1
NUR417 / NUR 417 Final Exam Care of
Adult II Concordia St. Paul Actual Exam
2026/2027 | Complete Exam-Style Questions |
100% Verified – Detailed Rationales – Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular Disorders | Q1 – Q10
Section 2 | Respiratory Disorders | Q11 – Q20
Section 3 | Renal and Endocrine Disorders | Q21 – Q30
Section 4 | Neurological and Musculoskeletal Disorders | Q31 – Q40
Section 5 | Multisystem and Critical Care Concepts | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old male is admitted to the telemetry unit with chest pressure that began 45 minutes
ago while mowing the lawn. Vital signs are BP 148/92, HR 98, RR 22, SpO2 94% on room air.
The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. The patient reports
nausea and diaphoresis. Which priority intervention should the nurse anticipate next?
A. Administer sublingual nitroglycerin every 5 minutes for three doses
B. Obtain a stat echocardiogram to assess ejection fraction
C. Prepare the patient for emergent percutaneous coronary intervention ✓ CORRECT
D. Initiate a heparin infusion and wait for troponin results
Correct Answer: C
,2
Rationale: Inferior ST-elevation myocardial infarction requires emergent reperfusion, and PCI is
the preferred strategy when available within the recommended time frame. Sublingual
nitroglycerin is appropriate for stable angina but does not reperfuse an occluded coronary artery
in STEMI. Door-to-balloon time targets emphasize that PCI should not be delayed waiting for
additional diagnostics or lab results.
Question 2 of 50
A 54-year-old female with a history of heart failure presents to the emergency department with
progressive dyspnea over the past three days. She has gained 4.5 kg since her last clinic visit.
Vital signs are BP 162/98, HR 110, RR 28, SpO2 88% on room air. Auscultation reveals crackles
to the mid-lung fields and an S3 gallop. Which assessment finding would most indicate that the
patient's condition is deteriorating?
A. Development of pink, frothy sputum
B. Jugular venous distension at 30 degrees
C. Presence of bilateral peripheral edema to the knees
D. Report of sleeping on three pillows instead of two ✓ CORRECT
Correct Answer: D
Rationale: An acute increase in orthopnea from two to three pillows signals worsening
pulmonary venous congestion and imminent respiratory compromise. Pink, frothy sputum
indicates severe pulmonary edema but usually appears after orthopnea has already escalated.
Jugular venous distension and peripheral edema are chronic markers of volume overload and do
not necessarily reflect acute deterioration.
Question 3 of 50
A 72-year-old male with atrial fibrillation on warfarin therapy presents after a fall. His INR is 5.8
and he has a large hematoma on his right thigh. Vital signs are stable. The provider orders
vitamin K 10 mg subcutaneously. What is the nurse's best response?
A. Administer the vitamin K in the deltoid muscle for faster absorption
B. Question the route because subcutaneous vitamin K has erratic absorption ✓ CORRECT
C. Give the medication with food to reduce gastrointestinal upset
D. Hold the dose until the pharmacy can verify the concentration
Correct Answer: B
Rationale: Subcutaneous administration of vitamin K results in unpredictable and delayed
absorption, making intravenous or oral routes preferred for reliable reversal of warfarin effect.
, 3
Intramuscular injection is contraindicated in patients with elevated INR due to bleeding risk.
Food does not significantly alter vitamin K absorption, and holding a provider order without a
valid clinical reason is inappropriate.
Question 4 of 50
A 61-year-old male is recovering on the cardiac step-down unit after an uncomplicated
myocardial infarction two days ago. During morning assessment, he reports sudden onset of
palpitations and lightheadedness. Telemetry shows a regular narrow-complex tachycardia at 180
beats per minute with no discernible P waves. His blood pressure is 102/64. What is the nurse's
immediate priority?
A. Perform synchronized cardioversion at 100 joules
B. Administer adenosine 6 mg rapid IV push followed by a saline flush ✓ CORRECT
C. Apply bilateral carotid sinus massage for 10 seconds
D. Prepare the patient for transcutaneous pacing
Correct Answer: B
Rationale: The rhythm is consistent with supraventricular tachycardia in a hemodynamically
stable patient, and adenosine is the first-line pharmacologic intervention per ACLS guidelines.
Synchronized cardioversion is reserved for unstable patients with signs of poor perfusion.
Carotid massage is never performed bilaterally due to risk of cerebral hypoperfusion.
Transcutaneous pacing is indicated for symptomatic bradycardia, not tachycardia.
Question 5 of 50
A 59-year-old female with severe aortic stenosis is scheduled for valve replacement. During
preoperative teaching, she asks why she becomes dizzy when she stands quickly. Which
explanation best addresses the underlying hemodynamic mechanism?
A. Rapid position changes cause transient left ventricular dilation
B. The stenotic valve cannot increase cardiac output to compensate for venous pooling ✓
CORRECT
C. Orthostatic hypotension results from autonomic dysfunction common in valve disease
D. Standing decreases preload, which overloads the noncompliant left ventricle
Correct Answer: B
Rationale: In fixed aortic stenosis, the cardiac output cannot augment in response to reduced
venous return during position changes, leading to cerebral hypoperfusion and dizziness. Left
ventricular dilation is not a transient response to standing. Autonomic dysfunction is not the
NUR417 / NUR 417 Final Exam Care of
Adult II Concordia St. Paul Actual Exam
2026/2027 | Complete Exam-Style Questions |
100% Verified – Detailed Rationales – Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular Disorders | Q1 – Q10
Section 2 | Respiratory Disorders | Q11 – Q20
Section 3 | Renal and Endocrine Disorders | Q21 – Q30
Section 4 | Neurological and Musculoskeletal Disorders | Q31 – Q40
Section 5 | Multisystem and Critical Care Concepts | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old male is admitted to the telemetry unit with chest pressure that began 45 minutes
ago while mowing the lawn. Vital signs are BP 148/92, HR 98, RR 22, SpO2 94% on room air.
The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. The patient reports
nausea and diaphoresis. Which priority intervention should the nurse anticipate next?
A. Administer sublingual nitroglycerin every 5 minutes for three doses
B. Obtain a stat echocardiogram to assess ejection fraction
C. Prepare the patient for emergent percutaneous coronary intervention ✓ CORRECT
D. Initiate a heparin infusion and wait for troponin results
Correct Answer: C
,2
Rationale: Inferior ST-elevation myocardial infarction requires emergent reperfusion, and PCI is
the preferred strategy when available within the recommended time frame. Sublingual
nitroglycerin is appropriate for stable angina but does not reperfuse an occluded coronary artery
in STEMI. Door-to-balloon time targets emphasize that PCI should not be delayed waiting for
additional diagnostics or lab results.
Question 2 of 50
A 54-year-old female with a history of heart failure presents to the emergency department with
progressive dyspnea over the past three days. She has gained 4.5 kg since her last clinic visit.
Vital signs are BP 162/98, HR 110, RR 28, SpO2 88% on room air. Auscultation reveals crackles
to the mid-lung fields and an S3 gallop. Which assessment finding would most indicate that the
patient's condition is deteriorating?
A. Development of pink, frothy sputum
B. Jugular venous distension at 30 degrees
C. Presence of bilateral peripheral edema to the knees
D. Report of sleeping on three pillows instead of two ✓ CORRECT
Correct Answer: D
Rationale: An acute increase in orthopnea from two to three pillows signals worsening
pulmonary venous congestion and imminent respiratory compromise. Pink, frothy sputum
indicates severe pulmonary edema but usually appears after orthopnea has already escalated.
Jugular venous distension and peripheral edema are chronic markers of volume overload and do
not necessarily reflect acute deterioration.
Question 3 of 50
A 72-year-old male with atrial fibrillation on warfarin therapy presents after a fall. His INR is 5.8
and he has a large hematoma on his right thigh. Vital signs are stable. The provider orders
vitamin K 10 mg subcutaneously. What is the nurse's best response?
A. Administer the vitamin K in the deltoid muscle for faster absorption
B. Question the route because subcutaneous vitamin K has erratic absorption ✓ CORRECT
C. Give the medication with food to reduce gastrointestinal upset
D. Hold the dose until the pharmacy can verify the concentration
Correct Answer: B
Rationale: Subcutaneous administration of vitamin K results in unpredictable and delayed
absorption, making intravenous or oral routes preferred for reliable reversal of warfarin effect.
, 3
Intramuscular injection is contraindicated in patients with elevated INR due to bleeding risk.
Food does not significantly alter vitamin K absorption, and holding a provider order without a
valid clinical reason is inappropriate.
Question 4 of 50
A 61-year-old male is recovering on the cardiac step-down unit after an uncomplicated
myocardial infarction two days ago. During morning assessment, he reports sudden onset of
palpitations and lightheadedness. Telemetry shows a regular narrow-complex tachycardia at 180
beats per minute with no discernible P waves. His blood pressure is 102/64. What is the nurse's
immediate priority?
A. Perform synchronized cardioversion at 100 joules
B. Administer adenosine 6 mg rapid IV push followed by a saline flush ✓ CORRECT
C. Apply bilateral carotid sinus massage for 10 seconds
D. Prepare the patient for transcutaneous pacing
Correct Answer: B
Rationale: The rhythm is consistent with supraventricular tachycardia in a hemodynamically
stable patient, and adenosine is the first-line pharmacologic intervention per ACLS guidelines.
Synchronized cardioversion is reserved for unstable patients with signs of poor perfusion.
Carotid massage is never performed bilaterally due to risk of cerebral hypoperfusion.
Transcutaneous pacing is indicated for symptomatic bradycardia, not tachycardia.
Question 5 of 50
A 59-year-old female with severe aortic stenosis is scheduled for valve replacement. During
preoperative teaching, she asks why she becomes dizzy when she stands quickly. Which
explanation best addresses the underlying hemodynamic mechanism?
A. Rapid position changes cause transient left ventricular dilation
B. The stenotic valve cannot increase cardiac output to compensate for venous pooling ✓
CORRECT
C. Orthostatic hypotension results from autonomic dysfunction common in valve disease
D. Standing decreases preload, which overloads the noncompliant left ventricle
Correct Answer: B
Rationale: In fixed aortic stenosis, the cardiac output cannot augment in response to reduced
venous return during position changes, leading to cerebral hypoperfusion and dizziness. Left
ventricular dilation is not a transient response to standing. Autonomic dysfunction is not the
