,NSG 2610 Exam 1 Adult Health Nursing II Questions And Answers
2026/2027 South College
Q1. A 67-year-old client with diabetes and chronic kidney disease
arrives at the emergency department with unusual fatigue, nausea,
diaphoresis, and increasing shortness of breath. The client denies
chest pain. Electrocardiography reveals new ischemic changes.
Which clinical interpretation is most appropriate?
A) The absence of chest pain excludes myocardial ischemia.
B) The symptoms are caused exclusively by chronic kidney disease.
C) Myocardial infarction should be considered despite the absence of typical
chest discomfort.
D) Acute coronary syndrome occurs only in clients with crushing chest pain.
Correct Answer: C) Myocardial infarction should be considered despite the
absence of typical chest discomfort.
Rationale: Acute coronary syndrome may present with atypical or non-chest-
pain symptoms, particularly in older adults and clients with diabetes or
chronic kidney disease. Dyspnea, diaphoresis, nausea, and unexplained
fatigue can indicate myocardial ischemia. Prompt electrocardiographic
assessment, serial troponin measurements, and evaluation for acute
coronary syndrome are necessary.
Q2. A 59-year-old client reports severe substernal chest pressure
lasting 45 minutes. The electrocardiogram demonstrates ST-
segment elevation in leads V2–V5 with reciprocal ST depression in
the inferior leads. Which coronary artery is most likely involved?
A) Left anterior descending coronary artery
B) Right coronary artery supplying the inferior wall
C) Left circumflex artery supplying the lateral wall exclusively
D) Posterior descending artery supplying the posterior wall exclusively
Correct Answer: A) Left anterior descending coronary artery
Rationale: ST elevation in anterior precordial leads suggests acute anterior
myocardial injury, commonly associated with left anterior descending
coronary artery occlusion. Reciprocal ST depression strengthens concern for
,acute coronary occlusion. Rapid reperfusion is essential to reduce myocardial
damage and complications.
Q3. A 64-year-old client with acute coronary syndrome has elevated
high-sensitivity cardiac troponin levels and horizontal ST depression
in leads V4–V6. No persistent ST elevation is present. Which
diagnosis is most consistent with the findings?
A) Uncomplicated stable angina
B) Acute pericarditis
C) Normal cardiac electrical activity
D) Non-ST-elevation myocardial infarction
Correct Answer: D) Non-ST-elevation myocardial infarction
Rationale: Non-ST-elevation myocardial infarction involves acute myocardial
injury with evidence of ischemia without persistent diagnostic ST elevation.
Troponin elevation supports myocardial injury, while ischemic symptoms or
electrocardiographic changes support infarction. Treatment may include
antithrombotic therapy, anti-ischemic interventions, and risk-guided invasive
evaluation.
Q4. A 71-year-old client with chest discomfort has high-sensitivity
troponin concentrations of 28 ng/L, 74 ng/L, and 183 ng/L over
successive measurements. The reference limit is 14 ng/L. Which
interpretation is most appropriate?
A) A single elevated troponin value always confirms coronary artery
occlusion.
B) The rising troponin pattern indicates acute myocardial injury and requires
correlation with ischemic evidence to diagnose myocardial infarction.
C) The values exclude myocardial injury.
D) Troponin measurements cannot change during acute cardiac illness.
Correct Answer: B) The rising troponin pattern indicates acute myocardial
injury and requires correlation with ischemic evidence to diagnose
myocardial infarction.
Rationale: A rise or fall in cardiac troponin indicates acute myocardial injury
when values exceed the assay's upper reference limit. Myocardial infarction
additionally requires clinical evidence of ischemia. Elevated troponin can also
, occur with myocarditis, pulmonary embolism, severe heart failure, and other
conditions.
Q5. A 62-year-old client is diagnosed with ST-elevation myocardial
infarction. The client arrives at a hospital capable of immediate
percutaneous coronary intervention. Which intervention has the
greatest priority for limiting myocardial necrosis?
A) Waiting for troponin concentrations to peak
B) Performing elective exercise stress testing
C) Prompt coronary reperfusion through primary percutaneous coronary
intervention
D) Administering long-term oral diuretics before evaluating coronary blood
flow
Correct Answer: C) Prompt coronary reperfusion through primary
percutaneous coronary intervention
Rationale: Acute ST-elevation myocardial infarction frequently results from
coronary artery occlusion. Timely reperfusion restores myocardial blood flow,
limits the extent of ischemic necrosis, and improves survival. Reperfusion
decisions should not be delayed for peak cardiac biomarker results.
Q6. A 58-year-old client with suspected acute myocardial infarction
is prescribed sublingual nitroglycerin. Blood pressure is 82/48
mmHg, and the client reports dizziness. Which nursing action is
most appropriate?
A) Administer nitroglycerin immediately because hypotension is expected.
B) Increase the prescribed nitroglycerin dose.
C) Encourage the client to stand before medication administration.
D) Withhold nitroglycerin and promptly report the hypotension for further
hemodynamic assessment.
Correct Answer: D) Withhold nitroglycerin and promptly report the
hypotension for further hemodynamic assessment.
Rationale: Nitroglycerin reduces venous return and myocardial oxygen
demand through vasodilation. In a hypotensive client, additional preload
reduction can worsen coronary perfusion and circulatory instability.
2026/2027 South College
Q1. A 67-year-old client with diabetes and chronic kidney disease
arrives at the emergency department with unusual fatigue, nausea,
diaphoresis, and increasing shortness of breath. The client denies
chest pain. Electrocardiography reveals new ischemic changes.
Which clinical interpretation is most appropriate?
A) The absence of chest pain excludes myocardial ischemia.
B) The symptoms are caused exclusively by chronic kidney disease.
C) Myocardial infarction should be considered despite the absence of typical
chest discomfort.
D) Acute coronary syndrome occurs only in clients with crushing chest pain.
Correct Answer: C) Myocardial infarction should be considered despite the
absence of typical chest discomfort.
Rationale: Acute coronary syndrome may present with atypical or non-chest-
pain symptoms, particularly in older adults and clients with diabetes or
chronic kidney disease. Dyspnea, diaphoresis, nausea, and unexplained
fatigue can indicate myocardial ischemia. Prompt electrocardiographic
assessment, serial troponin measurements, and evaluation for acute
coronary syndrome are necessary.
Q2. A 59-year-old client reports severe substernal chest pressure
lasting 45 minutes. The electrocardiogram demonstrates ST-
segment elevation in leads V2–V5 with reciprocal ST depression in
the inferior leads. Which coronary artery is most likely involved?
A) Left anterior descending coronary artery
B) Right coronary artery supplying the inferior wall
C) Left circumflex artery supplying the lateral wall exclusively
D) Posterior descending artery supplying the posterior wall exclusively
Correct Answer: A) Left anterior descending coronary artery
Rationale: ST elevation in anterior precordial leads suggests acute anterior
myocardial injury, commonly associated with left anterior descending
coronary artery occlusion. Reciprocal ST depression strengthens concern for
,acute coronary occlusion. Rapid reperfusion is essential to reduce myocardial
damage and complications.
Q3. A 64-year-old client with acute coronary syndrome has elevated
high-sensitivity cardiac troponin levels and horizontal ST depression
in leads V4–V6. No persistent ST elevation is present. Which
diagnosis is most consistent with the findings?
A) Uncomplicated stable angina
B) Acute pericarditis
C) Normal cardiac electrical activity
D) Non-ST-elevation myocardial infarction
Correct Answer: D) Non-ST-elevation myocardial infarction
Rationale: Non-ST-elevation myocardial infarction involves acute myocardial
injury with evidence of ischemia without persistent diagnostic ST elevation.
Troponin elevation supports myocardial injury, while ischemic symptoms or
electrocardiographic changes support infarction. Treatment may include
antithrombotic therapy, anti-ischemic interventions, and risk-guided invasive
evaluation.
Q4. A 71-year-old client with chest discomfort has high-sensitivity
troponin concentrations of 28 ng/L, 74 ng/L, and 183 ng/L over
successive measurements. The reference limit is 14 ng/L. Which
interpretation is most appropriate?
A) A single elevated troponin value always confirms coronary artery
occlusion.
B) The rising troponin pattern indicates acute myocardial injury and requires
correlation with ischemic evidence to diagnose myocardial infarction.
C) The values exclude myocardial injury.
D) Troponin measurements cannot change during acute cardiac illness.
Correct Answer: B) The rising troponin pattern indicates acute myocardial
injury and requires correlation with ischemic evidence to diagnose
myocardial infarction.
Rationale: A rise or fall in cardiac troponin indicates acute myocardial injury
when values exceed the assay's upper reference limit. Myocardial infarction
additionally requires clinical evidence of ischemia. Elevated troponin can also
, occur with myocarditis, pulmonary embolism, severe heart failure, and other
conditions.
Q5. A 62-year-old client is diagnosed with ST-elevation myocardial
infarction. The client arrives at a hospital capable of immediate
percutaneous coronary intervention. Which intervention has the
greatest priority for limiting myocardial necrosis?
A) Waiting for troponin concentrations to peak
B) Performing elective exercise stress testing
C) Prompt coronary reperfusion through primary percutaneous coronary
intervention
D) Administering long-term oral diuretics before evaluating coronary blood
flow
Correct Answer: C) Prompt coronary reperfusion through primary
percutaneous coronary intervention
Rationale: Acute ST-elevation myocardial infarction frequently results from
coronary artery occlusion. Timely reperfusion restores myocardial blood flow,
limits the extent of ischemic necrosis, and improves survival. Reperfusion
decisions should not be delayed for peak cardiac biomarker results.
Q6. A 58-year-old client with suspected acute myocardial infarction
is prescribed sublingual nitroglycerin. Blood pressure is 82/48
mmHg, and the client reports dizziness. Which nursing action is
most appropriate?
A) Administer nitroglycerin immediately because hypotension is expected.
B) Increase the prescribed nitroglycerin dose.
C) Encourage the client to stand before medication administration.
D) Withhold nitroglycerin and promptly report the hypotension for further
hemodynamic assessment.
Correct Answer: D) Withhold nitroglycerin and promptly report the
hypotension for further hemodynamic assessment.
Rationale: Nitroglycerin reduces venous return and myocardial oxygen
demand through vasodilation. In a hypotensive client, additional preload
reduction can worsen coronary perfusion and circulatory instability.
