AHA PALS Final Exam Questions and Answers

1) A patient admitted with severe abdominal pain, disproportionate to examination findings and poorly responsive to analgesia, is suspected to have:

2) A 55-year-old female patient has presented over the past few months with fatigue, cold intolerance, and weight gain. The nurse notes dry skin, a hoarse voice, and a protuberant tongue on physical examination. These findings are most indicative of:

3) A 58-year-old male with a history of smoking presents with progressive dyspnea and dry cough. A high-resolution CT scan shows bilateral reticular opacities with honeycombing, and pulmonary function tests reveal restrictive ventilatory defects. The MOST LIKELY diagnosis is:

4) The nurse assesses the patient who underwent exploratory laparotomy for severe abdominal trauma. The patient develops progressively increasing abdominal distension and oliguria, with the nurse noting a tense, firm abdomen with absent bowel sounds. Vital signs show a blood pressure of 90/60 mm Hg, heart rate of 120 bpm, respiratory rate of 24 breaths/min. As a priority, which of the following interventions should the nurse anticipate?

5) In the immediate postoperative period following CABG surgery, the nurse assesses the patient's cardiac rhythm and notes atrial fibrillation with rapid ventricular response. The priority intervention is to:

A patient admitted with severe sepsis suddenly develops dyspnea, tachypnea, and diffuse crackles on lung auscultation. ABG analysis on 4L/min oxygen via nasal cannula shows:
pH 7.48, pCO2 30 mm Hg, and pO2 55 mm Hg.
Chest X-ray indicates bilateral opacities. What condition should the nurse suspect?

7) A patient with Parkinson's disease experiences frequent episodes of coughing and choking while eating. The nurse identifies the need for:

8) How should the nurse assess the patient's signs and symptoms, when the patient undergoes a Whipple procedure for pancreatic cancer and presents with persistent nausea and vomiting on postoperative day 3?

9) In type 2 diabetes mellitus, what is the primary mechanism underlying hyperglycemia?

10) A sudden onset of dyspnea, tachypnea, and reduced breath sounds on the affected side is observed in a patient with a history of chronic obstructive pulmonary disease (COPD). The nurse suspects:

11) A patient with severe epigastric pain radiating to the back, nausea, and vomiting presents with a history of chronic alcohol abuse to the emergency department. Indications from the laboratory findings include elevated serum amylase and lipase levels. Abdominal ultrasound reveals interstitial edema. The nurse suspects:

In the intensive care unit, a patient fails multiple attempts to wean from mechanical ventilation despite the optimization of medical therapy. Arterial blood gas analysis shows:
pH 7.48, PaCO2 50 mmHg, PaO2 68 mmHg, HCO3 32 mEq/L.
The nurse should suspect:

13) What is the primary metabolic abnormality seen in diabetic ketoacidosis (DKA)?

14) Which diagnostic test would be most helpful in confirming the diagnosis for a patient with pulmonary arterial hypertension (PAH) who is admitted with dyspnea and fatigue?

15) A patient after a motor vehicle collision with suspected blunt abdominal trauma arrives at the emergency department. Which diagnostic test is most appropriate to confirm intra-abdominal bleeding when the assessment reveals hypotension, tachycardia, and diffuse abdominal tenderness?

16) A 45-year-old patient presents with syncope. ECG reveals a prolonged QT interval. What medication should the nurse be cautious in administering due to the risk of further prolonging the QT interval?

17) Which pathophysiological process is primarily responsible for the development of ARDS in a patient admitted with pneumonia who develops acute respiratory distress syndrome (ARDS)?

The arterial blood gas analysis of a patient admitted with shortness of breath and hypoxemia, diagnosed with acute respiratory failure, shows:
pH 7.30, pCO2 55 mm Hg, pO2 50 mm Hg.
The nurse anticipates which intervention is a priority?

19) Which intervention should the nurse anticipate as the next step in management when a patient admitted with hospital-acquired pneumonia (HAP) experiences worsening respiratory distress despite antibiotic therapy?

20) After being admitted with respiratory distress, a patient suddenly experiences chest pain, dyspnea, and tachycardia, and the nurse identifies an increased intensity of the pulmonary S2 sound upon auscultation. The nurse should suspect:

21) A patient with a history of unexplained dyspnea and fatigue presents with bilateral basilar crackles on lung auscultation. Echocardiography reveals ventricular dilatation and impaired systolic function. The nurse should suspect:

22) A patient with a history of carotid artery stenosis presents with sudden-onset weakness and difficulty speaking. Vital signs reveal a blood pressure of 180/90 mmHg and a heart rate of 110 bpm. What is the nurse's priority action?

23) A patient with chest pain and ST-segment elevation on the EKG arrives at the emergency department. The nurse should prioritize the following actions:

24) A patient suddenly develops fever, back pain, and hypotension after receiving a blood transfusion. The nurse's initial action should be to:

25) What complication should the nurse suspect if a 65-year-old female patient with a urinary catheter develops a high fever, hypotension, and altered mental status?

26) The nurse noticed paradoxical chest movement and decreased breath sounds on the left side during the assessment of a patient presented with a history of blunt chest trauma following a motor vehicle accident. The patient's oxygen saturation is 88% on room air. Which of the following interventions should the nurse prioritize?

27) After starting chemotherapy, a patient with acute myeloid leukemia (AML) presents with nausea, vomiting, and oliguria. Laboratory results reveal hyperuricemia, hyperkalemia, and hyperphosphatemia. The nurse's priority action is to:

28) During attempts to wean from mechanical ventilation, a patient with a history of chronic obstructive pulmonary disease (COPD) is unable to tolerate spontaneous breathing trials. The nurse identifies the primary reason for this difficulty as:

29) Which intervention is the priority in the management of a patient admitted with severe anemia, presenting symptoms such as fatigue, shortness of breath during physical activity, and pale skin, along with laboratory results showing low hemoglobin levels and decreased reticulocyte count?

30) A patient involved in a motor vehicle accident presents with anterior chest trauma and sudden onset dyspnea. Upon examination, there are muffled heart sounds and distended neck veins. The nurse's priority action should be to:

31) A patient suddenly develops petechiae and ecchymoses after being admitted with septic shock. Laboratory findings reveal a platelet count of 30,000/mm³. The nurse recognizes this condition as indicative of:

32) In the emergency department, a patient with suspected thoracic trauma is admitted with respiratory distress. Which conditions should the nurse suspect when upon assessment, the nurse notes decreased breath sounds on the left side and tracheal deviation to the right?

33) A patient admitted to the critical care unit exhibits altered mental status, diaphoresis, and tremors. If the fingerstick blood glucose reveals a level of 45 mg/dL, the initial action of the nurse should be to:

34) A patient with a history of heart failure presents with acute dyspnea, crackles on lung auscultation, and frothy pink sputum. What is the nurse's initial action?

35) With complaints of bilateral flank pain, dysuria, and fever, a 65-year-old male with a history of heart failure presents to the emergency department. Urinalysis shows pyuria and bacteriuria. The nurse suspects that the patient may be experiencing AKI secondary to:

36) A 65-year-old male presents with dyspnea on exertion, peripheral edema, and fatigue. An echocardiogram reveals biatrial enlargement and preserved ejection fraction. Which diagnostic test would confirm the suspicion of restrictive cardiomyopathy?

37) What is the primary etiology of type 1A diabetes mellitus?

38) Which intervention should the nurse prioritize in the plan of care, when a patient with leukemia is admitted to the intensive care unit (ICU) with leukopenia?

39) A patient with severe abdominal pain, distension, and altered mental status presents with a history of chronic alcohol abuse to the emergency department. Physical examination reveals asterixis, ascites, and spider angiomas. Laboratory results show elevated transaminases and serum bilirubin. The most likely diagnosis for this patient is:

40) Due to a lack of response to normal levels of antidiuretic hormone (ADH), which type of diabetes insipidus (DI) is caused?

41) A 65-year-old patient presents to the emergency department with sudden, severe chest pain radiating to the back. The pain is described as tearing. On examination, there is a notable difference in blood pressure between the arms. What should be the nurse's immediate action based on these findings?

42) What primary immunodeficiency disorder is most likely indicated, when a patient presents with recurrent, severe infections since infancy, along with absent T lymphocytes and immunoglobulins?

43) A patient is admitted to the critical care unit with newly diagnosed hyperthyroidism. The family insists on staying overnight, contrary to hospital policy. The nurse's most appropriate action is to:

44) A patient with severe dehydration presents with weakness, fatigue, and dry mucous membranes, and laboratory results show a serum sodium level of 152 mEq/L. The nurse should recognize this electrolyte imbalance as:

45) With a history of chronic liver disease, a 68-year-old patient presents with a sudden onset of bleeding from multiple sites. What should the nurse suspect when laboratory results indicate prolonged PT/INR, decreased platelet count, and elevated fibrin degradation products?

46) A 78-year-old patient with a history of dysphagia and recent aspiration episodes presents to the emergency department with confusion, fever, and productive cough with purulent sputum. What is the most appropriate initial nursing intervention?

47) What should be the nurse's priority intervention when a patient with a history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with heightened dyspnea, productive cough, fever, and bilateral coarse crackles upon auscultation?

48) A 60-year-old male presents to the emergency department with palpitations and dizziness. His ECG shows irregular QRS complexes with no discernible P waves, and the rhythm is irregularly irregular. Which type of arrhythmia is most likely present?

49) After a cardiac catheterization, the patient's groin puncture site begins bleeding profusely. The nurse's initial action should be to:

50) What is the primary purpose of femoral-popliteal bypass surgery in patients with severe peripheral arterial disease (PAD) or critical limb ischemia?

51) During the assessment of a patient with a thoracic aortic aneurysm, the nurse notes unequal blood pressure readings between the arms. Which action should the nurse take first?

52) A patient presents with sudden-onset chest pain that radiates to the back, along with dyspnea and tachycardia. On examination, the patient has distended neck veins and muffled heart sounds. The nurse should suspect:

53) A patient with chronic diarrhea, abdominal pain, and unintentional weight loss is admitted for severe Crohn's disease. Laboratory tests reveal decreased serum albumin and iron levels. The patient's condition is most indicative of:

54) Admitted to the ICU, a patient presents with confusion, weakness, and nausea. Which pharmacological intervention is most appropriate for managing this patient's condition, when laboratory findings reveal hyponatremia (serum sodium < 130 mEq/L) and urine osmolality > 100 mOsmol/kg?

55) Which intervention should the nurse prioritize, when a patient admitted with a suspected acute adrenal crisis presents with refractory hypotension despite volume resuscitation?

56) In the emergency department, a patient arrives with sudden onset severe leg pain, pallor, and absent pedal pulses. Which of the following assessment findings is characteristic of acute arterial occlusion?

57) What is a characteristic feature when a patient with chronic kidney disease (CKD) is in stage 3 according to the glomerular filtration rate (GFR) staging system?

58) What is the priority action for the nurse after observing diminished pulses and paresthesia in a patient with a tibial shaft fracture experiencing severe pain, swelling, and tense muscles in the affected leg?

59) During a severe asthma exacerbation, a patient's arterial blood gas reveals: pH 7.25, pCO2 60 mm Hg, HCO3 24 mEq/L. What acid-base imbalance is the patient experiencing?

60) A patient undergoes heart valve surgery and is being monitored postoperatively. Four hours after surgery, the nurse assesses the patient and notes a heart rate of 110 bpm, blood pressure of 90/60 mmHg, and urine output of 20 mL/hr. The nurse's immediate action should be to:

61) The nurse observes tremors, tachycardia, and agitation in a patient admitted with asthma exacerbation receiving frequent albuterol nebulizations. Which intervention should the nurse implement first?

62) Which preoperative test is essential for evaluating the extent of artery blockage before an endarterectomy?

63) During mealtime, a patient with a history of dysphagia presents with sudden onset dyspnea and coughing. The nurse should suspect:

64) The patient presents with altered mental status, extreme thirst, and polyuria, who has a history of type 2 diabetes. Vital signs reveal hypotension, tachycardia, and profound dehydration. Laboratory findings show blood glucose >600 mg/dL and serum osmolality >320 mOsm/kg. The nurse anticipates the need for which initial intervention, based on these findings?

65) A patient presents after a fall from a height with acute dyspnea and chest pain. Which conditions should the nurse suspect, when the physical examination reveals reduced breath sounds on the left side and crepitus upon palpation of the chest wall?

66) A 58-year-old male patient with a history of uncontrolled diabetes presents with fatigue, dyspnea, and lower extremity edema. Upon assessment, the nurse notes bilateral crackles upon auscultation and an enlarged left ventricle on the echocardiogram. The most likely diagnosis for this patient is:

67) A 65-year-old male with a history of heart failure presents with worsening dyspnea and bilateral crackles on lung auscultation. His BNP level is significantly elevated. Which diagnostic test should the nurse anticipate being ordered next?

68) A patient with a recent history of thoracentesis develops fever, chest pain, and purulent pleural fluid drainage. The nurse suspects:

A patient with severe asthma presents to the emergency department with increased dyspnea, chest tightness, and audible wheezing. Vital signs include:
a respiratory rate of 28 breaths/min, heart rate 110 bpm, oxygen saturation 89% on room air, and a peak expiratory flow rate (PEFR) of 50% of predicted. The nurse should anticipate which of the following interventions is a priority?

70) How should the nurse recognize these symptoms as indicative, when a patient presents with bright red hematemesis and melena?

71) What is the most important diagnostic test to confirm the diagnosis when a patient with suspected NSTEMI has chest pain and difficulty breathing?

72) In the emergency department, a patient arrives complaining of chest pain that occurs unpredictably, even at rest. Which diagnostic test is most appropriate to confirm the diagnosis of unstable angina?

73) HRCT of a 65-year-old female who presents with exertional dyspnea, non-productive cough, and bibasilar crackles on lung auscultation shows subpleural, basal-predominant reticular opacities with traction bronchiectasis. The MOST APPROPRIATE initial management for suspected pulmonary fibrosis is:

74) A 35-year-old female presents with chest pain exacerbated by exercise and relieved by rest. The echocardiogram shows asymmetric septal hypertrophy. Which condition is MOST LIKELY causing her symptoms?

75) A 58-year-old male patient presents to the emergency room with symptoms of chest pain radiating down his left arm, dyspnea, and profuse sweating. His blood pressure is 80/50 mm Hg, heart rate 110 bpm, and oxygen saturation 90% on room air. The nurse suspects cardiogenic shock due to:

76) A patient admitted for severe trauma after receiving a blood transfusion suddenly develops dyspnea, hypoxemia, and bilateral pulmonary infiltrates shortly. The nurse should suspect:

77) A patient presents to the emergency department with a suspected femur fracture following a fall. The nurse notices swelling and tenderness in the affected leg. The priority intervention for the nurse is to:

78) A 55-year-old patient with a history of hypertension presents to the emergency department with severe headache, blurred vision, and epistaxis. Vital signs show BP 220/120 mmHg. What initial intervention should the nurse prioritize?

79) Which condition should the nurse suspect when a 55-year-old male patient presents with redness, warmth, and tenderness on his lower leg and the nurse notes localized erythema with diffuse borders and palpable warmth?

80) A 60-year-old patient with a history of hypertension presents to the emergency department complaining of sudden-onset severe chest pain radiating to the back. Blood pressure in the right arm measures 180/100 mm Hg, while in the left arm, it's 140/80 mm Hg. What diagnostic test should the nurse anticipate to confirm suspected aortic dissection?