NSG 430 Adult Health Nursing II Exam 2 Review
Questions and Answers. Graded A+ (2026/2027)
Exam 2 Comprehensive Review — 2026 Academic Standard
Course Code: NSG 430
Focus Areas: Advanced Cardiovascular, Complex Respiratory, High-Acuity Renal, and Critical
Care Shock States
Section A: Advanced Cardiovascular Alterations and Hemodynamic Monitoring
Question 1
A nurse in the cardiac intensive care unit is monitoring a client with an pulmonary artery
(Swan-Ganz) catheter following an acute anterior wall myocardial infarction. The monitor
displays a sudden drop in the pulmonary artery wedge pressure (PAWP) from $14\text{
mmHg}$ to $4\text{ mmHg}$, accompanied by a blood pressure drop to $82/40\text{
mmHg}$ and a heart rate of $122\text{ bpm}$. Which action should the nurse prioritize?
A) Prepare to administer an intravenous bolus of regular insulin.
B) Increase the maintenance intravenous fluid infusion rate as prescribed to treat
hypovolemia.
C) Administer a rapid intravenous dose of furosemide.
D) Place the patient in a high-Fowler's position with feet hanging.
Correct Answer: B Rationale: A normal PAWP ranges between $6\text{ and }12\text{
mmHg}$. A low PAWP ($4\text{ mmHg}$) paired with hypotension and tachycardia indicates
a significant deficit in left ventricular end-diastolic volume (hypovolemia). Fluid resuscitation
is required to restore preload, increase cardiac output, and stabilize blood pressure.
Furosemide or high-Fowler's positioning would further deplete preload, worsening shock.
Question 2
A nurse is analyzing the cardiac rhythm strip of an adult client on a telemetry unit. The strip
shows a regular ventricular rhythm, a rate of $140\text{ bpm}$, a absent P waves, and a
wide, distorted QRS complex measuring $0.16\text{ seconds}$. The client is conscious, alert,
and reports mild chest pressure. What is the nurse's immediate action?
A) Deliver an unsynchronized high-energy defibrillation shock.
B) Administer oxygen and prepare for prescribed intravenous amiodarone infusion.
C) Perform immediate endotracheal suctioning.
D) Administer subcutaneous low-molecular-weight heparin.
,Correct Answer: B Rationale: The rhythm described is monomorphic Ventricular Tachycardia
(VT) with a pulse (stable). Because the client is conscious and hemodynamically stable (alert
with mild pressure), initial treatment is pharmacological with antiarrhythmics like
amiodarone. Unsynchronized defibrillation is reserved for pulseless VT or ventricular
fibrillation.
Question 3
A client is admitted to the emergency department presenting with severe, tearing chest pain
radiating to the back, dyspnea, and a blood pressure of $210/115\text{ mmHg}$. The nurse
notes a significant pulse deficit between the right and left radial arteries. Which condition
should the nurse suspect?
A) Acute pericarditis
B) Aortic dissection
C) Right-sided heart failure
D) Tension pneumothorax
Correct Answer: B Rationale: A classic presentation of an aortic dissection includes a sudden
onset of severe, "tearing" or "ripping" chest pain that radiates to the back, severe
hypertension, and asymmetric peripheral pulses or blood pressures between extremities
due to the intimal tear obstructing branch arteries.
Section B: Complex Respiratory Alterations and Ventilation Mechanics
Question 4
A nurse is caring for a client who is on mechanical ventilation in the intensive care unit. The
low-pressure/low-volume alarm on the ventilator begins sounding persistently. The nurse
assesses the client and finds no respiratory distress. Which issue should the nurse
investigate as the cause of this alarm?
A) Excessive secretions inside the endotracheal tube airway.
B) A disconnection of the ventilator tubing circuit or a leak in the endotracheal tube cuff.
C) The client is actively biting down on the endotracheal tube matrix.
D) Development of severe acute bronchospasms.
Correct Answer: B Rationale: Low-pressure ventilator alarms are triggered by a loss of
resistance or pressure within the system, typically caused by a circuit disconnection, a leak in
the endotracheal tube cuff, or a dislodged tube. High-pressure alarms are triggered by
obstructions such as secretions, coughing, kinking, or biting.
Question 5
,A nurse is evaluating the arterial blood gas (ABG) results of a client with acute respiratory
distress syndrome (ARDS) who is receiving mechanical ventilation with high positive end-
expiratory pressure (PEEP) settings: $\text{pH } 7.31, \text{ PaCO}_2\ 52\text{ mmHg}, \text{
PaO}_2\ 55\text{ mmHg}, \text{ HCO}_3^-\ 25\text{ mEq/L}$. The nurse should identify that
this configuration represents:
A) Uncompensated metabolic alkalosis with hyperoxemia.
B) Uncompensated respiratory acidosis with refractory hypoxemia.
C) Fully compensated respiratory alkalosis.
D) Partially compensated metabolic acidosis.
Correct Answer: B Rationale: The $\text{pH}$ ($7.31$) is low (acidosis), and the
$\text{PaCO}_2$ ($52\text{ mmHg}$) is high (respiratory origin). The $\text{HCO}_3^-$ is
within the normal range, confirming it is uncompensated. The low $\text{PaO}_2$ ($55\text{
mmHg}$) despite mechanical support with PEEP represents refractory hypoxemia, which is
the hallmark clinical feature of ARDS.
Section C: High-Acuity Renal Failure and Acid-Base Mastery
Question 6
A client with acute kidney injury (AKI) secondary to a severe crush injury enters the oliguric
phase. The nurse reviews the morning laboratory results: Blood Urea Nitrogen (BUN)
$68\text{ mg/dL}$, Serum Creatinine $4.2\text{ mg/dL}$, Serum Potassium $6.4\text{
mEq/L}$, and Serum Sodium $136\text{ mEq/L}$. Which provider prescription is the highest
priority for the nurse to implement?
A) Administer a dose of oral calcium carbonate with meals.
B) Administer intravenous calcium gluconate $10\%$ over 5 to 10 minutes.
C) Infuse a continuous maintenance fluid run of $0.45\%$ Normal Saline.
D) Restrict daily protein intake to less than $20\text{ grams}$.
Correct Answer: B Rationale: A serum potassium level of $6.4\text{ mEq/L}$ represents
severe, life-threatening hyperkalemia, placing the client at high risk for lethal cardiac
dysrhythmias (e.g., ventricular fibrillation). Intravenous calcium gluconate is administered
immediately to stabilize the myocardial cell membrane and protect the heart while other
therapies work to lower serum potassium levels.
Question 7
During a continuous renal replacement therapy (CRRT) session for an unstable client, the
nurse notes that the filter pressure monitor indicates a rapid rise, while the ultrafiltration
rate begins to fall. What does this technical shift suggest?
, A) The arterial access line has completely kinked.
B) The CRRT filter/dialyzer membrane is clotting.
C) The replacement fluid bag has run empty.
D) The client is experiencing acute fluid volume deficit.
Correct Answer: B Rationale: In CRRT, a progressive increase in filter pressure accompanied
by a drop in ultrafiltration efficiency is a direct indicator of circuit clotting. Blood cells and
fibrin thrombi deposit within the hollow fibers of the dialyzer, necessitating a system flush or
circuit change.
Section D: Shock States, Sepsis Protocols, and Multi-System Synthesis
Question 8
A nurse in the emergency department is assessing a client with a suspected systemic
infection. The client's vital signs are: Temperature $39.2^\circ\text{C}$
($102.5^\circ\text{F}$), Heart Rate $118\text{ bpm}$, Respiratory Rate $26\text{
breaths/min}$, and Blood Pressure $88/44\text{ mmHg}$. Following a $30\text{ mL/kg}$
crystalloid fluid bolus, the client's mean arterial pressure (MAP) remains $54\text{ mmHg}$,
and the serum lactate level is $4.2\text{ mmol/L}$. How should the nurse categorize this
state?
A) Compensated hypovolemic shock
B) Septic shock
C) Anaphylactic shock
D) Neurogenic shock
Correct Answer: B Rationale: Septic shock is defined as a subset of sepsis characterized by
persistent hypotension requiring vasopressors to maintain a $\text{MAP} \ge 65\text{
mmHg}$ and a serum lactate level $> 2\text{ mmol/L}$ despite adequate fluid resuscitation.
This client remains hypotensive ($\text{MAP} = 54\text{ mmHg}$) with an elevated lactate
level ($4.2\text{ mmol/L}$) following a full fluid challenge.
Question 9
A nurse is preparing to administer a continuous intravenous infusion of norepinephrine to a
client in refractory distributive shock. Which administrative protocol must the nurse verify
before initiating the infusion pump?
A) Infuse the medication exclusively through a peripheral 24-gauge angiocath line.
B) Ensure that the infusion runs through a central venous catheter line to prevent
extravasation tissue necrosis.
Questions and Answers. Graded A+ (2026/2027)
Exam 2 Comprehensive Review — 2026 Academic Standard
Course Code: NSG 430
Focus Areas: Advanced Cardiovascular, Complex Respiratory, High-Acuity Renal, and Critical
Care Shock States
Section A: Advanced Cardiovascular Alterations and Hemodynamic Monitoring
Question 1
A nurse in the cardiac intensive care unit is monitoring a client with an pulmonary artery
(Swan-Ganz) catheter following an acute anterior wall myocardial infarction. The monitor
displays a sudden drop in the pulmonary artery wedge pressure (PAWP) from $14\text{
mmHg}$ to $4\text{ mmHg}$, accompanied by a blood pressure drop to $82/40\text{
mmHg}$ and a heart rate of $122\text{ bpm}$. Which action should the nurse prioritize?
A) Prepare to administer an intravenous bolus of regular insulin.
B) Increase the maintenance intravenous fluid infusion rate as prescribed to treat
hypovolemia.
C) Administer a rapid intravenous dose of furosemide.
D) Place the patient in a high-Fowler's position with feet hanging.
Correct Answer: B Rationale: A normal PAWP ranges between $6\text{ and }12\text{
mmHg}$. A low PAWP ($4\text{ mmHg}$) paired with hypotension and tachycardia indicates
a significant deficit in left ventricular end-diastolic volume (hypovolemia). Fluid resuscitation
is required to restore preload, increase cardiac output, and stabilize blood pressure.
Furosemide or high-Fowler's positioning would further deplete preload, worsening shock.
Question 2
A nurse is analyzing the cardiac rhythm strip of an adult client on a telemetry unit. The strip
shows a regular ventricular rhythm, a rate of $140\text{ bpm}$, a absent P waves, and a
wide, distorted QRS complex measuring $0.16\text{ seconds}$. The client is conscious, alert,
and reports mild chest pressure. What is the nurse's immediate action?
A) Deliver an unsynchronized high-energy defibrillation shock.
B) Administer oxygen and prepare for prescribed intravenous amiodarone infusion.
C) Perform immediate endotracheal suctioning.
D) Administer subcutaneous low-molecular-weight heparin.
,Correct Answer: B Rationale: The rhythm described is monomorphic Ventricular Tachycardia
(VT) with a pulse (stable). Because the client is conscious and hemodynamically stable (alert
with mild pressure), initial treatment is pharmacological with antiarrhythmics like
amiodarone. Unsynchronized defibrillation is reserved for pulseless VT or ventricular
fibrillation.
Question 3
A client is admitted to the emergency department presenting with severe, tearing chest pain
radiating to the back, dyspnea, and a blood pressure of $210/115\text{ mmHg}$. The nurse
notes a significant pulse deficit between the right and left radial arteries. Which condition
should the nurse suspect?
A) Acute pericarditis
B) Aortic dissection
C) Right-sided heart failure
D) Tension pneumothorax
Correct Answer: B Rationale: A classic presentation of an aortic dissection includes a sudden
onset of severe, "tearing" or "ripping" chest pain that radiates to the back, severe
hypertension, and asymmetric peripheral pulses or blood pressures between extremities
due to the intimal tear obstructing branch arteries.
Section B: Complex Respiratory Alterations and Ventilation Mechanics
Question 4
A nurse is caring for a client who is on mechanical ventilation in the intensive care unit. The
low-pressure/low-volume alarm on the ventilator begins sounding persistently. The nurse
assesses the client and finds no respiratory distress. Which issue should the nurse
investigate as the cause of this alarm?
A) Excessive secretions inside the endotracheal tube airway.
B) A disconnection of the ventilator tubing circuit or a leak in the endotracheal tube cuff.
C) The client is actively biting down on the endotracheal tube matrix.
D) Development of severe acute bronchospasms.
Correct Answer: B Rationale: Low-pressure ventilator alarms are triggered by a loss of
resistance or pressure within the system, typically caused by a circuit disconnection, a leak in
the endotracheal tube cuff, or a dislodged tube. High-pressure alarms are triggered by
obstructions such as secretions, coughing, kinking, or biting.
Question 5
,A nurse is evaluating the arterial blood gas (ABG) results of a client with acute respiratory
distress syndrome (ARDS) who is receiving mechanical ventilation with high positive end-
expiratory pressure (PEEP) settings: $\text{pH } 7.31, \text{ PaCO}_2\ 52\text{ mmHg}, \text{
PaO}_2\ 55\text{ mmHg}, \text{ HCO}_3^-\ 25\text{ mEq/L}$. The nurse should identify that
this configuration represents:
A) Uncompensated metabolic alkalosis with hyperoxemia.
B) Uncompensated respiratory acidosis with refractory hypoxemia.
C) Fully compensated respiratory alkalosis.
D) Partially compensated metabolic acidosis.
Correct Answer: B Rationale: The $\text{pH}$ ($7.31$) is low (acidosis), and the
$\text{PaCO}_2$ ($52\text{ mmHg}$) is high (respiratory origin). The $\text{HCO}_3^-$ is
within the normal range, confirming it is uncompensated. The low $\text{PaO}_2$ ($55\text{
mmHg}$) despite mechanical support with PEEP represents refractory hypoxemia, which is
the hallmark clinical feature of ARDS.
Section C: High-Acuity Renal Failure and Acid-Base Mastery
Question 6
A client with acute kidney injury (AKI) secondary to a severe crush injury enters the oliguric
phase. The nurse reviews the morning laboratory results: Blood Urea Nitrogen (BUN)
$68\text{ mg/dL}$, Serum Creatinine $4.2\text{ mg/dL}$, Serum Potassium $6.4\text{
mEq/L}$, and Serum Sodium $136\text{ mEq/L}$. Which provider prescription is the highest
priority for the nurse to implement?
A) Administer a dose of oral calcium carbonate with meals.
B) Administer intravenous calcium gluconate $10\%$ over 5 to 10 minutes.
C) Infuse a continuous maintenance fluid run of $0.45\%$ Normal Saline.
D) Restrict daily protein intake to less than $20\text{ grams}$.
Correct Answer: B Rationale: A serum potassium level of $6.4\text{ mEq/L}$ represents
severe, life-threatening hyperkalemia, placing the client at high risk for lethal cardiac
dysrhythmias (e.g., ventricular fibrillation). Intravenous calcium gluconate is administered
immediately to stabilize the myocardial cell membrane and protect the heart while other
therapies work to lower serum potassium levels.
Question 7
During a continuous renal replacement therapy (CRRT) session for an unstable client, the
nurse notes that the filter pressure monitor indicates a rapid rise, while the ultrafiltration
rate begins to fall. What does this technical shift suggest?
, A) The arterial access line has completely kinked.
B) The CRRT filter/dialyzer membrane is clotting.
C) The replacement fluid bag has run empty.
D) The client is experiencing acute fluid volume deficit.
Correct Answer: B Rationale: In CRRT, a progressive increase in filter pressure accompanied
by a drop in ultrafiltration efficiency is a direct indicator of circuit clotting. Blood cells and
fibrin thrombi deposit within the hollow fibers of the dialyzer, necessitating a system flush or
circuit change.
Section D: Shock States, Sepsis Protocols, and Multi-System Synthesis
Question 8
A nurse in the emergency department is assessing a client with a suspected systemic
infection. The client's vital signs are: Temperature $39.2^\circ\text{C}$
($102.5^\circ\text{F}$), Heart Rate $118\text{ bpm}$, Respiratory Rate $26\text{
breaths/min}$, and Blood Pressure $88/44\text{ mmHg}$. Following a $30\text{ mL/kg}$
crystalloid fluid bolus, the client's mean arterial pressure (MAP) remains $54\text{ mmHg}$,
and the serum lactate level is $4.2\text{ mmol/L}$. How should the nurse categorize this
state?
A) Compensated hypovolemic shock
B) Septic shock
C) Anaphylactic shock
D) Neurogenic shock
Correct Answer: B Rationale: Septic shock is defined as a subset of sepsis characterized by
persistent hypotension requiring vasopressors to maintain a $\text{MAP} \ge 65\text{
mmHg}$ and a serum lactate level $> 2\text{ mmol/L}$ despite adequate fluid resuscitation.
This client remains hypotensive ($\text{MAP} = 54\text{ mmHg}$) with an elevated lactate
level ($4.2\text{ mmol/L}$) following a full fluid challenge.
Question 9
A nurse is preparing to administer a continuous intravenous infusion of norepinephrine to a
client in refractory distributive shock. Which administrative protocol must the nurse verify
before initiating the infusion pump?
A) Infuse the medication exclusively through a peripheral 24-gauge angiocath line.
B) Ensure that the infusion runs through a central venous catheter line to prevent
extravasation tissue necrosis.
