Comprehensive NSG 3250 Adult Health 3 Exam 2
Review | 250 Practice Questions, Verified Answers, and
Rationales (Galen College of Nursing
SECTION II: CARDIOVASCULAR DISORDERS (Questions 1–35)
1. The nurse is caring for a patient admitted with acute decompensated heart
failure. Which assessment finding requires the most immediate intervention?
A) Bibasilar crackles
B) Jugular venous distention
C) Pink, frothy sputum
D) 2+ pitting edema in the lower extremities
Correct Answer: C) Pink, frothy sputum
Rationale: Pink, frothy sputum is a hallmark sign of acute pulmonary
edema and flash pulmonary edema, indicating that fluid has rapidly flooded the
alveoli. This is a life-threatening emergency requiring immediate intervention,
typically including high-flow oxygen, IV furosemide, morphine, and possibly
noninvasive positive-pressure ventilation. While bibasilar crackles (A), JVD (B), and
peripheral edema (D) are all signs of heart failure, they represent chronic or
gradual decompensation rather than the acute, immediate threat to airway and
oxygenation posed by pink frothy sputum.
2. A patient with heart failure is prescribed furosemide 40 mg IV twice daily.
Which laboratory value should the nurse prioritize reviewing before
administration?
A) Serum sodium
B) Serum calcium
C) Serum potassium
D) Serum magnesium
Correct Answer: C) Serum potassium
Rationale: Furosemide is a loop diuretic that causes significant potassium
excretion along with water and sodium. Administering furosemide to a patient
,with pre-existing hypokalemia can precipitate life-threatening cardiac
arrhythmias, including ventricular tachycardia and fibrillation. The nurse must
verify that the potassium level is within a safe range (typically 3.5–5.0 mEq/L)
before administering the dose. While sodium (A), calcium (B), and magnesium (D)
are also affected by diuretic therapy, potassium is the most immediately life-
threatening electrolyte disturbance.
3. A patient presents with chest pain radiating to the left arm and jaw. The 12-
lead ECG shows ST elevation in leads II, III, and aVF. The nurse understands that
this represents an infarction of which area of the heart?
A) Anterior wall
B) Lateral wall
C) Inferior wall
D) Posterior wall
Correct Answer: C) Inferior wall
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction. These leads view the inferior surface of the heart, which is
supplied by the right coronary artery in approximately 80% of patients. Inferior
wall MIs are associated with a high risk of bradycardia and heart block due to the
involvement of the AV node. Anterior wall MIs (A) appear in V1–V4, lateral wall
MIs (B) in I, aVL, V5–V6, and posterior wall MIs (D) are suggested by reciprocal ST
depression in V1–V2.
4. (SATA) The nurse is providing discharge teaching to a patient with newly
diagnosed heart failure. Which statements by the patient indicate correct
understanding of self-management? Select all that apply.
A) "I will weigh myself every morning before breakfast."
B) "I will call my doctor if I gain 2 pounds in one day."
C) "I should limit my fluid intake to 1 liter per day."
D) "I will take my diuretic in the morning to avoid waking up at night."
E) "I can continue to use my NSAID for my arthritis pain."
Correct Answers: A, B, D
, Rationale: Daily weight monitoring (A) is the single most reliable indicator
of fluid status in heart failure patients—a weight gain of 2–3 pounds in one day or
5 pounds in one week requires provider notification (B). Taking diuretics in the
morning (D) prevents nocturia and sleep disruption. Option C is incorrect because
fluid restriction for heart failure is typically 1.5–2 liters per day, not 1 liter, unless
specifically ordered. Option E is incorrect because NSAIDs cause sodium and
water retention, worsening heart failure.
5. The nurse is caring for a patient receiving digoxin for heart failure. Which
assessment finding suggests digoxin toxicity?
A) Heart rate of 88 beats per minute
B) Anorexia and nausea
C) Blood pressure of 118/76 mmHg
D) Increased urine output
Correct Answer: B) Anorexia and nausea
Rationale: Anorexia, nausea, and vomiting are among the earliest and
most common signs of digoxin toxicity, occurring before cardiac arrhythmias
become evident. The therapeutic range for digoxin is narrow (0.5–2.0 ng/mL in
heart failure, with recent guidelines suggesting 0.5–0.9 ng/mL for HF). Other early
signs include visual disturbances (yellow-green halos), confusion, and bradycardia.
A normal heart rate (A) and blood pressure (C) do not indicate toxicity, and
increased urine output (D) is a therapeutic effect of digoxin's positive inotropic
action.
6. A patient is admitted with a potassium level of 6.2 mEq/L. Which ECG change
should the nurse expect to observe?
A) Prominent U waves
B) ST-segment depression
C) Shortened QT interval
D) Tall, peaked T waves
Correct Answer: D) Tall, peaked T waves
Rationale: Hyperkalemia (potassium >5.0 mEq/L) significantly affects
cardiac conduction. Tall, peaked T waves are one of the earliest and most
, characteristic ECG signs. As potassium levels continue to rise, the PR interval
lengthens, the QRS complex widens, and the pattern may progress to a sine wave
pattern and cardiac arrest. Prominent U waves (A) are associated with
hypokalemia, not hyperkalemia. ST depression (B) can be seen in hypokalemia or
ischemia, and a shortened QT interval (C) is associated with hypercalcemia.
7. The nurse is preparing to administer IV furosemide to a patient with acute
pulmonary edema. Which action should the nurse take first?
A) Assess the patient's blood pressure
B) Administer the medication rapidly as a bolus
C) Place the patient in high-Fowler's position
D) Insert an indwelling urinary catheter
Correct Answer: C) Place the patient in high-Fowler's position
Rationale: Positioning the patient in high-Fowler's position (90 degrees) is
an immediate, non-pharmacological intervention that reduces venous return to
the heart and decreases preload, improving respiratory effort. This should be
done first because it requires no physician order and provides immediate
symptomatic relief. Blood pressure assessment (A) is important but does not
precede the positioning intervention. Administering furosemide (B) requires a
patent IV and a physician order, and catheter insertion (D) is not an immediate
priority.
8. A patient who underwent a total hip arthroplasty 24 hours ago reports sudden
chest pain and shortness of breath. Which complication should the nurse suspect
first?
A) Myocardial infarction
B) Pneumonia
C) Atelectasis
D) Pulmonary embolism
Correct Answer: D) Pulmonary embolism
Rationale: Postoperative orthopedic patients are at high risk for venous
thromboembolism due to immobility, surgical trauma to blood vessels, and
hypercoagulability. The sudden onset of dyspnea and chest pain 24 hours
Review | 250 Practice Questions, Verified Answers, and
Rationales (Galen College of Nursing
SECTION II: CARDIOVASCULAR DISORDERS (Questions 1–35)
1. The nurse is caring for a patient admitted with acute decompensated heart
failure. Which assessment finding requires the most immediate intervention?
A) Bibasilar crackles
B) Jugular venous distention
C) Pink, frothy sputum
D) 2+ pitting edema in the lower extremities
Correct Answer: C) Pink, frothy sputum
Rationale: Pink, frothy sputum is a hallmark sign of acute pulmonary
edema and flash pulmonary edema, indicating that fluid has rapidly flooded the
alveoli. This is a life-threatening emergency requiring immediate intervention,
typically including high-flow oxygen, IV furosemide, morphine, and possibly
noninvasive positive-pressure ventilation. While bibasilar crackles (A), JVD (B), and
peripheral edema (D) are all signs of heart failure, they represent chronic or
gradual decompensation rather than the acute, immediate threat to airway and
oxygenation posed by pink frothy sputum.
2. A patient with heart failure is prescribed furosemide 40 mg IV twice daily.
Which laboratory value should the nurse prioritize reviewing before
administration?
A) Serum sodium
B) Serum calcium
C) Serum potassium
D) Serum magnesium
Correct Answer: C) Serum potassium
Rationale: Furosemide is a loop diuretic that causes significant potassium
excretion along with water and sodium. Administering furosemide to a patient
,with pre-existing hypokalemia can precipitate life-threatening cardiac
arrhythmias, including ventricular tachycardia and fibrillation. The nurse must
verify that the potassium level is within a safe range (typically 3.5–5.0 mEq/L)
before administering the dose. While sodium (A), calcium (B), and magnesium (D)
are also affected by diuretic therapy, potassium is the most immediately life-
threatening electrolyte disturbance.
3. A patient presents with chest pain radiating to the left arm and jaw. The 12-
lead ECG shows ST elevation in leads II, III, and aVF. The nurse understands that
this represents an infarction of which area of the heart?
A) Anterior wall
B) Lateral wall
C) Inferior wall
D) Posterior wall
Correct Answer: C) Inferior wall
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction. These leads view the inferior surface of the heart, which is
supplied by the right coronary artery in approximately 80% of patients. Inferior
wall MIs are associated with a high risk of bradycardia and heart block due to the
involvement of the AV node. Anterior wall MIs (A) appear in V1–V4, lateral wall
MIs (B) in I, aVL, V5–V6, and posterior wall MIs (D) are suggested by reciprocal ST
depression in V1–V2.
4. (SATA) The nurse is providing discharge teaching to a patient with newly
diagnosed heart failure. Which statements by the patient indicate correct
understanding of self-management? Select all that apply.
A) "I will weigh myself every morning before breakfast."
B) "I will call my doctor if I gain 2 pounds in one day."
C) "I should limit my fluid intake to 1 liter per day."
D) "I will take my diuretic in the morning to avoid waking up at night."
E) "I can continue to use my NSAID for my arthritis pain."
Correct Answers: A, B, D
, Rationale: Daily weight monitoring (A) is the single most reliable indicator
of fluid status in heart failure patients—a weight gain of 2–3 pounds in one day or
5 pounds in one week requires provider notification (B). Taking diuretics in the
morning (D) prevents nocturia and sleep disruption. Option C is incorrect because
fluid restriction for heart failure is typically 1.5–2 liters per day, not 1 liter, unless
specifically ordered. Option E is incorrect because NSAIDs cause sodium and
water retention, worsening heart failure.
5. The nurse is caring for a patient receiving digoxin for heart failure. Which
assessment finding suggests digoxin toxicity?
A) Heart rate of 88 beats per minute
B) Anorexia and nausea
C) Blood pressure of 118/76 mmHg
D) Increased urine output
Correct Answer: B) Anorexia and nausea
Rationale: Anorexia, nausea, and vomiting are among the earliest and
most common signs of digoxin toxicity, occurring before cardiac arrhythmias
become evident. The therapeutic range for digoxin is narrow (0.5–2.0 ng/mL in
heart failure, with recent guidelines suggesting 0.5–0.9 ng/mL for HF). Other early
signs include visual disturbances (yellow-green halos), confusion, and bradycardia.
A normal heart rate (A) and blood pressure (C) do not indicate toxicity, and
increased urine output (D) is a therapeutic effect of digoxin's positive inotropic
action.
6. A patient is admitted with a potassium level of 6.2 mEq/L. Which ECG change
should the nurse expect to observe?
A) Prominent U waves
B) ST-segment depression
C) Shortened QT interval
D) Tall, peaked T waves
Correct Answer: D) Tall, peaked T waves
Rationale: Hyperkalemia (potassium >5.0 mEq/L) significantly affects
cardiac conduction. Tall, peaked T waves are one of the earliest and most
, characteristic ECG signs. As potassium levels continue to rise, the PR interval
lengthens, the QRS complex widens, and the pattern may progress to a sine wave
pattern and cardiac arrest. Prominent U waves (A) are associated with
hypokalemia, not hyperkalemia. ST depression (B) can be seen in hypokalemia or
ischemia, and a shortened QT interval (C) is associated with hypercalcemia.
7. The nurse is preparing to administer IV furosemide to a patient with acute
pulmonary edema. Which action should the nurse take first?
A) Assess the patient's blood pressure
B) Administer the medication rapidly as a bolus
C) Place the patient in high-Fowler's position
D) Insert an indwelling urinary catheter
Correct Answer: C) Place the patient in high-Fowler's position
Rationale: Positioning the patient in high-Fowler's position (90 degrees) is
an immediate, non-pharmacological intervention that reduces venous return to
the heart and decreases preload, improving respiratory effort. This should be
done first because it requires no physician order and provides immediate
symptomatic relief. Blood pressure assessment (A) is important but does not
precede the positioning intervention. Administering furosemide (B) requires a
patent IV and a physician order, and catheter insertion (D) is not an immediate
priority.
8. A patient who underwent a total hip arthroplasty 24 hours ago reports sudden
chest pain and shortness of breath. Which complication should the nurse suspect
first?
A) Myocardial infarction
B) Pneumonia
C) Atelectasis
D) Pulmonary embolism
Correct Answer: D) Pulmonary embolism
Rationale: Postoperative orthopedic patients are at high risk for venous
thromboembolism due to immobility, surgical trauma to blood vessels, and
hypercoagulability. The sudden onset of dyspnea and chest pain 24 hours
