,Comprehensive Adult Health Nursing and
NUR 1320 Practice Exam – Updated 2026
(Graded A+)
Subject: Adult Health Nursing
Subtopic: Cardiovascular Pathophysiology and Hemodynamic
Management
Question 1: A patient with chronic heart failure (CHF) presents with acute decompensated heart
failure (ADHF). Hemodynamic monitoring reveals a cardiac index (CI) of 1.7 L/min/m²,
pulmonary artery wedge pressure (PAWP) of 26 mmHg, and systemic vascular resistance (SVR)
of 1,900 dynes/sec/cm⁻⁵. Which combination of pharmacological agents best addresses this
patient’s hemodynamic profile?
A) Phenylephrine and bolus isotonic crystalloids.
B) Milrinone and intravenous furosemide.
C) Metoprolol succinate and carvedilol.
D) Norepinephrine and sublingual nitroglycerin.
Correct Answer: B - Milrinone and intravenous furosemide.
Rationale: The patient is in a "wet and cold" state (low CI, high PAWP, high SVR). Furosemide
addresses the volume overload (high PAWP) by promoting diuresis. Milrinone is a
phosphodiesterase-3 inhibitor that provides inotropic support (to increase CI) and vasodilation
(to decrease SVR/afterload). Phenylephrine and norepinephrine would excessively increase SVR,
worsening cardiac workload. Beta-blockers (Metoprolol/Carvedilol) are typically held or
cautiously used during acute decompensated episodes due to their negative inotropic effects.
, Question 2: A 68-year-old patient post-coronary artery bypass graft (CABG) surgery suddenly
exhibits equalization of right atrial pressure, pulmonary artery diastolic pressure, and pulmonary
artery wedge pressure. What is the priority nursing intervention?
A) Administer a rapid fluid challenge.
B) Increase the positive end-expiratory pressure (PEEP) on the ventilator.
C) Notify the surgeon immediately to prepare for possible cardiac tamponade management.
D) Obtain a 12-lead ECG to rule out recurrent myocardial infarction.
Correct Answer: C - Notify the surgeon immediately to prepare for possible cardiac
tamponade management.
Rationale: Equalization of pressures in the chambers of the heart is a hallmark hemodynamic
finding of cardiac tamponade. Fluid challenges would further compromise cardiac output by
increasing compression. PEEP would decrease venous return and further reduce cardiac output.
While ECG is useful, the clinical presentation and hemodynamic profile demand immediate
surgical/procedural intervention.
Question 3: A patient is admitted with an inferior wall myocardial infarction (MI). The nurse
notes ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A) Left Anterior Descending (LAD) artery.
B) Left Circumflex (LCx) artery.
C) Right Coronary Artery (RCA).
D) Left Main Coronary Artery (LMCA).
Correct Answer: C - Right Coronary Artery (RCA).
Rationale: The inferior wall of the heart is primarily perfused by the RCA. Leads II, III, and aVF
correspond to this anatomical area. The LAD typically supplies the anterior wall (V1–V4), the
LCx typically supplies the lateral wall (I, aVL, V5, V6), and the LMCA leads to massive, multi-
vessel infarction.
Subtopic: Endocrine Emergencies
Question 4: A patient with Type 1 Diabetes is admitted with DKA. Serum labs: pH 7.18, HCO₃⁻
14 mEq/L, serum glucose 520 mg/dL, and potassium 2.8 mEq/L. Which action is the priority?
A) Begin an insulin drip at 0.1 units/kg/hr.
NUR 1320 Practice Exam – Updated 2026
(Graded A+)
Subject: Adult Health Nursing
Subtopic: Cardiovascular Pathophysiology and Hemodynamic
Management
Question 1: A patient with chronic heart failure (CHF) presents with acute decompensated heart
failure (ADHF). Hemodynamic monitoring reveals a cardiac index (CI) of 1.7 L/min/m²,
pulmonary artery wedge pressure (PAWP) of 26 mmHg, and systemic vascular resistance (SVR)
of 1,900 dynes/sec/cm⁻⁵. Which combination of pharmacological agents best addresses this
patient’s hemodynamic profile?
A) Phenylephrine and bolus isotonic crystalloids.
B) Milrinone and intravenous furosemide.
C) Metoprolol succinate and carvedilol.
D) Norepinephrine and sublingual nitroglycerin.
Correct Answer: B - Milrinone and intravenous furosemide.
Rationale: The patient is in a "wet and cold" state (low CI, high PAWP, high SVR). Furosemide
addresses the volume overload (high PAWP) by promoting diuresis. Milrinone is a
phosphodiesterase-3 inhibitor that provides inotropic support (to increase CI) and vasodilation
(to decrease SVR/afterload). Phenylephrine and norepinephrine would excessively increase SVR,
worsening cardiac workload. Beta-blockers (Metoprolol/Carvedilol) are typically held or
cautiously used during acute decompensated episodes due to their negative inotropic effects.
, Question 2: A 68-year-old patient post-coronary artery bypass graft (CABG) surgery suddenly
exhibits equalization of right atrial pressure, pulmonary artery diastolic pressure, and pulmonary
artery wedge pressure. What is the priority nursing intervention?
A) Administer a rapid fluid challenge.
B) Increase the positive end-expiratory pressure (PEEP) on the ventilator.
C) Notify the surgeon immediately to prepare for possible cardiac tamponade management.
D) Obtain a 12-lead ECG to rule out recurrent myocardial infarction.
Correct Answer: C - Notify the surgeon immediately to prepare for possible cardiac
tamponade management.
Rationale: Equalization of pressures in the chambers of the heart is a hallmark hemodynamic
finding of cardiac tamponade. Fluid challenges would further compromise cardiac output by
increasing compression. PEEP would decrease venous return and further reduce cardiac output.
While ECG is useful, the clinical presentation and hemodynamic profile demand immediate
surgical/procedural intervention.
Question 3: A patient is admitted with an inferior wall myocardial infarction (MI). The nurse
notes ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A) Left Anterior Descending (LAD) artery.
B) Left Circumflex (LCx) artery.
C) Right Coronary Artery (RCA).
D) Left Main Coronary Artery (LMCA).
Correct Answer: C - Right Coronary Artery (RCA).
Rationale: The inferior wall of the heart is primarily perfused by the RCA. Leads II, III, and aVF
correspond to this anatomical area. The LAD typically supplies the anterior wall (V1–V4), the
LCx typically supplies the lateral wall (I, aVL, V5, V6), and the LMCA leads to massive, multi-
vessel infarction.
Subtopic: Endocrine Emergencies
Question 4: A patient with Type 1 Diabetes is admitted with DKA. Serum labs: pH 7.18, HCO₃⁻
14 mEq/L, serum glucose 520 mg/dL, and potassium 2.8 mEq/L. Which action is the priority?
A) Begin an insulin drip at 0.1 units/kg/hr.
