NURS 354 Adult III Final (2026) PRACTICE
QUESTIONS WITH VERIFIED CORRECT ANSWERS ||
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Section 1: Advanced Cardiovascular & Hemodynamics (Questions 1-25)
1. A patient with an acute myocardial infarction (MI) has a blood pressure of 78/50 mm Hg, a
heart rate of 130 bpm, and cool, clammy skin. The nurse identifies this as which type of
shock?
A. Neurogenic shock
B. Cardiogenic shock
C. Septic shock
D. Hypovolemic shock
Answer: B. Cardiogenic shock
Rationale: Cardiogenic shock occurs when the heart muscle is damaged and cannot pump
effectively, leading to low cardiac output. The symptoms of hypotension, tachycardia, and
cool/clammy skin (signs of poor perfusion) following an MI are classic indicators.
2. What is the primary goal for administering a thrombolytic agent (e.g., Alteplase) to a
patient with an ST-elevation myocardial infarction (STEMI)?
A. To relieve chest pain
B. To dissolve the obstructive coronary thrombus
C. To reduce cardiac preload
D. To prevent ventricular arrhythmias
Answer: B. To dissolve the obstructive coronary thrombus
Rationale: Thrombolytics work by activating plasminogen to form plasmin, which breaks down
the fibrin clot causing the coronary artery occlusion.
3. During hemodynamic monitoring, a patient's pulmonary artery wedge pressure (PAWP) is
18 mm Hg. The nurse interprets this as most indicative of:
A. Hypovolemia
B. Left ventricular failure
C. Right ventricular failure
D. Pulmonary hypertension
Answer: B. Left ventricular failure
*Rationale: PAWP reflects left ventricular end-diastolic pressure (LVEDP). An elevated PAWP
(normal is 4-12 mm Hg) suggests left ventricular failure and fluid overload.*
,4. A patient with heart failure is started on Milrinone. The nurse understands this drug is a
positive inotrope and vasodilator, and its use requires careful monitoring for:
A. Hypertension
B. Hypokalemia
C. Ventricular dysrhythmias
D. Bradycardia
Answer: C. Ventricular dysrhythmias
Rationale: Milrinone, a phosphodiesterase inhibitor, can cause significant tachycardia and
ventricular arrhythmias as a major side effect.
5. The nurse is caring for a patient with a systolic blood pressure of 70 mm Hg and signs of
shock. Which IV fluid would be contraindicated if the patient is suspected to have cardiogenic
shock?
A. 0.9% Normal Saline
B. Lactated Ringer's
C. 5% Dextrose in Water (D5W)
D. Large-volume, rapid fluid boluses
Answer: D. Large-volume, rapid fluid boluses
Rationale: In cardiogenic shock, the primary problem is a failing pump. Aggressive fluid
administration can worsen pulmonary edema and heart failure by increasing preload on a
compromised left ventricle.
6. Which assessment finding is the earliest indicator of a worsening status in a patient with
left-sided heart failure?
A. Jugular venous distention (JVD)
B. Dependent edema
C. Crackles in the lung bases
D. A drop in oxygen saturation
Answer: D. A drop in oxygen saturation
Rationale: While crackles are classic for pulmonary edema, a subtle drop in SpO2 can be the
earliest sign of impaired gas exchange due to developing pulmonary congestion.
7. A patient with an automatic implantable cardioverter-defibrillator (AICD) is admitted after
receiving a shock. The patient states, "I was just watching TV and it went off." What is the
nurse's priority action?
A. Reassure the patient that this is normal.
B. Obtain a 12-lead ECG and interogate the AICD.
C. Administer a PRN dose of Lorazepam for anxiety.
D. Place a magnet over the device to deactivate it.
,Answer: B. Obtain a 12-lead ECG and interogate the AICD.
Rationale: An inappropriate shock (one not triggered by a lethal arrhythmia) requires immediate
investigation to determine the cause, which could be device malfunction or sensing of
artifact/atrial arrhythmias.
8. The nurse is preparing to administer Streptokinase. It is essential to screen for a history of:
A. Diabetes Mellitus
B. Previous allergic reaction to Streptokinase
C. Hypertension
D. Peptic Ulcer Disease
Answer: B. Previous allergic reaction to Streptokinase
Rationale: Streptokinase is a bacterial-derived product and can cause significant allergic
reactions, including anaphylaxis. A history of prior exposure or reaction is a critical
contraindication.
9. What is the target core temperature for a patient undergoing targeted temperature
management (therapeutic hypothermia) after cardiac arrest?
A. 28-30°C (82.4-86°F)
B. 32-36°C (89.6-96.8°F)
C. 36-38°C (96.8-100.4°F)
D. 38-40°C (100.4-104°F)
Answer: B. 32-36°C (89.6-96.8°F)
Rationale: Current guidelines recommend maintaining a constant target temperature between
32°C and 36°C for at least 24 hours to improve neurological outcomes.
10. Which laboratory value is most critical to monitor in a patient receiving IV Heparin for a
pulmonary embolism?
A. Prothrombin Time (PT)
B. Activated Partial Thromboplastin Time (aPTT)
C. International Normalized Ratio (INR)
D. Platelet count
Answer: B. Activated Partial Thromboplastin Time (aPTT)
Rationale: aPTT is the standard test used to monitor the therapeutic effect of unfractionated
heparin. The goal is typically 1.5 to 2.5 times the normal control value.
11. A patient's arterial blood gas (ABG) shows: pH 7.28, PaCO2 50 mm Hg, HCO3 24 mm Hg.
The nurse interprets this as:
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
, D. Metabolic Alkalosis
Answer: A. Respiratory Acidosis
Rationale: The pH is acidic (<7.35), the PaCO2 is elevated (>45), indicating a respiratory cause,
and the HCO3 is normal, indicating an uncompensated state.
12. The nurse is assessing a patient's jugular venous pressure (JVP). The patient should be
positioned at what angle?
A. Supine
B. 30-45 degrees
C. High Fowler's (90 degrees)
D. Trendelenburg
Answer: B. 30-45 degrees
Rationale: This angle allows for the best visualization of the internal jugular vein pulsation. If the
vein is distended above the clavicle at this angle, it indicates elevated central venous pressure.
13. Which finding in a patient with a permanent pacemaker requires immediate intervention?
A. The patient can feel the device under the skin.
B. Loss of capture on ECG pacing spikes are not followed by a QRS complex.
C. The incision is well-healed.
D. The device generator is visible on chest x-ray.
Answer: B. Loss of capture on ECG pacing spikes are not followed by a QRS complex.
Rationale: Loss of capture means the pacemaker impulse is not resulting in myocardial
depolarization. This is a failure of the device's primary function and can be life-threatening if the
patient is pacemaker-dependent.
14. A patient with chronic atrial fibrillation is prescribed Apixaban. The nurse's discharge
teaching should include:
A. "You will need to have your INR checked weekly."
B. "Report any signs of unusual bleeding or bruising immediately."
C. "This medication requires a monthly CBC."
D. "Take this medication on an empty stomach."
Answer: B. "Report any signs of unusual bleeding or bruising immediately."
Rationale: Apixaban is a direct oral anticoagulant (DOAC). Unlike warfarin, it does not require
routine INR monitoring, but the risk of bleeding is significant and patients must be educated to
recognize and report bleeding signs.
15. The H's and T's in Advanced Cardiac Life Support (ACLS) are used to identify:
A. Causes of bradycardia
B. Reversible causes of cardiac arrest
C. Signs of heart failure
QUESTIONS WITH VERIFIED CORRECT ANSWERS ||
100% GUARANTEED PASS <UPDATED VERSION>
Section 1: Advanced Cardiovascular & Hemodynamics (Questions 1-25)
1. A patient with an acute myocardial infarction (MI) has a blood pressure of 78/50 mm Hg, a
heart rate of 130 bpm, and cool, clammy skin. The nurse identifies this as which type of
shock?
A. Neurogenic shock
B. Cardiogenic shock
C. Septic shock
D. Hypovolemic shock
Answer: B. Cardiogenic shock
Rationale: Cardiogenic shock occurs when the heart muscle is damaged and cannot pump
effectively, leading to low cardiac output. The symptoms of hypotension, tachycardia, and
cool/clammy skin (signs of poor perfusion) following an MI are classic indicators.
2. What is the primary goal for administering a thrombolytic agent (e.g., Alteplase) to a
patient with an ST-elevation myocardial infarction (STEMI)?
A. To relieve chest pain
B. To dissolve the obstructive coronary thrombus
C. To reduce cardiac preload
D. To prevent ventricular arrhythmias
Answer: B. To dissolve the obstructive coronary thrombus
Rationale: Thrombolytics work by activating plasminogen to form plasmin, which breaks down
the fibrin clot causing the coronary artery occlusion.
3. During hemodynamic monitoring, a patient's pulmonary artery wedge pressure (PAWP) is
18 mm Hg. The nurse interprets this as most indicative of:
A. Hypovolemia
B. Left ventricular failure
C. Right ventricular failure
D. Pulmonary hypertension
Answer: B. Left ventricular failure
*Rationale: PAWP reflects left ventricular end-diastolic pressure (LVEDP). An elevated PAWP
(normal is 4-12 mm Hg) suggests left ventricular failure and fluid overload.*
,4. A patient with heart failure is started on Milrinone. The nurse understands this drug is a
positive inotrope and vasodilator, and its use requires careful monitoring for:
A. Hypertension
B. Hypokalemia
C. Ventricular dysrhythmias
D. Bradycardia
Answer: C. Ventricular dysrhythmias
Rationale: Milrinone, a phosphodiesterase inhibitor, can cause significant tachycardia and
ventricular arrhythmias as a major side effect.
5. The nurse is caring for a patient with a systolic blood pressure of 70 mm Hg and signs of
shock. Which IV fluid would be contraindicated if the patient is suspected to have cardiogenic
shock?
A. 0.9% Normal Saline
B. Lactated Ringer's
C. 5% Dextrose in Water (D5W)
D. Large-volume, rapid fluid boluses
Answer: D. Large-volume, rapid fluid boluses
Rationale: In cardiogenic shock, the primary problem is a failing pump. Aggressive fluid
administration can worsen pulmonary edema and heart failure by increasing preload on a
compromised left ventricle.
6. Which assessment finding is the earliest indicator of a worsening status in a patient with
left-sided heart failure?
A. Jugular venous distention (JVD)
B. Dependent edema
C. Crackles in the lung bases
D. A drop in oxygen saturation
Answer: D. A drop in oxygen saturation
Rationale: While crackles are classic for pulmonary edema, a subtle drop in SpO2 can be the
earliest sign of impaired gas exchange due to developing pulmonary congestion.
7. A patient with an automatic implantable cardioverter-defibrillator (AICD) is admitted after
receiving a shock. The patient states, "I was just watching TV and it went off." What is the
nurse's priority action?
A. Reassure the patient that this is normal.
B. Obtain a 12-lead ECG and interogate the AICD.
C. Administer a PRN dose of Lorazepam for anxiety.
D. Place a magnet over the device to deactivate it.
,Answer: B. Obtain a 12-lead ECG and interogate the AICD.
Rationale: An inappropriate shock (one not triggered by a lethal arrhythmia) requires immediate
investigation to determine the cause, which could be device malfunction or sensing of
artifact/atrial arrhythmias.
8. The nurse is preparing to administer Streptokinase. It is essential to screen for a history of:
A. Diabetes Mellitus
B. Previous allergic reaction to Streptokinase
C. Hypertension
D. Peptic Ulcer Disease
Answer: B. Previous allergic reaction to Streptokinase
Rationale: Streptokinase is a bacterial-derived product and can cause significant allergic
reactions, including anaphylaxis. A history of prior exposure or reaction is a critical
contraindication.
9. What is the target core temperature for a patient undergoing targeted temperature
management (therapeutic hypothermia) after cardiac arrest?
A. 28-30°C (82.4-86°F)
B. 32-36°C (89.6-96.8°F)
C. 36-38°C (96.8-100.4°F)
D. 38-40°C (100.4-104°F)
Answer: B. 32-36°C (89.6-96.8°F)
Rationale: Current guidelines recommend maintaining a constant target temperature between
32°C and 36°C for at least 24 hours to improve neurological outcomes.
10. Which laboratory value is most critical to monitor in a patient receiving IV Heparin for a
pulmonary embolism?
A. Prothrombin Time (PT)
B. Activated Partial Thromboplastin Time (aPTT)
C. International Normalized Ratio (INR)
D. Platelet count
Answer: B. Activated Partial Thromboplastin Time (aPTT)
Rationale: aPTT is the standard test used to monitor the therapeutic effect of unfractionated
heparin. The goal is typically 1.5 to 2.5 times the normal control value.
11. A patient's arterial blood gas (ABG) shows: pH 7.28, PaCO2 50 mm Hg, HCO3 24 mm Hg.
The nurse interprets this as:
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
, D. Metabolic Alkalosis
Answer: A. Respiratory Acidosis
Rationale: The pH is acidic (<7.35), the PaCO2 is elevated (>45), indicating a respiratory cause,
and the HCO3 is normal, indicating an uncompensated state.
12. The nurse is assessing a patient's jugular venous pressure (JVP). The patient should be
positioned at what angle?
A. Supine
B. 30-45 degrees
C. High Fowler's (90 degrees)
D. Trendelenburg
Answer: B. 30-45 degrees
Rationale: This angle allows for the best visualization of the internal jugular vein pulsation. If the
vein is distended above the clavicle at this angle, it indicates elevated central venous pressure.
13. Which finding in a patient with a permanent pacemaker requires immediate intervention?
A. The patient can feel the device under the skin.
B. Loss of capture on ECG pacing spikes are not followed by a QRS complex.
C. The incision is well-healed.
D. The device generator is visible on chest x-ray.
Answer: B. Loss of capture on ECG pacing spikes are not followed by a QRS complex.
Rationale: Loss of capture means the pacemaker impulse is not resulting in myocardial
depolarization. This is a failure of the device's primary function and can be life-threatening if the
patient is pacemaker-dependent.
14. A patient with chronic atrial fibrillation is prescribed Apixaban. The nurse's discharge
teaching should include:
A. "You will need to have your INR checked weekly."
B. "Report any signs of unusual bleeding or bruising immediately."
C. "This medication requires a monthly CBC."
D. "Take this medication on an empty stomach."
Answer: B. "Report any signs of unusual bleeding or bruising immediately."
Rationale: Apixaban is a direct oral anticoagulant (DOAC). Unlike warfarin, it does not require
routine INR monitoring, but the risk of bleeding is significant and patients must be educated to
recognize and report bleeding signs.
15. The H's and T's in Advanced Cardiac Life Support (ACLS) are used to identify:
A. Causes of bradycardia
B. Reversible causes of cardiac arrest
C. Signs of heart failure
