NR 341 EXAM 2 – COMPLEX ADULT HEALTH NURSING Comprehensive Practice Examination – 100 Questions Original NCLEX-Style Questions with Detailed Rationales All correct answers are highlighted in bold green.

1



NR 341 EXAM 2 – COMPLEX ADULT HEALTH NURSING \
Comprehensive Practice Examination – 100 Questions \
Original NCLEX-Style Questions with Detailed Rationales \ All
correct answers are highlighted in bold green.


SECTION 1: CARDIOVASCULAR (Questions 1–18)
QUESTION 1
A client is admitted with acute coronary syndrome. The ECG shows ST-segment
elevation in leads II, III, and aVF. The nurse should recognize this pattern as
indicative of:
A) Anterior wall myocardial infarction
B) Lateral wall myocardial infarction
C) Inferior wall myocardial infarction
D) Posterior wall myocardial infarction
RATIONALE: Leads II, III, and aVF look at the inferior wall of the left ventricle.
Occlusion of the right coronary artery (RCA) or the left circumflex artery can cause
inferior wall MI. Anterior wall MI shows ST elevation in V1-V4. Lateral wall MI
shows changes in I, aVL, V5, V6. Posterior wall MI may show ST depression in V1-
V3 (reciprocal changes).


QUESTION 2
A client with acute myocardial infarction is receiving IV unfractionated heparin.
The aPTT is 85 seconds (control 30 seconds). The nurse should:
A) Increase the heparin infusion rate
B) Decrease the heparin infusion rate per protocol
C) Discontinue the heparin infusion immediately
D) Administer protamine sulfate
RATIONALE: Therapeutic aPTT for heparin is 1.5–2.5 times the control (45–75
seconds). An aPTT of 85 is supratherapeutic, increasing bleeding risk. The nurse


pg. 1

,2


should decrease the infusion rate per the facility's titration protocol.
Discontinuation is not indicated unless there is active bleeding or a critically high
aPTT. Protamine is reserved for life-threatening hemorrhage.


QUESTION 3
A client 3 days post-myocardial infarction develops a new, loud holosystolic
murmur at the left lower sternal border, pulmonary crackles, and acute dyspnea.
The nurse should suspect:
A) Papillary muscle rupture with mitral regurgitation
B) Ventricular septal rupture
C) Pericarditis
D) Aortic dissection
RATIONALE: Ventricular septal rupture is a mechanical complication of MI that
typically occurs 2–7 days post-infarct. It presents with a new, harsh holosystolic
murmur at the LLSB, signs of acute heart failure, and cardiogenic shock. Papillary
muscle rupture causes a murmur at the APEX radiating to the axilla. Pericarditis
causes a friction rub. Aortic dissection causes a diastolic murmur.


QUESTION 4
A client with chronic heart failure is receiving carvedilol. The nurse should hold
the medication and notify the provider for which finding?
A) Heart rate 68 bpm
B) Blood pressure 108/70 mm Hg
C) Heart rate 50 bpm and dizziness
D) Respiratory rate 18/min
RATIONALE: Carvedilol is a non-selective beta-blocker that can cause bradycardia
and hypotension. A heart rate of 50 bpm with symptoms of dizziness indicates the
dose may be too high or the client is not tolerating the medication. The nurse
should hold the medication and notify the provider. A heart rate of 68 is
acceptable; a BP of 108/70 is tolerable.


pg. 2

,3




QUESTION 5
A client with heart failure with reduced ejection fraction (HFrEF) is started on
spironolactone. Which serum laboratory value is MOST important to monitor?
A) Sodium
B) Potassium
C) Calcium
D) Glucose
RATIONALE: Spironolactone is a potassium-sparing diuretic that can cause life-
threatening HYPERKALEMIA, especially in combination with ACE inhibitors or
ARBs. The nurse must monitor serum potassium closely, particularly in the first
few weeks of therapy and with dose increases. Sodium is also monitored but not
the priority. Calcium and glucose are not directly affected by spironolactone.


QUESTION 6
A client with atrial fibrillation is prescribed warfarin. The target INR for stroke
prevention in non-valvular atrial fibrillation is:
A) 1.5–2.0
B) 2.0–3.0
C) 2.5–3.5
D) 3.0–4.0
RATIONALE: For non-valvular atrial fibrillation, the recommended INR is 2.0–3.0.
Higher targets (2.5–3.5) are used for mechanical heart valves. The nurse must
educate the client about consistent vitamin K intake, regular INR monitoring, and
signs of bleeding.


QUESTION 7
A client with acute decompensated heart failure is receiving IV furosemide. Which
finding indicates a therapeutic response?


pg. 3

, 4


A) Decreased heart rate
B) Increased urine output and decreased crackles
C) Increased blood pressure
D) Decreased respiratory rate only
RATIONALE: Furosemide is a loop diuretic that reduces fluid overload.
Therapeutic response includes increased urine output, decreased pulmonary
crackles, improved oxygenation, decreased jugular venous distention, and weight
loss. Heart rate may decrease as fluid status improves. Blood pressure may
decrease with diuresis.


QUESTION 8
A client with peripheral arterial disease (PAD) reports rest pain in the right foot.
The foot is pale and cool. The nurse should:
A) Elevate the foot above the heart
B) Keep the foot in a dependent position and notify the provider
C) Apply a heating pad
D) Ambulate the client
RATIONALE: Rest pain indicates critical limb ischemia—a medical emergency
requiring immediate revascularization. The foot should be kept in a DEPENDENT
position to maximize blood flow. Elevation and cold worsen ischemia. Heat should
not be applied to ischemic tissue. The provider must be notified immediately for
urgent vascular surgical referral.


QUESTION 9
A client with an abdominal aortic aneurysm (AAA) reports sudden, severe back
pain. The nurse should:
A) Administer pain medication and reassess
B) Notify the provider immediately; suspect rupture
C) Apply a cold compress to the abdomen
D) Place the client in Trendelenburg position


pg. 4