NSG 4100 EXAM 1
Foundations of Complex Adult Health — 100-Question
Practice Exam with Answer Key & Rationales
Section A: Cardiovascular Disorders
Question 1: A nurse is caring for a client with left-sided heart failure. Which finding should the
nurse expect?
● A. Jugular vein distention
● B. Crackles in the lung bases
● C. Peripheral pitting edema
● D. Hepatomegaly
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
producing crackles and pulmonary congestion. JVD, peripheral edema, and hepatomegaly are
signs of right-sided failure.
Question 2: A client with heart failure is prescribed furosemide. Which electrolyte should the
nurse monitor closely?
● A. Sodium
● B. Potassium
● C. Calcium
● D. Phosphate
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting, increasing
the risk for hypokalemia and dysrhythmias.
Question 3: A nurse is assessing a client for early manifestations of an acute coronary syndrome.
Which symptom is most consistent with unstable angina?
● A. Chest pain relieved completely by rest
● B. Chest pain at rest lasting more than 15 minutes
● C. Pain only with strenuous exercise that resolves with nitroglycerin
● D. Sharp pain that worsens with inspiration
Rationale: Unstable angina presents as chest pain occurring at rest or with minimal exertion,
often lasting longer than stable angina and not fully relieved by rest or a single nitroglycerin
dose.
Question 4: A client is admitted with an ST-elevation myocardial infarction (STEMI). Which
intervention is the priority?
● A. Administer oral aspirin
● B. Obtain a 12-lead ECG
● C. Transport to cardiac catheterization within 90 minutes
, ● D. Draw cardiac biomarkers
Rationale: For STEMI, timely reperfusion via percutaneous coronary intervention within 90
minutes of arrival is the priority to minimize myocardial damage; door-to-balloon time is a key
quality metric.
Question 5: A nurse notes a client's troponin level is elevated 6 hours after chest pain onset.
What does this finding indicate?
● A. Myocardial cell injury or necrosis
● B. Renal impairment
● C. Resolved angina
● D. Pulmonary embolism
Rationale: Troponin is a cardiac-specific biomarker that rises with myocardial cell injury and is
the most sensitive and specific marker for acute MI.
Question 6: A client taking metoprolol for hypertension should be instructed to report which
finding?
● A. Heart rate of 68/min
● B. Mild fatigue during the first week
● C. Heart rate less than 50/min
● D. Occasional headache
Rationale: Beta blockers like metoprolol can cause bradycardia; a heart rate under 50/min
should be reported as it may require dose adjustment.
Question 7: A nurse is caring for a client in atrial fibrillation with a rapid ventricular response.
Which assessment finding is most concerning?
● A. Irregular pulse at 90/min
● B. Blood pressure of 88/56 mm Hg with dizziness
● C. Occasional palpitations
● D. Mild fatigue
Rationale: Hypotension with dizziness suggests hemodynamic instability related to the rapid,
irregular rhythm and requires immediate intervention such as rate or rhythm control.
Question 8: A client with atrial fibrillation is started on warfarin. Which lab value does the nurse
monitor to evaluate therapeutic effect?
● A. Platelet count
● B. INR
● C. aPTT
● D. Hemoglobin
Rationale: Warfarin therapy is monitored using the INR, with a therapeutic range typically
between 2 and 3 for most indications.
, Question 9: A client reports substernal chest pressure radiating to the left arm. Which action
should the nurse take first?
● A. Obtain a full set of vital signs and a 12-lead ECG
● B. Administer sublingual nitroglycerin without assessing blood pressure
● C. Call the client's primary provider only
● D. Ambulate the client to reduce anxiety
Rationale: Rapid assessment including vital signs and an ECG guides safe treatment decisions,
such as whether nitroglycerin can be given without causing hypotension.
Question 10: A nurse is teaching a client about lifestyle modifications for hypertension. Which
statement indicates understanding?
● A. "I should limit my sodium intake to less than 2,300 mg per day."
● B. "I can stop my medication once my blood pressure is normal."
● C. "I should avoid all forms of exercise."
● D. "Caffeine has no effect on my blood pressure."
Rationale: Sodium restriction is a key lifestyle modification for hypertension management;
antihypertensive medications should not be stopped without provider guidance.
Question 11: A client with a history of heart failure gains 3 lb (1.4 kg) in 2 days. What is the
nurse's priority action?
● A. Encourage increased fluid intake
● B. Notify the provider of the weight gain
● C. Document and reassess in 1 week
● D. Instruct the client to increase sodium intake
Rationale: A rapid weight gain of 2-3 lb in 24 hours or 3-5 lb in a week suggests fluid retention
and worsening heart failure, requiring prompt provider notification.
Question 12: Which hemodynamic change is expected in cardiogenic shock secondary to left
ventricular failure?
● A. Increased cardiac output
● B. Decreased systemic vascular resistance
● C. Decreased cardiac output with increased systemic vascular resistance
● D. Increased venous return
Rationale: In cardiogenic shock, the failing heart cannot maintain adequate cardiac output,
triggering compensatory vasoconstriction that increases systemic vascular resistance.
Question 13: A nurse is caring for a client receiving IV nitroglycerin for chest pain. Which
parameter requires the closest monitoring?
● A. Blood glucose
● B. Blood pressure
● C. Urine output
Foundations of Complex Adult Health — 100-Question
Practice Exam with Answer Key & Rationales
Section A: Cardiovascular Disorders
Question 1: A nurse is caring for a client with left-sided heart failure. Which finding should the
nurse expect?
● A. Jugular vein distention
● B. Crackles in the lung bases
● C. Peripheral pitting edema
● D. Hepatomegaly
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
producing crackles and pulmonary congestion. JVD, peripheral edema, and hepatomegaly are
signs of right-sided failure.
Question 2: A client with heart failure is prescribed furosemide. Which electrolyte should the
nurse monitor closely?
● A. Sodium
● B. Potassium
● C. Calcium
● D. Phosphate
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting, increasing
the risk for hypokalemia and dysrhythmias.
Question 3: A nurse is assessing a client for early manifestations of an acute coronary syndrome.
Which symptom is most consistent with unstable angina?
● A. Chest pain relieved completely by rest
● B. Chest pain at rest lasting more than 15 minutes
● C. Pain only with strenuous exercise that resolves with nitroglycerin
● D. Sharp pain that worsens with inspiration
Rationale: Unstable angina presents as chest pain occurring at rest or with minimal exertion,
often lasting longer than stable angina and not fully relieved by rest or a single nitroglycerin
dose.
Question 4: A client is admitted with an ST-elevation myocardial infarction (STEMI). Which
intervention is the priority?
● A. Administer oral aspirin
● B. Obtain a 12-lead ECG
● C. Transport to cardiac catheterization within 90 minutes
, ● D. Draw cardiac biomarkers
Rationale: For STEMI, timely reperfusion via percutaneous coronary intervention within 90
minutes of arrival is the priority to minimize myocardial damage; door-to-balloon time is a key
quality metric.
Question 5: A nurse notes a client's troponin level is elevated 6 hours after chest pain onset.
What does this finding indicate?
● A. Myocardial cell injury or necrosis
● B. Renal impairment
● C. Resolved angina
● D. Pulmonary embolism
Rationale: Troponin is a cardiac-specific biomarker that rises with myocardial cell injury and is
the most sensitive and specific marker for acute MI.
Question 6: A client taking metoprolol for hypertension should be instructed to report which
finding?
● A. Heart rate of 68/min
● B. Mild fatigue during the first week
● C. Heart rate less than 50/min
● D. Occasional headache
Rationale: Beta blockers like metoprolol can cause bradycardia; a heart rate under 50/min
should be reported as it may require dose adjustment.
Question 7: A nurse is caring for a client in atrial fibrillation with a rapid ventricular response.
Which assessment finding is most concerning?
● A. Irregular pulse at 90/min
● B. Blood pressure of 88/56 mm Hg with dizziness
● C. Occasional palpitations
● D. Mild fatigue
Rationale: Hypotension with dizziness suggests hemodynamic instability related to the rapid,
irregular rhythm and requires immediate intervention such as rate or rhythm control.
Question 8: A client with atrial fibrillation is started on warfarin. Which lab value does the nurse
monitor to evaluate therapeutic effect?
● A. Platelet count
● B. INR
● C. aPTT
● D. Hemoglobin
Rationale: Warfarin therapy is monitored using the INR, with a therapeutic range typically
between 2 and 3 for most indications.
, Question 9: A client reports substernal chest pressure radiating to the left arm. Which action
should the nurse take first?
● A. Obtain a full set of vital signs and a 12-lead ECG
● B. Administer sublingual nitroglycerin without assessing blood pressure
● C. Call the client's primary provider only
● D. Ambulate the client to reduce anxiety
Rationale: Rapid assessment including vital signs and an ECG guides safe treatment decisions,
such as whether nitroglycerin can be given without causing hypotension.
Question 10: A nurse is teaching a client about lifestyle modifications for hypertension. Which
statement indicates understanding?
● A. "I should limit my sodium intake to less than 2,300 mg per day."
● B. "I can stop my medication once my blood pressure is normal."
● C. "I should avoid all forms of exercise."
● D. "Caffeine has no effect on my blood pressure."
Rationale: Sodium restriction is a key lifestyle modification for hypertension management;
antihypertensive medications should not be stopped without provider guidance.
Question 11: A client with a history of heart failure gains 3 lb (1.4 kg) in 2 days. What is the
nurse's priority action?
● A. Encourage increased fluid intake
● B. Notify the provider of the weight gain
● C. Document and reassess in 1 week
● D. Instruct the client to increase sodium intake
Rationale: A rapid weight gain of 2-3 lb in 24 hours or 3-5 lb in a week suggests fluid retention
and worsening heart failure, requiring prompt provider notification.
Question 12: Which hemodynamic change is expected in cardiogenic shock secondary to left
ventricular failure?
● A. Increased cardiac output
● B. Decreased systemic vascular resistance
● C. Decreased cardiac output with increased systemic vascular resistance
● D. Increased venous return
Rationale: In cardiogenic shock, the failing heart cannot maintain adequate cardiac output,
triggering compensatory vasoconstriction that increases systemic vascular resistance.
Question 13: A nurse is caring for a client receiving IV nitroglycerin for chest pain. Which
parameter requires the closest monitoring?
● A. Blood glucose
● B. Blood pressure
● C. Urine output
