GALEN COLLEGE OF NURSING | PRACTICE
E X A M I N AT I O N
NSG 3130 Exam 4
Fundamental Concepts
& Skills for Nursing
Practice II
Comprehensive practice test covering cardiovascular,
respiratory, hematologic, immunologic, oncology, shock
and sepsis, emergency, and professional nursing
concepts aligned with the NSG 3130 curriculum.
130 Questions | 7 Sections | Scenario-Based & Recall
Cardiovascular, Respiratory, Hematologic, Oncology, Shock/Sepsis,
Emergency/Disaster, and Professional Issues
Cognitive Levels: 25% Recall, 55% Application, 20% Analysis
L AT E S T P R A C T I C E T E S T | N S G 3 1 3 0 E X A M 4 R E V I E W
,Section 1: Cardiovascular Disorders 2
Section 2: Respiratory Disorders 9
Section 3: Hematologic and Immunologic Disorders 16
Section 4: Oncology Nursing 21
Section 5: Shock, Sepsis, and Multisystem Dysfunction 26
Section 6: Emergency and Disaster Nursing 30
Section 7: Professional Issues and End-of-Life Care 34
Page 1
,Section 1: Cardiovascular Disorders
Hypertension, CAD, Heart Failure, Valvular Disorders, Peripheral Vascular Disease, and Cardiac Diagnostics (Q1-Q30)
Q1: A 52-year-old African American male is diagnosed with primary (essential) hypertension after repeated readings of
158/96 mmHg. He tells the nurse, "I feel completely fine, so I really don't think I need medication." Which response by
the nurse best reflects understanding of the pathophysiology of primary hypertension?
'Primary hypertension is caused by a specific kidney problem that increases fluid volume.'
'Even without symptoms, persistently elevated pressure damages your blood vessels and increases your risk for
stroke and kidney disease.'
'Since you feel fine, we can hold off on medication and monitor your BP at home for six months.'
'Primary hypertension is mainly caused by stress and will resolve once you reduce your workload.'
Correct Answer: b
Rationale: Primary (essential) hypertension has no single identifiable cause but involves a complex interplay of genetic, vascular, and
neurohormonal factors that progressively increase systemic vascular resistance. The insidious nature of primary hypertension means
patients are often asymptomatic while end-organ damage to the kidneys, heart, brain, and eyes progresses silently. The nurse must educate
the patient that treatment is indicated regardless of symptoms, consistent with ACC/AHA guideline recommendations to reduce
cardiovascular and renal morbidity.
Q2: A 34-year-old female presents to the emergency department with sudden-onset severe headache, diaphoresis, and a
blood pressure of 218/128 mmHg. She reports palpitations and anxiety. Urinary metanephrines are elevated. Which
diagnosis does the nurse anticipate, and which safety intervention is the priority?
Primary hypertension; initiate lifestyle modifications and schedule a follow-up in 3 months.
Hypertensive urgency; administer oral clonidine and discharge with outpatient follow-up.
Pheochromocytoma-induced hypertensive crisis; prepare for IV phentolamine and continuous hemodynamic
monitoring.
Panic attack with secondary hypertension; administer anxiolytics and reassess blood pressure in 1 hour.
Correct Answer: c
Rationale: Elevated urinary metanephrines strongly suggest a pheochromocytoma, a catecholamine-secreting tumor that causes episodic
severe hypertension. This constitutes a hypertensive emergency when end-organ symptoms (severe headache, diaphoresis) are present,
requiring IV alpha-adrenergic blockers such as phentolamine to counteract catecholamine-mediated vasoconstriction. Beta-blockers must
never be given first because unopposed alpha stimulation can worsen vasoconstriction, a critical safety consideration for nursing
management.
Q3: A nurse is providing discharge teaching to a 60-year-old patient with newly diagnosed stage 1 hypertension. The
patient's current BMI is 32, she consumes a high-sodium diet, and she drinks two glasses of wine nightly. Which
statement by the patient indicates the teaching was effective?
'I will switch from table salt to sea salt, which is less harmful to my blood pressure.'
'I should aim to lose about 5% to 10% of my body weight and limit my sodium to less than 1,500 mg per day.'
'Since I'm already on medication, my diet and weight don't really affect my blood pressure much.'
'I'll cut back to one glass of wine per night, which is within safe limits and won't affect my BP.'
Correct Answer: b
Rationale: Non-pharmacologic management of hypertension includes weight reduction (5% to 10% of body weight), sodium restriction to
less than 1,500 mg/day, the DASH diet, and limiting alcohol. Sea salt contains the same amount of sodium as table salt and is a common
misconception among patients. Even when medications are prescribed, lifestyle modifications remain essential because they enhance BP
control and may reduce the number or dose of antihypertensive agents needed.
Q4: A 45-year-old male with hypertension and type 2 diabetes is started on lisinopril. Two weeks later, he reports a
persistent dry cough and swelling of his lips. His serum potassium is 5.6 mEq/L. What is the nurse's priority action?
Instruct the patient to take the medication at bedtime to minimize coughing during the day.
Hold the lisinopril, notify the provider immediately, and assess the patient's airway.
Encourage increased fluid intake to dilute the elevated potassium level.
Reassure the patient that the dry cough is a harmless side effect that typically resolves on its own.
Correct Answer: b
Rationale: Angioedema (lip swelling) is a potentially life-threatening hypersensitivity reaction to ACE inhibitors caused by bradykinin
accumulation, and it requires immediate drug discontinuation and airway assessment. Hyperkalemia (>5.0 mEq/L) is another significant
Page 2
, adverse effect of ACE inhibitors due to decreased aldosterone secretion. Although the dry cough is a common and non-life-threatening
side effect, angioedema takes priority over both the cough and hyperkalemia because of the risk of airway compromise.
Q5: Which statement accurately describes a key difference between primary and secondary hypertension?
Primary hypertension has a sudden onset, whereas secondary hypertension develops gradually over many years.
Primary hypertension accounts for approximately 90% to 95% of all cases and has no identifiable cause, whereas
secondary hypertension results from a specific underlying condition such as renal artery stenosis or Cushing
syndrome.
Secondary hypertension is more common in older adults, while primary hypertension typically affects younger patients
under age 30.
Primary hypertension always requires surgical intervention, whereas secondary hypertension is managed with lifestyle
changes alone.
Correct Answer: b
Rationale: Primary (essential) hypertension comprises 90% to 95% of hypertension cases and is idiopathic, involving complex interactions
among genetic, neurohormonal, and vascular factors. Secondary hypertension accounts for 5% to 10% of cases and has a specific
identifiable cause such as renal artery stenosis, pheochromocytoma, hyperaldosteronism, or Cushing syndrome. Secondary hypertension
often presents with more severe or abrupt elevations, younger age of onset, or resistance to standard therapy, which should prompt further
diagnostic workup.
Q6: A 65-year-old male with a history of hyperlipidemia and smoking presents to the emergency department with
crushing substernal chest pain that began 30 minutes ago. The 12-lead ECG shows ST-segment elevation in leads II, III,
and aVF. The nurse recognizes this pattern indicates which condition and which coronary artery territory?
Anterior wall STEMI involving the left anterior descending artery.
Inferior wall STEMI involving the right coronary artery.
Lateral wall NSTEMI involving the circumflex artery.
Posterior wall STEMI involving the left main coronary artery.
Correct Answer: b
Rationale: ST-segment elevation in leads II, III, and aVF localizes the injury to the inferior wall of the left ventricle, most commonly
supplied by the right coronary artery (RCA). Inferior STEMI is critical to identify because it is frequently associated with right ventricular
involvement, which requires careful hemodynamic management including avoidance of nitroglycerin and large fluid boluses. Time to
reperfusion (PCI or fibrinolytics) is the most important determinant of outcomes in STEMI, making rapid ECG interpretation a core
nursing competency.
Q7: A 58-year-old female tells the nurse she has been experiencing chest discomfort when climbing stairs or walking
uphill for the past 3 months. The discomfort is relieved by rest. Over the past week, the pain has occurred at rest twice,
lasting 15 to 20 minutes each time. The nurse recognizes this change in pattern as which condition, and what is the
priority nursing action?
Stable angina; teach the patient to rest when symptoms occur and take sublingual nitroglycerin as prescribed.
Unstable angina; obtain a 12-lead ECG, initiate continuous cardiac monitoring, and notify the provider
immediately.
Variant (Prinzmetal) angina; administer calcium channel blockers and assess for coronary artery spasm triggers.
Noncardiac chest pain; explore musculoskeletal causes and reassure the patient.
Correct Answer: b
Rationale: The progression from predictable exertional chest pain (stable angina) to rest pain that is more frequent, prolonged, or severe
indicates unstable angina, a form of acute coronary syndrome. Unstable angina reflects ruptured atherosclerotic plaque with partial
thrombus formation and is a medical emergency requiring immediate ECG, cardiac monitoring, and provider notification to determine the
need for antiplatelet therapy, anticoagulation, and possible urgent catheterization. Differentiating stable from unstable angina is a critical
nursing assessment skill that directly affects triage and intervention timing.
Q8: A patient diagnosed with NSTEMI has serial cardiac biomarkers drawn. The initial troponin I is 0.04 ng/mL
(reference < 0.04), and 6 hours later it is 0.32 ng/mL. The patient asks the nurse what this means. Which response is
most accurate?
'Your troponin level is back to normal, which means there is no damage to your heart muscle.'
'The rising troponin level indicates that heart muscle cells have been injured, which helps confirm the diagnosis
of a heart attack.'
'Troponin is only elevated during a STEMI, so these results suggest your diagnosis is incorrect.'
Page 3
E X A M I N AT I O N
NSG 3130 Exam 4
Fundamental Concepts
& Skills for Nursing
Practice II
Comprehensive practice test covering cardiovascular,
respiratory, hematologic, immunologic, oncology, shock
and sepsis, emergency, and professional nursing
concepts aligned with the NSG 3130 curriculum.
130 Questions | 7 Sections | Scenario-Based & Recall
Cardiovascular, Respiratory, Hematologic, Oncology, Shock/Sepsis,
Emergency/Disaster, and Professional Issues
Cognitive Levels: 25% Recall, 55% Application, 20% Analysis
L AT E S T P R A C T I C E T E S T | N S G 3 1 3 0 E X A M 4 R E V I E W
,Section 1: Cardiovascular Disorders 2
Section 2: Respiratory Disorders 9
Section 3: Hematologic and Immunologic Disorders 16
Section 4: Oncology Nursing 21
Section 5: Shock, Sepsis, and Multisystem Dysfunction 26
Section 6: Emergency and Disaster Nursing 30
Section 7: Professional Issues and End-of-Life Care 34
Page 1
,Section 1: Cardiovascular Disorders
Hypertension, CAD, Heart Failure, Valvular Disorders, Peripheral Vascular Disease, and Cardiac Diagnostics (Q1-Q30)
Q1: A 52-year-old African American male is diagnosed with primary (essential) hypertension after repeated readings of
158/96 mmHg. He tells the nurse, "I feel completely fine, so I really don't think I need medication." Which response by
the nurse best reflects understanding of the pathophysiology of primary hypertension?
'Primary hypertension is caused by a specific kidney problem that increases fluid volume.'
'Even without symptoms, persistently elevated pressure damages your blood vessels and increases your risk for
stroke and kidney disease.'
'Since you feel fine, we can hold off on medication and monitor your BP at home for six months.'
'Primary hypertension is mainly caused by stress and will resolve once you reduce your workload.'
Correct Answer: b
Rationale: Primary (essential) hypertension has no single identifiable cause but involves a complex interplay of genetic, vascular, and
neurohormonal factors that progressively increase systemic vascular resistance. The insidious nature of primary hypertension means
patients are often asymptomatic while end-organ damage to the kidneys, heart, brain, and eyes progresses silently. The nurse must educate
the patient that treatment is indicated regardless of symptoms, consistent with ACC/AHA guideline recommendations to reduce
cardiovascular and renal morbidity.
Q2: A 34-year-old female presents to the emergency department with sudden-onset severe headache, diaphoresis, and a
blood pressure of 218/128 mmHg. She reports palpitations and anxiety. Urinary metanephrines are elevated. Which
diagnosis does the nurse anticipate, and which safety intervention is the priority?
Primary hypertension; initiate lifestyle modifications and schedule a follow-up in 3 months.
Hypertensive urgency; administer oral clonidine and discharge with outpatient follow-up.
Pheochromocytoma-induced hypertensive crisis; prepare for IV phentolamine and continuous hemodynamic
monitoring.
Panic attack with secondary hypertension; administer anxiolytics and reassess blood pressure in 1 hour.
Correct Answer: c
Rationale: Elevated urinary metanephrines strongly suggest a pheochromocytoma, a catecholamine-secreting tumor that causes episodic
severe hypertension. This constitutes a hypertensive emergency when end-organ symptoms (severe headache, diaphoresis) are present,
requiring IV alpha-adrenergic blockers such as phentolamine to counteract catecholamine-mediated vasoconstriction. Beta-blockers must
never be given first because unopposed alpha stimulation can worsen vasoconstriction, a critical safety consideration for nursing
management.
Q3: A nurse is providing discharge teaching to a 60-year-old patient with newly diagnosed stage 1 hypertension. The
patient's current BMI is 32, she consumes a high-sodium diet, and she drinks two glasses of wine nightly. Which
statement by the patient indicates the teaching was effective?
'I will switch from table salt to sea salt, which is less harmful to my blood pressure.'
'I should aim to lose about 5% to 10% of my body weight and limit my sodium to less than 1,500 mg per day.'
'Since I'm already on medication, my diet and weight don't really affect my blood pressure much.'
'I'll cut back to one glass of wine per night, which is within safe limits and won't affect my BP.'
Correct Answer: b
Rationale: Non-pharmacologic management of hypertension includes weight reduction (5% to 10% of body weight), sodium restriction to
less than 1,500 mg/day, the DASH diet, and limiting alcohol. Sea salt contains the same amount of sodium as table salt and is a common
misconception among patients. Even when medications are prescribed, lifestyle modifications remain essential because they enhance BP
control and may reduce the number or dose of antihypertensive agents needed.
Q4: A 45-year-old male with hypertension and type 2 diabetes is started on lisinopril. Two weeks later, he reports a
persistent dry cough and swelling of his lips. His serum potassium is 5.6 mEq/L. What is the nurse's priority action?
Instruct the patient to take the medication at bedtime to minimize coughing during the day.
Hold the lisinopril, notify the provider immediately, and assess the patient's airway.
Encourage increased fluid intake to dilute the elevated potassium level.
Reassure the patient that the dry cough is a harmless side effect that typically resolves on its own.
Correct Answer: b
Rationale: Angioedema (lip swelling) is a potentially life-threatening hypersensitivity reaction to ACE inhibitors caused by bradykinin
accumulation, and it requires immediate drug discontinuation and airway assessment. Hyperkalemia (>5.0 mEq/L) is another significant
Page 2
, adverse effect of ACE inhibitors due to decreased aldosterone secretion. Although the dry cough is a common and non-life-threatening
side effect, angioedema takes priority over both the cough and hyperkalemia because of the risk of airway compromise.
Q5: Which statement accurately describes a key difference between primary and secondary hypertension?
Primary hypertension has a sudden onset, whereas secondary hypertension develops gradually over many years.
Primary hypertension accounts for approximately 90% to 95% of all cases and has no identifiable cause, whereas
secondary hypertension results from a specific underlying condition such as renal artery stenosis or Cushing
syndrome.
Secondary hypertension is more common in older adults, while primary hypertension typically affects younger patients
under age 30.
Primary hypertension always requires surgical intervention, whereas secondary hypertension is managed with lifestyle
changes alone.
Correct Answer: b
Rationale: Primary (essential) hypertension comprises 90% to 95% of hypertension cases and is idiopathic, involving complex interactions
among genetic, neurohormonal, and vascular factors. Secondary hypertension accounts for 5% to 10% of cases and has a specific
identifiable cause such as renal artery stenosis, pheochromocytoma, hyperaldosteronism, or Cushing syndrome. Secondary hypertension
often presents with more severe or abrupt elevations, younger age of onset, or resistance to standard therapy, which should prompt further
diagnostic workup.
Q6: A 65-year-old male with a history of hyperlipidemia and smoking presents to the emergency department with
crushing substernal chest pain that began 30 minutes ago. The 12-lead ECG shows ST-segment elevation in leads II, III,
and aVF. The nurse recognizes this pattern indicates which condition and which coronary artery territory?
Anterior wall STEMI involving the left anterior descending artery.
Inferior wall STEMI involving the right coronary artery.
Lateral wall NSTEMI involving the circumflex artery.
Posterior wall STEMI involving the left main coronary artery.
Correct Answer: b
Rationale: ST-segment elevation in leads II, III, and aVF localizes the injury to the inferior wall of the left ventricle, most commonly
supplied by the right coronary artery (RCA). Inferior STEMI is critical to identify because it is frequently associated with right ventricular
involvement, which requires careful hemodynamic management including avoidance of nitroglycerin and large fluid boluses. Time to
reperfusion (PCI or fibrinolytics) is the most important determinant of outcomes in STEMI, making rapid ECG interpretation a core
nursing competency.
Q7: A 58-year-old female tells the nurse she has been experiencing chest discomfort when climbing stairs or walking
uphill for the past 3 months. The discomfort is relieved by rest. Over the past week, the pain has occurred at rest twice,
lasting 15 to 20 minutes each time. The nurse recognizes this change in pattern as which condition, and what is the
priority nursing action?
Stable angina; teach the patient to rest when symptoms occur and take sublingual nitroglycerin as prescribed.
Unstable angina; obtain a 12-lead ECG, initiate continuous cardiac monitoring, and notify the provider
immediately.
Variant (Prinzmetal) angina; administer calcium channel blockers and assess for coronary artery spasm triggers.
Noncardiac chest pain; explore musculoskeletal causes and reassure the patient.
Correct Answer: b
Rationale: The progression from predictable exertional chest pain (stable angina) to rest pain that is more frequent, prolonged, or severe
indicates unstable angina, a form of acute coronary syndrome. Unstable angina reflects ruptured atherosclerotic plaque with partial
thrombus formation and is a medical emergency requiring immediate ECG, cardiac monitoring, and provider notification to determine the
need for antiplatelet therapy, anticoagulation, and possible urgent catheterization. Differentiating stable from unstable angina is a critical
nursing assessment skill that directly affects triage and intervention timing.
Q8: A patient diagnosed with NSTEMI has serial cardiac biomarkers drawn. The initial troponin I is 0.04 ng/mL
(reference < 0.04), and 6 hours later it is 0.32 ng/mL. The patient asks the nurse what this means. Which response is
most accurate?
'Your troponin level is back to normal, which means there is no damage to your heart muscle.'
'The rising troponin level indicates that heart muscle cells have been injured, which helps confirm the diagnosis
of a heart attack.'
'Troponin is only elevated during a STEMI, so these results suggest your diagnosis is incorrect.'
Page 3
