NUR2571 Professional Nursing II Final Exam
Quiz Bank 2026/2027 - Rated A Guide for
Rasmussen College
Case Study 1: Patient M.J.
68-year-old with CHF (EF 30 %) and Type 2 DM admitted with acute dyspnea, 3 kg
weight gain in 48 h, and frothy pink sputum.
Which assessment finding, noted 15 minutes after admission, best confirms the nurse’s
primary hypothesis of acute decompensated heart failure?
1. A) SpO₂ 89 % on 4 L nasal cannula
B) Respiratory rate 32 with accessory muscle use
C) S₃ gallop auscultated at apex
D) Fine crackles two-thirds up both posterior lung fields
Correct Answer: D
Correct Answer Text: Fine crackles two-thirds up both posterior lung fields
Rationale: 2026 AHA guidelines emphasize that bilateral pulmonary congestion
(fine crackles > half lung field) is the most specific bedside cue for ADHF-related
fluid overload. While hypoxia (A) and tachypnea (B) support respiratory distress,
crackles (D) directly reflect elevated LV filling pressures. S₃ (C) is insensitive in
older adults.
M.J.’s provider orders high-dose IV furosemide 80 mg bolus followed by 10 mg/hr
continuous infusion. Which laboratory value requires immediate follow-up before
initiation?
2. A) Serum potassium 3.2 mEq/L
B) Blood urea nitrogen 28 mg/dL
C) Serum creatinine 1.4 mg/dL (baseline 1.3)
D) Serum glucose 198 mg/dL
Correct Answer: A
Correct Answer Text: Serum potassium 3.2 mEq/L
Rationale: Loop diuretics potentiate hypokalemia and increase digoxin toxicity
, risk; therefore, K⁺ < 3.5 mEq/L must be corrected first per 2026 ADHF pathway.
Mild creatinine rise (C) is acceptable; BUN (B) and glucose (D) do not preclude
diuresis.
After 6 hours, M.J. has produced 1,350 mL urine but now reports “throbbing” right-sided
headache 8/10. BP 210/110 mmHg, HR 92. Which action is most appropriate?
3. A) Administer PO nifedipine 10 mg capsule bite-and-swallow
B) Start IV nicardipine 5 mg/hr and titrate per protocol
C) Hold furosemide and give 500 mL NS over 30 min
D) Obtain CT head without contrast immediately
Correct Answer: B
Correct Answer Text: Start IV nicardipine 5 mg/hr and titrate per protocol
Rationale: 2026 AHA hypertensive emergency guidance endorses short-acting IV
calcium-channel blocker (B) for controlled reduction (goal 10-20 % in first hour)
while maintaining diuresis. Sublingual nifedipine (A) causes precipitous drop;
saline bolus (C) worsens fluid overload; CT (D) is premature without neuro-deficit.
Case Study 2: Patient K.L.
55-year-old post-cholecystectomy (laparoscopic) POD #1, history of COPD (GOLD stage
2) and chronic lower-back pain on oxycodone 5 mg PO q6h PRN.
At 0200, K.L. reports “can’t catch my breath.” Respirations 28, SpO₂ 90 % on 2 L NC
(baseline 94 %), scattered expiratory wheezes, temperature 37.9 °C. Which action
should the nurse take first?
4. A) Increase oxygen to 4 L and obtain ABG
B) Coach patient in pursed-lip breathing and administer prescribed albuterol
nebulizer
C) Call provider for STAT chest X-ray
D) Administer oxycodone 5 mg to reduce anxiety-related dyspnea
Correct Answer: B
Correct Answer Text: Coach patient in pursed-lip breathing and administer
prescribed albuterol nebulizer
Rationale: Initial management follows 2026 GOLD COPD exacerbation pathway:
bronchodilator therapy and patient coaching (B) address airway obstruction first.
Increasing O₂ (A) may blunt hypoxic drive; imaging (C) is secondary; opioids (D)
risk respiratory depression.
Quiz Bank 2026/2027 - Rated A Guide for
Rasmussen College
Case Study 1: Patient M.J.
68-year-old with CHF (EF 30 %) and Type 2 DM admitted with acute dyspnea, 3 kg
weight gain in 48 h, and frothy pink sputum.
Which assessment finding, noted 15 minutes after admission, best confirms the nurse’s
primary hypothesis of acute decompensated heart failure?
1. A) SpO₂ 89 % on 4 L nasal cannula
B) Respiratory rate 32 with accessory muscle use
C) S₃ gallop auscultated at apex
D) Fine crackles two-thirds up both posterior lung fields
Correct Answer: D
Correct Answer Text: Fine crackles two-thirds up both posterior lung fields
Rationale: 2026 AHA guidelines emphasize that bilateral pulmonary congestion
(fine crackles > half lung field) is the most specific bedside cue for ADHF-related
fluid overload. While hypoxia (A) and tachypnea (B) support respiratory distress,
crackles (D) directly reflect elevated LV filling pressures. S₃ (C) is insensitive in
older adults.
M.J.’s provider orders high-dose IV furosemide 80 mg bolus followed by 10 mg/hr
continuous infusion. Which laboratory value requires immediate follow-up before
initiation?
2. A) Serum potassium 3.2 mEq/L
B) Blood urea nitrogen 28 mg/dL
C) Serum creatinine 1.4 mg/dL (baseline 1.3)
D) Serum glucose 198 mg/dL
Correct Answer: A
Correct Answer Text: Serum potassium 3.2 mEq/L
Rationale: Loop diuretics potentiate hypokalemia and increase digoxin toxicity
, risk; therefore, K⁺ < 3.5 mEq/L must be corrected first per 2026 ADHF pathway.
Mild creatinine rise (C) is acceptable; BUN (B) and glucose (D) do not preclude
diuresis.
After 6 hours, M.J. has produced 1,350 mL urine but now reports “throbbing” right-sided
headache 8/10. BP 210/110 mmHg, HR 92. Which action is most appropriate?
3. A) Administer PO nifedipine 10 mg capsule bite-and-swallow
B) Start IV nicardipine 5 mg/hr and titrate per protocol
C) Hold furosemide and give 500 mL NS over 30 min
D) Obtain CT head without contrast immediately
Correct Answer: B
Correct Answer Text: Start IV nicardipine 5 mg/hr and titrate per protocol
Rationale: 2026 AHA hypertensive emergency guidance endorses short-acting IV
calcium-channel blocker (B) for controlled reduction (goal 10-20 % in first hour)
while maintaining diuresis. Sublingual nifedipine (A) causes precipitous drop;
saline bolus (C) worsens fluid overload; CT (D) is premature without neuro-deficit.
Case Study 2: Patient K.L.
55-year-old post-cholecystectomy (laparoscopic) POD #1, history of COPD (GOLD stage
2) and chronic lower-back pain on oxycodone 5 mg PO q6h PRN.
At 0200, K.L. reports “can’t catch my breath.” Respirations 28, SpO₂ 90 % on 2 L NC
(baseline 94 %), scattered expiratory wheezes, temperature 37.9 °C. Which action
should the nurse take first?
4. A) Increase oxygen to 4 L and obtain ABG
B) Coach patient in pursed-lip breathing and administer prescribed albuterol
nebulizer
C) Call provider for STAT chest X-ray
D) Administer oxycodone 5 mg to reduce anxiety-related dyspnea
Correct Answer: B
Correct Answer Text: Coach patient in pursed-lip breathing and administer
prescribed albuterol nebulizer
Rationale: Initial management follows 2026 GOLD COPD exacerbation pathway:
bronchodilator therapy and patient coaching (B) address airway obstruction first.
Increasing O₂ (A) may blunt hypoxic drive; imaging (C) is secondary; opioids (D)
risk respiratory depression.
