

Explanation

An increasing respiratory rate combined with new confusion is an early warning sign of clinical deterioration, often preceding cardiac arrest by hours. Early recognition allows the nurse to escalate care before the patient decompensates further.

Question 13Assessment, Triage, and Clinical Decision-Making

A patient with a known penicillin allergy is prescribed a cephalosporin. Which action should the nurse take before administration?

  1. Hold the drug and document the allergy only
  2. Administer the drug and monitor closely
  3. Verify the allergy history and clarify the order with the prescriber Correct answer.
  4. Substitute a different antibiotic independently

Explanation

Patients with penicillin allergy may have cross-reactivity with some cephalosporins, so the nurse must verify the nature and severity of the reaction and clarify the order with the prescriber. Independent substitution or administration without clarification could cause a serious allergic reaction.

Question 14Assessment, Triage, and Clinical Decision-Making

Which patient should be assigned the highest priority when a nurse must triage several arrivals simultaneously?

  1. A patient requesting a work excuse note
  2. A patient with a minor rash and no distress
  3. A patient with severe difficulty breathing and audible wheezing Correct answer.
  4. A patient with a sprained ankle and stable vital signs

Explanation

Severe respiratory distress with audible wheezing indicates an immediate threat to airway and breathing and takes priority over minor musculoskeletal or dermatologic complaints. Airway and breathing problems are addressed first in any triage system.

Question 15Assessment, Triage, and Clinical Decision-Making

A patient with a suspected cervical spine injury must be assessed. Which approach best protects the airway while maintaining spinal precautions?

  1. Turn the patient prone to open the airway
  2. Hyperextend the neck to improve visualization
  3. Perform a head-tilt chin-lift maneuver
  4. Maintain manual in-line stabilization and use a jaw-thrust maneuver Correct answer.

Explanation

Manual in-line stabilization with a jaw-thrust maneuver opens the airway without extending the cervical spine, reducing the risk of secondary spinal cord injury. Head-tilt and neck hyperextension are contraindicated when a cervical injury is suspected.

Question 16Assessment, Triage, and Clinical Decision-Making

Which vital sign change is most concerning in a patient with a suspected internal bleed?

  1. Temperature rising from 36.8 to 37.2 degrees Celsius
  2. Respiratory rate falling from 16 to 14 breaths per minute
  3. Heart rate rising from 78 to 118 beats per minute Correct answer.
  4. Oxygen saturation rising from 95 to 98 percent

Explanation

A rising heart rate is an early compensatory response to blood loss and often precedes a measurable drop in blood pressure. Recognizing this trend allows the nurse to escalate care and anticipate volume replacement before decompensation occurs.

Question 17Assessment, Triage, and Clinical Decision-Making

Which screening question is most appropriate for identifying alcohol withdrawal risk at triage?

  1. Do you exercise regularly?
  2. How many servings of vegetables do you eat daily?
  3. What is your occupation?
  4. When was your last drink of alcohol? Correct answer.

Explanation

The timing of the last alcohol intake helps predict when withdrawal symptoms may begin and guides monitoring and treatment planning. Withdrawal can progress to seizures or delirium tremens, so early identification is essential.

Question 18Assessment, Triage, and Clinical Decision-Making

A patient with an altered level of consciousness and a blood glucose of 42 mg/dL is brought to the emergency department. What is the priority interpretation?

  1. The altered mental status is likely unrelated to the glucose value
  2. The low glucose is a reversible cause of the altered mental status Correct answer.
  3. The patient should be observed without treatment
  4. The patient requires immediate psychiatric evaluation

Explanation

Hypoglycemia is a rapidly reversible cause of altered consciousness and must be corrected promptly to prevent neurologic injury. Treating the glucose first often resolves the mental status change without further workup.

Question 19Assessment, Triage, and Clinical Decision-Making

Which element is essential to document when a patient leaves the emergency department against medical advice?

  1. The patient's insurance provider
  2. The number of staff present at discharge
  3. The patient's preferred discharge time
  4. The specific risks explained and the patient's understanding of them Correct answer.

Explanation

Documentation of an against-medical-advice departure must record the risks and alternatives explained, the patient's comprehension, and the fact that the patient chose to leave. This protects the patient and demonstrates that informed refusal was respected.

Question 20Assessment, Triage, and Clinical Decision-Making

A patient is unable to provide a history and has no identification. What is the most appropriate initial step?

  1. Delay all care until identification is confirmed
  2. Provide necessary emergency care and document the unidentified status Correct answer.
  3. Ask the patient to return when they have identification
  4. Refuse treatment until a family member arrives

Explanation

Emergency care must never be delayed because of missing identification; treatment proceeds while the unidentified status is documented. Identifiers are established later through hospital processes once the patient is stabilized.

Question 21Assessment, Triage, and Clinical Decision-Making

Which assessment finding most strongly suggests a tension pneumothorax in a patient with sudden deterioration after chest trauma?

  1. Tracheal deviation away from the affected side with hypotension Correct answer.
  2. A dry cough with normal vital signs
  3. Localized bruising at the injury site
  4. Bilateral equal breath sounds

Explanation

Tension pneumothorax produces progressive respiratory and hemodynamic compromise, with absent breath sounds on the affected side, tracheal deviation away from the affected side, and hypotension. Immediate decompression is required to prevent cardiovascular collapse.

Question 22Assessment, Triage, and Clinical Decision-Making

A patient presents with a swollen, painful leg after prolonged immobilization. Which action best reflects appropriate triage decision-making?

  1. Apply heat and discharge the patient
  2. Escalate for urgent evaluation of possible deep vein thrombosis Correct answer.
  3. Massage the leg to relieve discomfort
  4. Instruct the patient to walk briskly to improve circulation

Explanation

Unilateral leg swelling after immobilization raises concern for deep vein thrombosis, which can embolize to the lungs and cause pulmonary embolism. The patient requires urgent evaluation, and massage or vigorous activity could dislodge a clot.

Question 23Assessment, Triage, and Clinical Decision-Making

A patient with severe sepsis is being triaged. Which set of findings is most consistent with this diagnosis?

  1. Temperature 36.9 degrees Celsius, heart rate 70, respiratory rate 14
  2. Temperature 36.5 degrees Celsius, heart rate 88, respiratory rate 18
  3. Temperature 37.1 degrees Celsius, heart rate 62, respiratory rate 12
  4. Temperature 38.9 degrees Celsius, heart rate 118, respiratory rate 26, hypotension Correct answer.

Explanation

Sepsis is characterized by signs of infection plus systemic dysfunction such as fever, tachycardia, tachypnea, and hypotension. This combination meets the criteria for a high-acuity triage category and requires immediate resuscitation.

Question 24Assessment, Triage, and Clinical Decision-Making

Which patient statement most strongly indicates a need for immediate suicide risk assessment in triage?

  1. I have been feeling tired lately
  2. I have trouble sleeping
  3. I am worried about my job
  4. I have a plan to end my life tonight Correct answer.

Explanation

A specific plan with intent and a timeframe indicates high acute suicide risk and requires immediate safety measures and psychiatric evaluation. General symptoms such as fatigue or insomnia warrant screening but do not convey the same imminent danger.

Question 25Assessment, Triage, and Clinical Decision-Making

A patient with a suspected overdose is unresponsive with a respiratory rate of 4 breaths per minute. Which sequence of priorities is most appropriate?

  1. Open the airway and support ventilation, then identify the substance Correct answer.
  2. Ask the family for a medication list, then start oxygen
  3. Obtain a full toxicology screen, then assess the airway
  4. Document the presentation, then call the provider

Explanation

Airway and breathing take precedence over diagnostic testing, so ventilation must be supported before substance identification. Once the patient is stabilized, history and toxicology testing can guide antidote selection and further treatment.

Question 26Assessment, Triage, and Clinical Decision-Making

During a primary survey, a trauma patient's airway is open but breathing is shallow and the chest is not expanding symmetrically. Which action should the nurse take next?

  1. Obtain a full set of vital signs and a 12-lead ECG before intervening
  2. Insert a large-bore IV and begin rapid crystalloid infusion
  3. Assist ventilations with a bag-valve-mask while preparing for further airway support Correct answer.
  4. Apply a cervical collar and defer breathing assessment until imaging is complete

Explanation

In the ABCDE primary survey, inadequate breathing after a patent airway is corrected immediately with assisted ventilation before moving to circulation. Oxygenation failure kills faster than volume loss, so bag-valve-mask support and preparation for advanced airway management take precedence over diagnostic testing or IV access.

Question 27Assessment, Triage, and Clinical Decision-Making

A patient is brought in after a fall and is confused, repeatedly asking where they are. Which tool is designed specifically to grade level of consciousness in the emergency setting?

  1. The Morse Fall Scale
  2. The Richmond Agitation-Sedation Scale
  3. The NIH Stroke Scale
  4. The Glasgow Coma Scale Correct answer.

Explanation

The Glasgow Coma Scale scores eye opening, verbal response, and motor response to produce a reproducible number (3 to 15) that quantifies consciousness and detects deterioration over time. The other tools measure stroke severity, sedation depth, or fall risk rather than global level of consciousness.

Question 28Assessment, Triage, and Clinical Decision-Making

A patient with crushing chest pain is diaphoretic and nauseated. The triage nurse notes the pain radiates to the left jaw and the patient has a history of diabetes. Which action best reflects appropriate urgency assignment?

  1. Assign a low-acuity category and reassess after other patients are registered
  2. Ask the patient to complete intake paperwork before any clinical assessment
  3. Place the patient in the waiting room because pain intensity alone does not determine acuity
  4. Escort the patient directly to a monitored bed and obtain an ECG within minutes Correct answer.

Explanation

Jaw radiation, diaphoresis, and nausea suggest an acute coronary syndrome, and diabetic patients may present atypically; time-critical conditions require immediate ECG and monitored placement. Acuity is driven by the likelihood of a life-threatening cause, not by the patient's stated pain score or arrival order.

Question 29Assessment, Triage, and Clinical Decision-Making

An older adult is brought in by family who report two days of confusion and decreased oral intake. The patient is afebrile with a heart rate of 104 beats per minute and dry mucous membranes. Which interpretation best guides triage?

  1. A normal temperature excludes serious infection in this population
  2. Confusion should be attributed to dementia until a family history is obtained
  3. The combination suggests possible sepsis or dehydration and warrants prompt evaluation Correct answer.
  4. Delirium is expected in older adults and requires only routine triage

Explanation

Older adults often mount a blunted febrile response, so infection may present with confusion, tachycardia, and dehydration rather than fever. Acute altered mental status in a previously lucid older adult is a high-risk finding that requires urgent evaluation for sepsis and volume depletion.

Question 30Assessment, Triage, and Clinical Decision-Making

A patient is receiving a continuous infusion of a high-alert vasoactive medication through a peripheral line. Which monitoring plan best reflects safe clinical decision-making?

  1. Increase the infusion rate whenever the blood pressure reading is below target
  2. Verify the pump programming and infusion site at handoff only
  3. Check the site and vital signs once per shift unless the patient reports pain
  4. Reassess the site, rate, and hemodynamic response at frequent defined intervals Correct answer.

Explanation

High-alert vasoactive infusions can cause extravasation and abrupt hemodynamic swings, so the site, pump settings, and patient response must be verified at frequent, defined intervals rather than once per shift. Titration follows a prescribed protocol with reassessment, not an unstructured response to a single reading.

Question 31Resuscitation and Cardiovascular Emergencies

A patient in the emergency department is unresponsive, not breathing, and has no palpable pulse. According to basic life support guidelines, which action should the nurse take first?

  1. Check a blood glucose level
  2. Obtain a 12-lead ECG
  3. Give two rescue breaths before compressions
  4. Begin chest compressions immediately Correct answer.

Explanation

When a patient is unresponsive with no breathing and no pulse, high-quality chest compressions must start without delay because circulation is absent and every minute without perfusion reduces survival. Compressions are the foundation of cardiopulmonary resuscitation and take priority over diagnostic testing.

Question 32Resuscitation and Cardiovascular Emergencies

During adult chest compressions, which technique reflects high-quality cardiopulmonary resuscitation?

  1. Pause compressions for 30 seconds to reassess the pulse
  2. Compress at a rate of 60 per minute with shallow depth
  3. Lean on the chest between compressions to maintain contact
  4. Push hard at least 5 cm deep and allow full chest recoil Correct answer.

Explanation

High-quality compressions require adequate depth of at least 5 cm in adults, a rate of 100 to 120 per minute, and complete chest recoil so the heart can refill. Leaning on the chest or prolonged pauses reduces venous return and coronary perfusion pressure.

Question 33Resuscitation and Cardiovascular Emergencies

An adult patient is found unresponsive with agonal gasping. The nurse has no pulse check available and must act. What is the most appropriate immediate action?

  1. Place the patient in the recovery position
  2. Administer oral glucose
  3. Wait for the gasping to stop
  4. Start compressions and treat as cardiac arrest Correct answer.

Explanation

Agonal gasps are not effective breathing and are a common sign of cardiac arrest. When a patient is unresponsive with abnormal or absent breathing, the nurse should assume cardiac arrest and begin compressions immediately rather than waiting.

Question 34Resuscitation and Cardiovascular Emergencies

Which finding most strongly suggests that a patient is experiencing an acute myocardial infarction rather than angina?

  1. Sharp pain that worsens with deep inspiration
  2. Pain reproduced by pressing on the chest wall
  3. Chest pain that persists despite rest and nitroglycerin Correct answer.
  4. Chest discomfort relieved within minutes by rest

Explanation

Ischemic pain of myocardial infarction typically persists longer than angina and is not relieved by rest or nitroglycerin. Pain relieved promptly by rest or nitroglycerin is characteristic of stable angina rather than infarction.

Question 35Resuscitation and Cardiovascular Emergencies

A patient with an acute coronary syndrome is prescribed nitroglycerin. Which assessment finding should prompt the nurse to withhold the drug and notify the provider?

  1. Blood pressure of 84/50 mm Hg Correct answer.
  2. History of well-controlled diabetes
  3. Report of a mild headache
  4. Heart rate of 88 beats per minute

Explanation

Nitroglycerin is a vasodilator that can cause profound hypotension, so it is withheld when systolic pressure is low. A systolic pressure around 84 mm Hg is a contraindication to giving the drug without further orders.

Question 36Resuscitation and Cardiovascular Emergencies

A patient with a suspected acute coronary syndrome has no aspirin allergy and no active bleeding. Which medication should the nurse anticipate giving early?

  1. Subcutaneous heparin alone
  2. Intravenous furosemide
  3. Oral potassium chloride
  4. Chewed aspirin Correct answer.

Explanation

Chewed aspirin is given early in suspected acute coronary syndrome because it rapidly inhibits platelet aggregation and reduces mortality. It is not given if there is a true allergy or active bleeding.

Question 37Resuscitation and Cardiovascular Emergencies

A patient becomes unresponsive and pulseless while attached to a monitor that shows ventricular fibrillation. What is the priority intervention?

  1. Administer atropine
  2. Perform synchronized cardioversion
  3. Begin transcutaneous pacing
  4. Deliver an unsynchronized defibrillation shock Correct answer.

Explanation

Ventricular fibrillation is a shockable pulseless rhythm, and the definitive treatment is immediate unsynchronized defibrillation along with high-quality compressions. Synchronization is impossible and inappropriate when there is no organized rhythm or pulse.

Question 38Resuscitation and Cardiovascular Emergencies

Which patient statement best indicates understanding of how to use sublingual nitroglycerin for angina at home?

  1. I will take three tablets at once if the pain is severe.
  2. I will swallow the tablet whole with a full glass of water.
  3. I will keep the tablets in a warm place near a window.
  4. I will place the tablet under my tongue and sit down before taking it. Correct answer.

Explanation

Sublingual nitroglycerin is absorbed under the tongue, and the patient should be sitting or lying down because vasodilation can cause hypotension and syncope. The drug should be stored in a cool, dark place and taken one dose at a time per the prescribed regimen.

Question 39Resuscitation and Cardiovascular Emergencies

A patient with a suspected acute coronary syndrome is being assessed. Which action is most important while awaiting definitive treatment?

  1. Delay monitoring until troponin results return
  2. Give a large meal to maintain energy
  3. Encourage the patient to walk to reduce anxiety
  4. Obtain a 12-lead ECG and place the patient on continuous cardiac monitoring Correct answer.

Explanation

An early 12-lead ECG identifies ST-elevation infarction and guides reperfusion timing, while continuous monitoring detects dangerous dysrhythmias that may occur suddenly. Activity and meals are restricted during active ischemia, and monitoring should never wait for laboratory results.

Question 40Resuscitation and Cardiovascular Emergencies

During a code, the monitor shows asystole in a patient with confirmed absence of pulse. Which action is appropriate?

  1. Deliver an immediate defibrillation shock
  2. Give a bolus of atropine as the primary drug
  3. Continue high-quality compressions and give epinephrine Correct answer.
  4. Perform synchronized cardioversion

Explanation

Asystole is a nonshockable rhythm, so treatment centers on high-quality compressions and epinephrine while reversible causes are sought. Defibrillation and cardioversion are ineffective for asystole and may interrupt needed compressions.

Question 41Resuscitation and Cardiovascular Emergencies

A patient with unstable tachycardia and a palpable pulse has a blood pressure of 78/44 mm Hg and reports chest pain. What intervention should the nurse anticipate?

  1. Synchronized cardioversion Correct answer.
  2. Administration of oral beta blockers
  3. Vagal maneuvers repeated until symptoms resolve
  4. Immediate unsynchronized defibrillation

Explanation

An unstable tachyarrhythmia with hypotension and ischemic symptoms in a patient who has a pulse is treated with synchronized cardioversion, which delivers a shock timed to the QRS complex. Unsynchronized shocks are reserved for pulseless ventricular fibrillation or pulseless ventricular tachycardia.

Question 42Resuscitation and Cardiovascular Emergencies

A patient is in cardiac arrest, and the rhythm is pulseless ventricular tachycardia. After the first defibrillation and a cycle of compressions, what should the nurse prepare to give?

  1. Epinephrine 1 mg intravenously Correct answer.
  2. Adenosine 6 mg rapid push
  3. Atropine 1 mg intravenously
  4. Diltiazem 20 mg intravenous push

Explanation

In adult cardiac arrest with a shockable rhythm, epinephrine is given after the initial defibrillation attempts and continued every few minutes during resuscitation. Adenosine, diltiazem, and atropine are not part of pulseless arrest management.

Question 43Resuscitation and Cardiovascular Emergencies

A patient with a heart rate of 38 beats per minute is dizzy and hypotensive. Which initial intervention is most appropriate while preparing for pacing?

  1. Administer atropine as ordered Correct answer.
  2. Start a diltiazem infusion
  3. Perform immediate defibrillation
  4. Give a rapid bolus of adenosine

Explanation

Symptomatic bradycardia with hypotension is initially treated with atropine to increase the heart rate, followed by pacing or other measures if atropine is ineffective. Adenosine and diltiazem slow conduction and would worsen the bradycardia.

Question 44Resuscitation and Cardiovascular Emergencies

Which set of findings is most consistent with cardiogenic shock complicating an acute myocardial infarction?

  1. Fever with localized lung crackles only
  2. Hypertension with bradycardia and dry skin
  3. Warm flushed skin with bounding pulses
  4. Hypotension with cool clammy skin and decreased urine output Correct answer.

Explanation

Cardiogenic shock results from pump failure, producing hypotension, poor peripheral perfusion with cool clammy skin, and reduced renal perfusion with low urine output. Warm bounding pulses suggest a distributive rather than cardiogenic cause.

Question 45Resuscitation and Cardiovascular Emergencies

A patient with chest pain has a 12-lead ECG showing ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?

  1. Right coronary artery Correct answer.
  2. Left main coronary artery
  3. Left circumflex artery
  4. Left anterior descending artery

Explanation

ST elevation in the inferior leads II, III, and aVF localizes ischemia to the inferior wall, most often supplied by the right coronary artery. The left anterior descending supplies the anterior wall, and the circumflex supplies the lateral wall.

Question 46Resuscitation and Cardiovascular Emergencies

A patient is being monitored after resuscitation. Which finding indicates return of spontaneous circulation?

  1. Continued ventricular fibrillation on the monitor
  2. Fixed dilated pupils with no pulse
  3. Agonal gasps without a detectable pulse
  4. A palpable pulse with an organized rhythm on the monitor Correct answer.

Explanation

Return of spontaneous circulation is defined by a palpable pulse and an organized rhythm that generates effective perfusion, often accompanied by improved responsiveness or blood pressure. Persistent ventricular fibrillation or absent pulses indicate ongoing arrest.

Question 47Resuscitation and Cardiovascular Emergencies

A patient with acute decompensated heart failure is in respiratory distress with bilateral crackles and an oxygen saturation of 86 percent on room air. Which action should the nurse take first?

  1. Place the patient flat to improve venous return
  2. Encourage the patient to drink fluids
  3. Position upright and apply supplemental oxygen Correct answer.
  4. Give a bolus of intravenous normal saline

Explanation

Hypoxemia with pulmonary edema is managed first by sitting the patient upright to improve ventilation and by giving supplemental oxygen to correct hypoxemia. Fluid boluses and supine positioning would worsen pulmonary congestion.

Question 48Resuscitation and Cardiovascular Emergencies

A patient with a permanent pacemaker reports dizziness, and the monitor shows pacing spikes without subsequent QRS complexes. What does this finding most likely indicate?

  1. Normal pacemaker function
  2. Failure to capture Correct answer.
  3. Failure to sense
  4. Oversensing of atrial activity

Explanation

Pacing spikes that are not followed by a QRS complex indicate failure to capture, meaning the stimulus does not depolarize the myocardium. Failure to sense would show pacing spikes occurring inappropriately after intrinsic beats rather than absent capture.

Question 49Resuscitation and Cardiovascular Emergencies

A patient is found in cardiac arrest, and the nurse notes a large amount of vomit in the airway. What action is most appropriate during resuscitation?

  1. Give rescue breaths forcefully to push the vomit aside
  2. Delay compressions until suction equipment arrives
  3. Stop compressions for several minutes to clear the airway completely
  4. Suction the airway and continue high-quality compressions with minimal interruption Correct answer.

Explanation

A obstructed airway must be cleared with suction, but compressions should continue with only brief interruptions because circulation is the priority. Prolonged pauses to clear the airway reduce perfusion and worsen survival.

Question 50Resuscitation and Cardiovascular Emergencies

A patient with severe chest pain is being evaluated for acute coronary syndrome. Which laboratory result is most specific for myocardial injury?

  1. Elevated troponin Correct answer.
  2. Elevated white blood cell count
  3. Elevated D-dimer
  4. Elevated creatine kinase total

Explanation

Troponin is highly specific for myocardial injury and rises in acute myocardial infarction, making it the preferred biomarker. Total creatine kinase is less specific because it also rises with skeletal muscle injury.