NSG 430 Exam 2 - Adult Health Nursing II |
GCU (Latest 2026/2027) Actual Questions &
Answers (A+ Graded) Chamberlain College
Of Nursing
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
50 exam-style multiple-choice questions. Each question includes the correct answer and a complete rationale
for focused revision.
COVERAGE
This exam assesses advanced application of the nursing process to adults with complex cardiovascular,
respiratory, neurological, endocrine, renal, gastrointestinal, musculoskeletal, perioperative, and critical care
conditions. Items require clinical judgment, prioritization, interpretation of diagnostics, and evidence-based
decision-making consistent with the NCLEX-RN 2026 test plan and QSEN competencies.
STUDY GUIDE
Recommended duration: 2.5 hours. Passing target: 76% (standard for GCU pre-licensure courses).
HIGHP - Page 1 of 17
,1. Which arterial blood gas finding most strongly suggests early acute respiratory distress
syndrome?
[ ] A. pH 7.48, PaCO2 30 mm Hg, PaO2 80 mm Hg on room air
[ ] B. pH 7.30, PaCO2 50 mm Hg, PaO2 60 mm Hg on room air
[ ] C. pH 7.40, PaCO2 40 mm Hg, PaO2 55 mm Hg despite supplemental oxygen
[ ] D. pH 7.25, PaCO2 55 mm Hg, PaO2 90 mm Hg on 2 L nasal cannula
CORRECT: C. pH 7.40, PaCO2 40 mm Hg, PaO2 55 mm Hg despite supplemental oxygen
ARDS is characterized by refractory hypoxemia (PaO2 <60 mm Hg despite increasing FiO2) with an initially
normal or low PaCO2 due to hyperventilation, making option C the best indicator. Options A and B reflect
hyperventilation or hypoventilation without refractory hypoxemia, and D shows hypoxemia with hypercapnia
suggesting a different etiology like opioid-induced hypoventilation.
2. A patient on furosemide for heart failure develops muscle weakness and a new onset of
confusion. Which ECG change is most concerning?
[ ] A. Prominent U waves and flattened T waves
[ ] B. Tall, peaked T waves and widened QRS
[ ] C. ST elevation in contiguous leads
[ ] D. Prolonged PR interval with first-degree block
CORRECT: A. Prominent U waves and flattened T waves
Loop diuretics like furosemide cause hypokalemia, which manifests as flattened T waves, prominent U
waves, and increased risk for dysrhythmias; confusion and weakness are classic symptoms. Tall peaked T
waves and widened QRS indicate hyperkalemia, ST elevation suggests myocardial injury, and first-degree
block can occur with various electrolyte imbalances but is less specific.
3. Which intervention is the priority when a patient with a new tracheostomy exhibits
sudden bleeding from the stoma and respiratory distress?
[ ] A. Suction the tracheostomy and apply direct pressure to the stoma
[ ] B. Hyperinflate the cuff and notify the provider immediately
[ ] C. Remove the tracheostomy tube and insert an oral airway
[ ] D. Administer a nebulized vasoconstrictor and obtain a chest x-ray
CORRECT: B. Hyperinflate the cuff and notify the provider immediately
Bleeding from a tracheostomy stoma with distress may indicate a tracheoinnominate artery fistula, a
life-threatening emergency; hyperinflating the cuff can tamponade the bleeding while emergency help is
summoned. Suctioning and pressure may worsen the bleed, removing the tube risks loss of airway, and
nebulized vasoconstrictors are not first-line for this emergency.
HIGHP - Page 2 of 17
, 4. Which finding in a patient with acute pancreatitis indicates the highest priority for
nursing intervention?
[ ] A. Serum lipase 450 U/L and amylase 600 U/L
[ ] B. Grey Turner's sign and Cullen's sign
[ ] C. Heart rate 112 beats/min and blood pressure 88/50 mm Hg
[ ] D. Nausea and vomiting with a distended abdomen
CORRECT: C. Heart rate 112 beats/min and blood pressure 88/50 mm Hg
Tachycardia and hypotension suggest hypovolemic shock from third-spacing and possible hemorrhage,
requiring immediate fluid resuscitation and monitoring; this is the most life-threatening. Elevated enzymes
confirm pancreatitis but do not dictate immediate action, Grey Turner's and Cullen's signs indicate
retroperitoneal bleeding but are not as acutely actionable, and nausea/vomiting are expected symptoms.
5. Which assessment finding best differentiates myasthenic crisis from cholinergic crisis
in a patient with myasthenia gravis?
[ ] A. Profound muscle weakness with respiratory compromise
[ ] B. Miosis, salivation, and bradycardia
[ ] C. Improved strength after edrophonium administration
[ ] D. Diplopia and ptosis worsening throughout the day
CORRECT: B. Miosis, salivation, and bradycardia
Cholinergic crisis results from excessive anticholinesterase medication and presents with muscarinic
symptoms like miosis, salivation, and bradycardia; myasthenic crisis lacks these. Profound weakness and
respiratory compromise occur in both, edrophonium improves myasthenic but not cholinergic crisis, and
diplopia/ptosis are general myasthenia symptoms.
6. Which laboratory result in a patient receiving total parenteral nutrition requires
immediate action?
[ ] A. Serum glucose 185 mg/dL
[ ] B. Serum potassium 3.2 mEq/L
[ ] C. Serum sodium 138 mEq/L
[ ] D. Serum phosphorus 1.0 mg/dL
CORRECT: D. Serum phosphorus 1.0 mg/dL
Severe hypophosphatemia (1.0 mg/dL) can cause respiratory failure, cardiac dysfunction, and
rhabdomyolysis, requiring immediate replacement; refeeding syndrome is a common cause in TPN patients.
Glucose 185 is mild hyperglycemia, potassium 3.2 is borderline low, and sodium 138 is normal.
HIGHP - Page 3 of 17
GCU (Latest 2026/2027) Actual Questions &
Answers (A+ Graded) Chamberlain College
Of Nursing
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
50 exam-style multiple-choice questions. Each question includes the correct answer and a complete rationale
for focused revision.
COVERAGE
This exam assesses advanced application of the nursing process to adults with complex cardiovascular,
respiratory, neurological, endocrine, renal, gastrointestinal, musculoskeletal, perioperative, and critical care
conditions. Items require clinical judgment, prioritization, interpretation of diagnostics, and evidence-based
decision-making consistent with the NCLEX-RN 2026 test plan and QSEN competencies.
STUDY GUIDE
Recommended duration: 2.5 hours. Passing target: 76% (standard for GCU pre-licensure courses).
HIGHP - Page 1 of 17
,1. Which arterial blood gas finding most strongly suggests early acute respiratory distress
syndrome?
[ ] A. pH 7.48, PaCO2 30 mm Hg, PaO2 80 mm Hg on room air
[ ] B. pH 7.30, PaCO2 50 mm Hg, PaO2 60 mm Hg on room air
[ ] C. pH 7.40, PaCO2 40 mm Hg, PaO2 55 mm Hg despite supplemental oxygen
[ ] D. pH 7.25, PaCO2 55 mm Hg, PaO2 90 mm Hg on 2 L nasal cannula
CORRECT: C. pH 7.40, PaCO2 40 mm Hg, PaO2 55 mm Hg despite supplemental oxygen
ARDS is characterized by refractory hypoxemia (PaO2 <60 mm Hg despite increasing FiO2) with an initially
normal or low PaCO2 due to hyperventilation, making option C the best indicator. Options A and B reflect
hyperventilation or hypoventilation without refractory hypoxemia, and D shows hypoxemia with hypercapnia
suggesting a different etiology like opioid-induced hypoventilation.
2. A patient on furosemide for heart failure develops muscle weakness and a new onset of
confusion. Which ECG change is most concerning?
[ ] A. Prominent U waves and flattened T waves
[ ] B. Tall, peaked T waves and widened QRS
[ ] C. ST elevation in contiguous leads
[ ] D. Prolonged PR interval with first-degree block
CORRECT: A. Prominent U waves and flattened T waves
Loop diuretics like furosemide cause hypokalemia, which manifests as flattened T waves, prominent U
waves, and increased risk for dysrhythmias; confusion and weakness are classic symptoms. Tall peaked T
waves and widened QRS indicate hyperkalemia, ST elevation suggests myocardial injury, and first-degree
block can occur with various electrolyte imbalances but is less specific.
3. Which intervention is the priority when a patient with a new tracheostomy exhibits
sudden bleeding from the stoma and respiratory distress?
[ ] A. Suction the tracheostomy and apply direct pressure to the stoma
[ ] B. Hyperinflate the cuff and notify the provider immediately
[ ] C. Remove the tracheostomy tube and insert an oral airway
[ ] D. Administer a nebulized vasoconstrictor and obtain a chest x-ray
CORRECT: B. Hyperinflate the cuff and notify the provider immediately
Bleeding from a tracheostomy stoma with distress may indicate a tracheoinnominate artery fistula, a
life-threatening emergency; hyperinflating the cuff can tamponade the bleeding while emergency help is
summoned. Suctioning and pressure may worsen the bleed, removing the tube risks loss of airway, and
nebulized vasoconstrictors are not first-line for this emergency.
HIGHP - Page 2 of 17
, 4. Which finding in a patient with acute pancreatitis indicates the highest priority for
nursing intervention?
[ ] A. Serum lipase 450 U/L and amylase 600 U/L
[ ] B. Grey Turner's sign and Cullen's sign
[ ] C. Heart rate 112 beats/min and blood pressure 88/50 mm Hg
[ ] D. Nausea and vomiting with a distended abdomen
CORRECT: C. Heart rate 112 beats/min and blood pressure 88/50 mm Hg
Tachycardia and hypotension suggest hypovolemic shock from third-spacing and possible hemorrhage,
requiring immediate fluid resuscitation and monitoring; this is the most life-threatening. Elevated enzymes
confirm pancreatitis but do not dictate immediate action, Grey Turner's and Cullen's signs indicate
retroperitoneal bleeding but are not as acutely actionable, and nausea/vomiting are expected symptoms.
5. Which assessment finding best differentiates myasthenic crisis from cholinergic crisis
in a patient with myasthenia gravis?
[ ] A. Profound muscle weakness with respiratory compromise
[ ] B. Miosis, salivation, and bradycardia
[ ] C. Improved strength after edrophonium administration
[ ] D. Diplopia and ptosis worsening throughout the day
CORRECT: B. Miosis, salivation, and bradycardia
Cholinergic crisis results from excessive anticholinesterase medication and presents with muscarinic
symptoms like miosis, salivation, and bradycardia; myasthenic crisis lacks these. Profound weakness and
respiratory compromise occur in both, edrophonium improves myasthenic but not cholinergic crisis, and
diplopia/ptosis are general myasthenia symptoms.
6. Which laboratory result in a patient receiving total parenteral nutrition requires
immediate action?
[ ] A. Serum glucose 185 mg/dL
[ ] B. Serum potassium 3.2 mEq/L
[ ] C. Serum sodium 138 mEq/L
[ ] D. Serum phosphorus 1.0 mg/dL
CORRECT: D. Serum phosphorus 1.0 mg/dL
Severe hypophosphatemia (1.0 mg/dL) can cause respiratory failure, cardiac dysfunction, and
rhabdomyolysis, requiring immediate replacement; refeeding syndrome is a common cause in TPN patients.
Glucose 185 is mild hyperglycemia, potassium 3.2 is borderline low, and sodium 138 is normal.
HIGHP - Page 3 of 17
