NR 341/ NR341 COMPLEX ADULT HEALTH
EXAM 1 LATEST REAL EXAM QUESTIONS AND
CORRECT ANSWERS|AGRADE
Course
NR 341/ NR341 COMPLEX ADULT HEALTH
Question 1
A 68‐year‐old male with a history of systolic heart failure is admitted with worsening dyspnea
and fatigue. Which medication is considered first‐line to reduce afterload and improve long‐
term survival in such patients?
A. Beta-blockers
B. ACE inhibitors
C. Calcium channel blockers
D. Loop diuretics
Correct Answer: B. ACE inhibitors
Rationale: ACE inhibitors decrease afterload and have proven mortality benefits in systolic
heart failure. Although beta-blockers and diuretics are also important, ACE inhibitors are key for
long‐term improvement.
Question 2
A patient presents to the emergency department with crushing chest pain and an ECG showing
ST-elevation in the anterior leads. If a percutaneous coronary intervention (PCI) cannot be
performed within 120 minutes, what is the most appropriate next step in management?
A. Initiate high-dose beta-blocker therapy
B. Begin thrombolytic therapy
C. Schedule an elective angiography
D. Monitor and repeat ECG in 6 hours
Correct Answer: B. Begin thrombolytic therapy
Rationale: Timely reperfusion is critical in STEMI. If PCI is unavailable within the
recommended window, thrombolytic therapy should be administered promptly to restore
coronary perfusion.
Question 3
A 72-year-old patient with severe COPD is admitted for an acute exacerbation. Which
intervention must be administered with caution to avoid precipitating CO₂ retention?
,A. Supplemental oxygen therapy
B. Non-invasive positive pressure ventilation
C. Systemic corticosteroids
D. Broad-spectrum antibiotics
Correct Answer: A. Supplemental oxygen therapy
Rationale: In COPD patients, excessive oxygen administration can diminish their respiratory
drive and worsen CO₂ retention. Oxygen should be titrated carefully to maintain target
saturations.
Question 4
A 55-year-old patient with type 2 diabetes presents with signs of diabetic ketoacidosis (DKA).
Despite an initial presentation of hyperkalemia, what electrolyte abnormality becomes critical to
monitor and correct once insulin therapy is started?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypocalcemia
Correct Answer: C. Hypokalemia
Rationale: Insulin drives potassium into cells, and without proper monitoring, serum levels can
drop precipitously, leading to life-threatening arrhythmias. Thus, potassium replacement is vital
during DKA management.
Question 5
In acute ischemic stroke management, the window for safely administering tissue plasminogen
activator (tPA) is generally within:
A. 1 hour of symptom onset
B. 3 to 4.5 hours of symptom onset
C. 6 hours of symptom onset
D. 12 hours of symptom onset
Correct Answer: B. 3 to 4.5 hours of symptom onset
Rationale: Current guidelines recommend administering tPA within 3 to 4.5 hours after
symptom onset for eligible patients, with some protocols advocating treatment as soon as
possible within that window.
,Question 6
A patient with advanced chronic kidney disease presents with a serum potassium of 6.2 mEq/L
and ECG changes indicative of hyperkalemia. What is the most immediate nursing intervention?
A. Initiate emergent hemodialysis
B. Administer intravenous calcium gluconate
C. Begin treatment with potassium-binding resins
D. Start a loop diuretic infusion
Correct Answer: B. Administer intravenous calcium gluconate
Rationale: IV calcium gluconate is used immediately to stabilize the cardiac membranes in
life-threatening hyperkalemia. Further measures to reduce potassium levels follow stabilization.
Question 7
A 60-year-old patient with sepsis secondary to pneumonia is admitted to the ICU. Early
goal-directed therapy for sepsis emphasizes which of the following interventions?
A. High-dose corticosteroids
B. Immediate broad-spectrum antibiotics and aggressive fluid resuscitation
C. Urgent surgical drainage
D. Conservative management with observation
Correct Answer: B. Immediate broad-spectrum antibiotics and aggressive fluid resuscitation
Rationale: Early identification and treatment with antibiotics plus fluid resuscitation are
cornerstones of sepsis management and have been shown to improve outcomes.
Question 8
When managing postoperative pain in a patient with a history of opioid addiction, which strategy
is most appropriate?
A. Administer high doses of opioids for complete pain relief
B. Utilize multimodal pain management strategies including non-opioid medications
C. Rely solely on non-pharmacological interventions
D. Avoid all pain medications to prevent triggering addiction
Correct Answer: B. Utilize multimodal pain management strategies including non-opioid
medications
Rationale: A multimodal approach allows effective pain control while minimizing opioid use,
which is essential for patients with a history of addiction.
, Question 9
Polypharmacy poses significant risks for adverse drug events in elderly patients. What strategy is
most effective in minimizing these risks?
A. Increasing doses of all prescribed medications
B. Regularly reviewing and reconciling the medication list
C. Encouraging patients to self‐medicate based on previous experience
D. Eliminating all medications regardless of the clinical indication
Correct Answer: B. Regularly reviewing and reconciling the medication list
Rationale: Routine medication review helps identify potential drug interactions, duplications,
and unnecessary therapies, reducing the risk of adverse events.
Question 10
In end-of-life care for a patient with advanced chronic illness, which approach best respects
patient autonomy?
A. Implement aggressive life-sustaining treatments without consulting the patient
B. Engage in shared decision-making with the patient and family regarding care options
C. Withhold prognostic information to avoid causing distress
D. Allow family members to make decisions without patient input
Correct Answer: B. Engage in shared decision-making with the patient and family regarding
care options
Rationale: Shared decision-making respects patient autonomy by incorporating the patient’s
values and preferences into the care plan, especially during complex end-of-life decisions.
Question 11
In the management of acute respiratory distress syndrome (ARDS), which ventilator strategy is
recommended to minimize ventilator-induced lung injury?
A. High tidal volume ventilation
B. Low tidal volume ventilation
C. Rapid respiratory rate ventilation
D. No positive end-expiratory pressure (PEEP)
Correct Answer: B. Low tidal volume ventilation
Rationale: Using low tidal volumes (approximately 6 mL/kg of ideal body weight) minimizes
overdistention of alveoli, thereby reducing ventilator-induced lung injury and improving survival
in ARDS patients.
EXAM 1 LATEST REAL EXAM QUESTIONS AND
CORRECT ANSWERS|AGRADE
Course
NR 341/ NR341 COMPLEX ADULT HEALTH
Question 1
A 68‐year‐old male with a history of systolic heart failure is admitted with worsening dyspnea
and fatigue. Which medication is considered first‐line to reduce afterload and improve long‐
term survival in such patients?
A. Beta-blockers
B. ACE inhibitors
C. Calcium channel blockers
D. Loop diuretics
Correct Answer: B. ACE inhibitors
Rationale: ACE inhibitors decrease afterload and have proven mortality benefits in systolic
heart failure. Although beta-blockers and diuretics are also important, ACE inhibitors are key for
long‐term improvement.
Question 2
A patient presents to the emergency department with crushing chest pain and an ECG showing
ST-elevation in the anterior leads. If a percutaneous coronary intervention (PCI) cannot be
performed within 120 minutes, what is the most appropriate next step in management?
A. Initiate high-dose beta-blocker therapy
B. Begin thrombolytic therapy
C. Schedule an elective angiography
D. Monitor and repeat ECG in 6 hours
Correct Answer: B. Begin thrombolytic therapy
Rationale: Timely reperfusion is critical in STEMI. If PCI is unavailable within the
recommended window, thrombolytic therapy should be administered promptly to restore
coronary perfusion.
Question 3
A 72-year-old patient with severe COPD is admitted for an acute exacerbation. Which
intervention must be administered with caution to avoid precipitating CO₂ retention?
,A. Supplemental oxygen therapy
B. Non-invasive positive pressure ventilation
C. Systemic corticosteroids
D. Broad-spectrum antibiotics
Correct Answer: A. Supplemental oxygen therapy
Rationale: In COPD patients, excessive oxygen administration can diminish their respiratory
drive and worsen CO₂ retention. Oxygen should be titrated carefully to maintain target
saturations.
Question 4
A 55-year-old patient with type 2 diabetes presents with signs of diabetic ketoacidosis (DKA).
Despite an initial presentation of hyperkalemia, what electrolyte abnormality becomes critical to
monitor and correct once insulin therapy is started?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypocalcemia
Correct Answer: C. Hypokalemia
Rationale: Insulin drives potassium into cells, and without proper monitoring, serum levels can
drop precipitously, leading to life-threatening arrhythmias. Thus, potassium replacement is vital
during DKA management.
Question 5
In acute ischemic stroke management, the window for safely administering tissue plasminogen
activator (tPA) is generally within:
A. 1 hour of symptom onset
B. 3 to 4.5 hours of symptom onset
C. 6 hours of symptom onset
D. 12 hours of symptom onset
Correct Answer: B. 3 to 4.5 hours of symptom onset
Rationale: Current guidelines recommend administering tPA within 3 to 4.5 hours after
symptom onset for eligible patients, with some protocols advocating treatment as soon as
possible within that window.
,Question 6
A patient with advanced chronic kidney disease presents with a serum potassium of 6.2 mEq/L
and ECG changes indicative of hyperkalemia. What is the most immediate nursing intervention?
A. Initiate emergent hemodialysis
B. Administer intravenous calcium gluconate
C. Begin treatment with potassium-binding resins
D. Start a loop diuretic infusion
Correct Answer: B. Administer intravenous calcium gluconate
Rationale: IV calcium gluconate is used immediately to stabilize the cardiac membranes in
life-threatening hyperkalemia. Further measures to reduce potassium levels follow stabilization.
Question 7
A 60-year-old patient with sepsis secondary to pneumonia is admitted to the ICU. Early
goal-directed therapy for sepsis emphasizes which of the following interventions?
A. High-dose corticosteroids
B. Immediate broad-spectrum antibiotics and aggressive fluid resuscitation
C. Urgent surgical drainage
D. Conservative management with observation
Correct Answer: B. Immediate broad-spectrum antibiotics and aggressive fluid resuscitation
Rationale: Early identification and treatment with antibiotics plus fluid resuscitation are
cornerstones of sepsis management and have been shown to improve outcomes.
Question 8
When managing postoperative pain in a patient with a history of opioid addiction, which strategy
is most appropriate?
A. Administer high doses of opioids for complete pain relief
B. Utilize multimodal pain management strategies including non-opioid medications
C. Rely solely on non-pharmacological interventions
D. Avoid all pain medications to prevent triggering addiction
Correct Answer: B. Utilize multimodal pain management strategies including non-opioid
medications
Rationale: A multimodal approach allows effective pain control while minimizing opioid use,
which is essential for patients with a history of addiction.
, Question 9
Polypharmacy poses significant risks for adverse drug events in elderly patients. What strategy is
most effective in minimizing these risks?
A. Increasing doses of all prescribed medications
B. Regularly reviewing and reconciling the medication list
C. Encouraging patients to self‐medicate based on previous experience
D. Eliminating all medications regardless of the clinical indication
Correct Answer: B. Regularly reviewing and reconciling the medication list
Rationale: Routine medication review helps identify potential drug interactions, duplications,
and unnecessary therapies, reducing the risk of adverse events.
Question 10
In end-of-life care for a patient with advanced chronic illness, which approach best respects
patient autonomy?
A. Implement aggressive life-sustaining treatments without consulting the patient
B. Engage in shared decision-making with the patient and family regarding care options
C. Withhold prognostic information to avoid causing distress
D. Allow family members to make decisions without patient input
Correct Answer: B. Engage in shared decision-making with the patient and family regarding
care options
Rationale: Shared decision-making respects patient autonomy by incorporating the patient’s
values and preferences into the care plan, especially during complex end-of-life decisions.
Question 11
In the management of acute respiratory distress syndrome (ARDS), which ventilator strategy is
recommended to minimize ventilator-induced lung injury?
A. High tidal volume ventilation
B. Low tidal volume ventilation
C. Rapid respiratory rate ventilation
D. No positive end-expiratory pressure (PEEP)
Correct Answer: B. Low tidal volume ventilation
Rationale: Using low tidal volumes (approximately 6 mL/kg of ideal body weight) minimizes
overdistention of alveoli, thereby reducing ventilator-induced lung injury and improving survival
in ARDS patients.
