NSG 430 Exam 4 – GCU Adult Health Nursing II – (2026) Actual Questions &
Answers
Section 1: Cardiovascular Disorders (Questions 1-25)
1. A patient with acute decompensated heart failure presents with pulmonary
edema and a blood pressure of 90/60 mm Hg. Which hemodynamic profile is
most consistent, and what is the priority intervention?
A) High cardiac output, low SVR; administer IV fluids
B) Low cardiac output, high SVR; initiate inotropic support with dobutamine
C) Low cardiac output, low SVR; administer vasopressin
D) High cardiac output, high SVR; start nitroprusside
Answer: B
Rationale: Acute decompensated heart failure with hypotension typically reflects
low cardiac output and compensatory high systemic vascular resistance (SVR).
Inotropic support (e.g., dobutamine) improves contractility and cardiac output.
Fluids would worsen pulmonary edema; vasopressors may be considered but
dobutamine is first-line for low-output failure.
,2. A patient in the cardiac ICU has a pulmonary artery catheter in place. PAOP is
24 mm Hg, and cardiac index is 1.8 L/min/m². What condition is most likely?
A) Cardiogenic shock; administer furosemide and consider intra-aortic balloon
pump
B) Hypovolemic shock; administer 500 mL bolus of normal saline
C) Distributive shock; start norepinephrine
D) Obstructive shock; prepare for pericardiocentesis
Answer: A
Rationale: Elevated PAOP (>18 mm Hg) with low cardiac index (<2.2 L/min/m²)
indicates cardiogenic shock with pulmonary congestion. Diuresis reduces preload,
and an intra-aortic balloon pump augments coronary perfusion and decreases
afterload.
3. A patient with chronic heart failure and LVEF of 30% is starting guideline-
directed medical therapy. Which combination has been shown to reduce
mortality?
A) Metoprolol tartrate, digoxin, spironolactone
,B) Carvedilol, lisinopril, furosemide as needed
C) Sacubitril/valsartan, bisoprolol, spironolactone
D) Amlodipine, losartan, hydrochlorothiazide
Answer: C
Rationale: Sacubitril/valsartan (ARNI) has demonstrated superior mortality
reduction compared to ACE inhibitors in the PARADIGM-HF trial. Beta-blockers
(bisoprolol, carvedilol, metoprolol succinate) and mineralocorticoid receptor
antagonists (spironolactone) are also mortality-reducing.
4. After cardiac arrest due to ventricular fibrillation, a patient receives
defibrillation and amiodarone. ROSC is achieved, and ECG shows ST-segment
elevation in leads V1-V4. What is the most appropriate next step?
A) Administer thrombolytic therapy immediately
B) Proceed to emergent coronary angiography with PCI
C) Start therapeutic hypothermia and obtain head CT
D) Administer heparin and admit for medical management
, Answer: B
Rationale: ST-segment elevation after cardiac arrest indicates acute myocardial
infarction. Emergent coronary angiography with PCI is the standard of care for
STEMI, as it reduces mortality and improves outcomes.
5. A patient with severe aortic stenosis is scheduled for TAVR. Which finding
would be a contraindication?
A) Bicuspid aortic valve morphology
B) Left ventricular ejection fraction of 35%
C) Porcelain aorta with extensive calcification
D) Severe mitral regurgitation
Answer: C
Rationale: Porcelain aorta (extensive calcification of the ascending aorta) is a
relative contraindication to TAVR due to increased risk of aortic rupture or
embolization.
Answers
Section 1: Cardiovascular Disorders (Questions 1-25)
1. A patient with acute decompensated heart failure presents with pulmonary
edema and a blood pressure of 90/60 mm Hg. Which hemodynamic profile is
most consistent, and what is the priority intervention?
A) High cardiac output, low SVR; administer IV fluids
B) Low cardiac output, high SVR; initiate inotropic support with dobutamine
C) Low cardiac output, low SVR; administer vasopressin
D) High cardiac output, high SVR; start nitroprusside
Answer: B
Rationale: Acute decompensated heart failure with hypotension typically reflects
low cardiac output and compensatory high systemic vascular resistance (SVR).
Inotropic support (e.g., dobutamine) improves contractility and cardiac output.
Fluids would worsen pulmonary edema; vasopressors may be considered but
dobutamine is first-line for low-output failure.
,2. A patient in the cardiac ICU has a pulmonary artery catheter in place. PAOP is
24 mm Hg, and cardiac index is 1.8 L/min/m². What condition is most likely?
A) Cardiogenic shock; administer furosemide and consider intra-aortic balloon
pump
B) Hypovolemic shock; administer 500 mL bolus of normal saline
C) Distributive shock; start norepinephrine
D) Obstructive shock; prepare for pericardiocentesis
Answer: A
Rationale: Elevated PAOP (>18 mm Hg) with low cardiac index (<2.2 L/min/m²)
indicates cardiogenic shock with pulmonary congestion. Diuresis reduces preload,
and an intra-aortic balloon pump augments coronary perfusion and decreases
afterload.
3. A patient with chronic heart failure and LVEF of 30% is starting guideline-
directed medical therapy. Which combination has been shown to reduce
mortality?
A) Metoprolol tartrate, digoxin, spironolactone
,B) Carvedilol, lisinopril, furosemide as needed
C) Sacubitril/valsartan, bisoprolol, spironolactone
D) Amlodipine, losartan, hydrochlorothiazide
Answer: C
Rationale: Sacubitril/valsartan (ARNI) has demonstrated superior mortality
reduction compared to ACE inhibitors in the PARADIGM-HF trial. Beta-blockers
(bisoprolol, carvedilol, metoprolol succinate) and mineralocorticoid receptor
antagonists (spironolactone) are also mortality-reducing.
4. After cardiac arrest due to ventricular fibrillation, a patient receives
defibrillation and amiodarone. ROSC is achieved, and ECG shows ST-segment
elevation in leads V1-V4. What is the most appropriate next step?
A) Administer thrombolytic therapy immediately
B) Proceed to emergent coronary angiography with PCI
C) Start therapeutic hypothermia and obtain head CT
D) Administer heparin and admit for medical management
, Answer: B
Rationale: ST-segment elevation after cardiac arrest indicates acute myocardial
infarction. Emergent coronary angiography with PCI is the standard of care for
STEMI, as it reduces mortality and improves outcomes.
5. A patient with severe aortic stenosis is scheduled for TAVR. Which finding
would be a contraindication?
A) Bicuspid aortic valve morphology
B) Left ventricular ejection fraction of 35%
C) Porcelain aorta with extensive calcification
D) Severe mitral regurgitation
Answer: C
Rationale: Porcelain aorta (extensive calcification of the ascending aorta) is a
relative contraindication to TAVR due to increased risk of aortic rupture or
embolization.
