A nurse is preparing to perform synchronized cardioversion on a patient with unstable supraventricular tachycardia. Which actions must the nurse take to ensure safety before delivering the shock?
Select all that apply.
Verbally command all staff to stand clear of the bed.
Visually verify that no one is touching the patient.
Move flowing oxygen sources away from the patient's chest.
Hold the patient's shoulders to prevent movement.
Hold the metal IV pole to stabilize it during the shock.
Show the answers and explanation
Answers: A, B and C.
A – Verbally command all staff to stand clear of the bed.
B – Visually verify that no one is touching the patient.
C – Move flowing oxygen sources away from the patient's chest.
To ensure safety during cardioversion, the nurse must verbally clear the room and visually confirm that no one is touching the patient, bed, or connected equipment. Flowing oxygen must be moved away from the chest to prevent fire from electrical sparks. No staff should touch the patient or conductive objects like metal poles during shock delivery.
Why the others are wrong
D – Holding the patient's shoulders puts the nurse at risk for receiving an electrical shock during energy delivery.
E – Touching the metal IV pole is unsafe because metal can conduct electricity and cause a shock to the nurse.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
2Question
The nurse is teaching a client with a history of infective endocarditis about the need for antibiotic prophylaxis before future procedures. Which procedures require antibiotic prophylaxis?
Select all that apply.
Routine diagnostic cystoscopy
Dental extraction
Routine screening colonoscopy
Adjustment of orthodontic appliances
Dental scaling and cleaning
Show the answers and explanation
Answers: B and E.
B – Dental extraction
E – Dental scaling and cleaning
Clients with a history of infective endocarditis require antibiotic prophylaxis before dental procedures that manipulate gingival tissue, the periapical region, or perforate the oral mucosa, such as extractions and scaling. Prophylaxis is no longer recommended for routine gastrointestinal, genitourinary, or non-invasive orthodontic procedures unless an active infection is being treated.
Why the others are wrong
A – Routine genitourinary procedures like cystoscopies do not require antibiotic prophylaxis in the absence of an active infection.
C – Routine gastrointestinal procedures like colonoscopies do not require antibiotic prophylaxis unless an active infection is present.
D – Orthodontic appliance adjustments do not manipulate the gingival tissue or oral mucosa and do not require prophylaxis.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
3Question
A nurse is caring for a patient with a temporary transvenous pacemaker. Which actions should the nurse implement to prevent microshock?
Select all that apply.
Ensure all bedside electrical equipment is grounded.
Keep the pacing generator enclosed in its plastic cover.
Wear clean, dry gloves when handling the pacemaker leads.
Adjust the electric bed controls while holding the catheter.
Tape any exposed electrode terminals directly to the skin.
Show the answers and explanation
Answers: A, B and C.
A – Ensure all bedside electrical equipment is grounded.
B – Keep the pacing generator enclosed in its plastic cover.
C – Wear clean, dry gloves when handling the pacemaker leads.
To prevent microshock, the nurse must insulate the patient from stray electrical currents. Wearing clean, dry gloves when handling leads, keeping the generator covered, and ensuring all bedside equipment is properly grounded are essential safety measures. Touching electrical devices while handling pacemaker components creates a pathway for lethal currents directly to the myocardium.
Why the others are wrong
D – Operating electrical devices like bed controls while touching pacemaker components allows leakage currents to travel through the nurse to the patient.
E – Taping exposed terminals to the skin is contraindicated because moisture and contact can conduct stray currents directly to the heart.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
4Question
The nurse prepares to administer digoxin to an adult client with heart failure. Which clinical findings require the nurse to withhold the medication and notify the healthcare provider?
Select all that apply.
Serum potassium level of 3.1 mEq/L
Apical pulse rate of 54 beats/min
Blood pressure of 104/62 mm Hg
Report of new-onset nausea and anorexia
Serum digoxin level of 0.8 ng/mL
Show the answers and explanation
Answers: A, B and D.
A – Serum potassium level of 3.1 mEq/L
B – Apical pulse rate of 54 beats/min
D – Report of new-onset nausea and anorexia
Digoxin must be withheld and the provider notified for an apical pulse under 60 beats/min, signs of toxicity such as nausea and anorexia, or hypokalemia (potassium under 3.5 mEq/L), which increases the risk of life-threatening digoxin-induced arrhythmias.
Why the others are wrong
C – Digoxin does not significantly lower blood pressure, so a blood pressure of 104/62 mm Hg does not require withholding the dose.
E – A digoxin level of 0.8 ng/mL is within the normal therapeutic range of 0.5 to 2.0 ng/mL.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
5Question
A nurse is providing discharge teaching to a patient who has been prescribed sublingual nitroglycerin for stable angina. To ensure patient safety, which instructions should the nurse include?
Select all that apply.
Wait at least two hours after sildenafil to take a dose.
Sit or lie down before taking a dose.
Do not use sildenafil or tadalafil with this medication.
Stand up immediately if you feel dizzy after a dose.
Change positions slowly when rising from a chair or bed.
Show the answers and explanation
Answers: B, C and E.
B – Sit or lie down before taking a dose.
C – Do not use sildenafil or tadalafil with this medication.
E – Change positions slowly when rising from a chair or bed.
Sublingual nitroglycerin causes potent vasodilation, which can lead to severe orthostatic hypotension and falls. Patients must sit or lie down before taking a dose and change positions slowly. Concomitant use of phosphodiesterase-5 inhibitors like sildenafil or tadalafil is strictly contraindicated due to the risk of life-threatening, severe hypotension.
Why the others are wrong
A – Nitroglycerin is strictly contraindicated with sildenafil; a two-hour window is unsafe as sildenafil's effects last much longer.
D – Standing up during dizziness worsens orthostatic hypotension and increases the risk of syncope and falls.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
6Question
A nurse is assisting with an emergency bedside pericardiocentesis for a client with cardiac tamponade. Which actions should the nurse perform to ensure safety during and immediately after the procedure?
Select all that apply.
Monitor the ECG for ST elevation indicating myocardial contact.
Expect ST-segment depression if the needle touches the heart.
Place the client in a prone position immediately post-procedure.
Assess for muffled heart sounds and narrowed pulse pressure.
Monitor the drainage system for sudden cessation of output.
Show the answers and explanation
Answers: A, D and E.
A – Monitor the ECG for ST elevation indicating myocardial contact.
D – Assess for muffled heart sounds and narrowed pulse pressure.
E – Monitor the drainage system for sudden cessation of output.
During pericardiocentesis, connecting the needle to an ECG monitor allows detection of myocardial contact, signaled by ST-segment elevation or PVCs. Post-procedure, the nurse must monitor for recurrent tamponade by assessing for muffled heart sounds, narrowed pulse pressure, and checking the drainage system for sudden blockages that could cause fluid to re-accumulate.
Why the others are wrong
B – Contact between the needle and the myocardium produces ST-segment elevation, not depression, indicating an injury current.
C – Prone positioning is contraindicated; the client should be in a semi-Fowler's to Fowler's position to promote drainage and ease breathing.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
7Question
A nurse is providing discharge teaching to a client who is starting warfarin therapy for atrial fibrillation. Which instructions should the nurse include to ensure client safety?
Select all that apply.
Take aspirin for mild headaches or joint pain.
Use an electric razor instead of a straight blade.
Use a soft-bristled toothbrush for oral hygiene.
Report any dark, tarry stools to the provider.
Avoid eating all green leafy vegetables entirely.
Show the answers and explanation
Answers: B, C and D.
B – Use an electric razor instead of a straight blade.
C – Use a soft-bristled toothbrush for oral hygiene.
D – Report any dark, tarry stools to the provider.
To prevent bleeding complications, clients on warfarin should use electric razors and soft-bristled toothbrushes. Dark, tarry stools indicate potential gastrointestinal bleeding and must be reported immediately.
Why the others are wrong
A – Aspirin increases the risk of bleeding and should be avoided unless specifically prescribed by the healthcare provider.
E – Clients should maintain a consistent intake of vitamin K rather than eliminating green leafy vegetables entirely.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
8Question
A nurse is preparing to assess a client with suspected carotid artery stenosis. Which actions should the nurse take to prevent carotid sinus syncope or plaque embolization?
Select all that apply.
Palpate each carotid artery individually.
Palpate both carotid arteries simultaneously.
Use gentle pressure when palpating the pulse.
Press firmly on the carotid sinus to assess tone.
Avoid massaging the area near the carotid sinus.
Show the answers and explanation
Answers: A, C and E.
A – Palpate each carotid artery individually.
C – Use gentle pressure when palpating the pulse.
E – Avoid massaging the area near the carotid sinus.
The nurse must palpate one carotid artery at a time to maintain cerebral perfusion and prevent syncope. Applying gentle pressure and avoiding carotid sinus massage prevents vagal stimulation, bradycardia, hypotension, and dislodgement of atherosclerotic plaque that could cause a transient ischemic attack or stroke.
Why the others are wrong
B – Palpating bilateral carotids simultaneously compromises cerebral blood flow and can trigger severe syncope or cerebral ischemia.
D – Applying firm pressure over the carotid sinus stimulates vagal baroreceptors, risking dangerous bradycardia, hypotension, and plaque dislodgement.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
9Question
A nurse cares for a client recovering three days after coronary artery bypass graft surgery with a leg saphenous vein harvest incision. Which interventions should the nurse include in the plan of care?
Select all that apply.
Apply a warm heating pad to decrease localized edema
Report progressive numbness or pallor in the foot
Palpate bilateral pedal pulses and capillary refill
Scrub the incision vigorously with an antiseptic soap
Elevate the donor extremity when the client is seated
Show the answers and explanation
Answers: B, C and E.
B – Report progressive numbness or pallor in the foot
C – Palpate bilateral pedal pulses and capillary refill
E – Elevate the donor extremity when the client is seated
Elevating the surgical extremity decreases dependent edema and supports tissue healing. Routine neurovascular checks, including bilateral pedal pulse palpation and capillary refill, verify adequate distal arterial perfusion. Worsening numbness or pallor indicates potential neurovascular compromise or ischemia and requires immediate reporting and evaluation.
Why the others are wrong
A – Thermal applications cause vasodilation that worsens edema and pose a significant burn hazard due to potential sensory deficits.
D – Vigorous scrubbing disrupts delicate granulating tissue and compromises the incision barrier, increasing infection risk.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
10Question
A nurse is caring for a client with a left femoral intra-aortic balloon pump. Which assessment findings indicate a complication that requires immediate nursing action?
Select all that apply.
Left radial pulse remains equal in strength to the right.
Head of the bed maintained at a 20-degree elevation.
Flecks of blood observed in the clear IABP drive tubing.
Sudden decrease in urine output to 10 mL over one hour.
Diminished left dorsalis pedis pulse with a cool foot.
Show the answers and explanation
Answers: C, D and E.
C – Flecks of blood observed in the clear IABP drive tubing.
D – Sudden decrease in urine output to 10 mL over one hour.
E – Diminished left dorsalis pedis pulse with a cool foot.
Blood in the drive tubing indicates balloon rupture, requiring immediate pumping cessation to prevent helium embolism. A cool extremity with a diminished pulse signals limb ischemia from arterial occlusion. Sudden oliguria suggests distal catheter migration occluding the renal arteries. These findings represent urgent IABP complications requiring prompt nursing intervention.
Why the others are wrong
A – Equal bilateral radial pulses demonstrate normal upper extremity perfusion and indicate that the catheter has not migrated proximally into the left subclavian artery.
B – Maintaining the head of the bed at 20 degrees is an appropriate safety intervention to prevent balloon catheter kinking and femoral site bleeding.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
11Question
A client receiving a peripheral norepinephrine infusion develops blanching, coolness, and edema around the insertion site. Which immediate actions should the nurse take?
Select all that apply.
Stop the infusion immediately
Flush the intravenous line with normal saline
Infiltrate phentolamine around the site
Aspirate residual drug from the catheter
Apply an ice pack to the affected area
Show the answers and explanation
Answers: A, C and D.
A – Stop the infusion immediately
C – Infiltrate phentolamine around the site
D – Aspirate residual drug from the catheter
Immediate cessation of the infusion prevents further tissue exposure to the vesicant. Aspirating the catheter withdraws residual drug from the lumen without advancing it into surrounding tissues. Phentolamine, an alpha-adrenergic antagonist, reverses intense local vasoconstriction when infiltrated subcutaneously around the ischemic area to prevent tissue necrosis.
Why the others are wrong
B – Flushing the intravenous line must be avoided because it forces remaining vesicant medication directly into the surrounding tissue.
E – Cold applications worsen local ischemia caused by vasopressors by inducing further vasoconstriction and increasing the risk of necrosis.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
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