NSG 4100 / NSG4100 Nursing Practice Adult Health III
Exam 3 Guide Actual 2026/2027 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: COMPLEX CARDIOVASCULAR DISORDERS (12
Questions)
Q1: A client with acute decompensated heart failure presents with severe dyspnea,
orthopnea, and pink frothy sputum. Which medication should the nurse anticipate
administering first?
A. Digoxin 0.25 mg IV push
B. Furosemide 40 mg IV push [CORRECT]
C. Carvedilol 12.5 mg PO
D. Enalapril 5 mg PO
Correct Answer: B
Rationale: IV furosemide is the priority in acute pulmonary edema because it
produces rapid venodilation (reducing preload within minutes) followed by diuresis,
relieving pulmonary congestion and improving oxygenation before other
interventions.
Q2: A client with ST-elevation myocardial infarction (STEMI) is receiving reperfusion
therapy with alteplase (tPA). Which assessment finding requires immediate
intervention?
A. Blood pressure of 148/92 mmHg
B. Bleeding from the IV insertion site with hematoma expansion [CORRECT]
C. Heart rate of 88 bpm with regular rhythm
D. Mild headache rated 2/10
Correct Answer: B
Rationale: Alteplase is a fibrinolytic agent that carries significant bleeding risk;
expanding hematoma indicates active hemorrhage requiring immediate pressure,
,discontinuation of the infusion, and physician notification to prevent life-threatening
bleeding.
Q3: A client with atrial fibrillation has a new onset of slurred speech and right-sided
weakness. Which complication has most likely occurred?
A. Digoxin toxicity
B. Cerebral embolism from left atrial thrombus [CORRECT]
C. Hypertensive encephalopathy
D. Transient ischemic attack without clinical significance
Correct Answer: B
Rationale: Atrial fibrillation causes blood stasis in the left atrial appendage,
promoting thrombus formation; embolization to the cerebral circulation causes
stroke, manifesting as focal neurologic deficits such as aphasia and hemiparesis.
Q4: A client with a thoracic aortic aneurysm reports sudden, tearing chest pain
radiating to the back. Blood pressure is 190/110 mmHg in the right arm and 140/88
mmHg in the left arm. Which intervention is the priority?
A. Administering aspirin 325 mg PO
B. Initiating IV beta-blockade to reduce shear stress and blood pressure [CORRECT]
C. Preparing the client for immediate coronary angiography
D. Administering thrombolytic therapy
Correct Answer: B
Rationale: Acute aortic dissection requires immediate beta-blockade (esmolol or
labetalol) to reduce heart rate, blood pressure, and dP/dt (shear stress), preventing
extension of the dissection; aspirin and thrombolytics are contraindicated.
Q5: A client with heart failure has a serum BNP of 1,850 pg/mL. Which clinical
finding is most consistent with this laboratory value?
A. Improved cardiac function with reduced ventricular stretch
B. Severe volume overload and ventricular wall stress [CORRECT]
C. Normal compensatory response to mild fluid retention
D. Artifact from concurrent ACE inhibitor therapy
Correct Answer: B
Rationale: B-type natriuretic peptide (BNP) is released from ventricular myocardium
in response to stretch; levels >400 pg/mL indicate severe heart failure with
significant volume overload and elevated ventricular filling pressures.
, Q6: A client with third-degree AV block has a heart rate of 32 bpm, syncope, and
hypotension. Which intervention is most appropriate?
A. Atropine 0.5 mg IV push
B. Transcutaneous pacing [CORRECT]
C. Dopamine infusion at 2 mcg/kg/min
D. Defibrillation at 200 joules
Correct Answer: B
Rationale: Third-degree AV block with hemodynamic instability (syncope,
hypotension) requires immediate transcutaneous pacing to maintain adequate
cardiac output; atropine is often ineffective in complete heart block, and defibrillation
is for pulseless rhythms.
Q7: A client post-cardiac catheterization via the femoral artery develops a groin
hematoma and absent distal pulses. Which complication is suspected?
A. Contrast-induced nephropathy
B. Arterial occlusion from retroperitoneal bleeding or thrombosis [CORRECT]
C. Vasovagal response to the procedure
D. Allergic reaction to the local anesthetic
Correct Answer: B
Rationale: Absent distal pulses with groin hematoma after femoral catheterization
indicates arterial compromise from either expanding retroperitoneal hemorrhage
compressing the vessel or thrombus formation at the access site, requiring
immediate vascular surgery consultation.
Q8: A client with hypertrophic cardiomyopathy (HCM) experiences syncope during
exertion. Which teaching is most important?
A. "Increase your fluid intake to improve preload."
B. "Avoid strenuous exercise and competitive sports." [CORRECT]
C. "Take your diuretic before exercise to reduce afterload."
D. "Use isometric exercises to strengthen your heart muscle."
Correct Answer: B
Rationale: HCM causes dynamic left ventricular outflow tract obstruction that
worsens with exertion, increasing risk of sudden cardiac death; clients must avoid
strenuous activity and competitive sports, which are the most common triggers for
fatal arrhythmias.
Exam 3 Guide Actual 2026/2027 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: COMPLEX CARDIOVASCULAR DISORDERS (12
Questions)
Q1: A client with acute decompensated heart failure presents with severe dyspnea,
orthopnea, and pink frothy sputum. Which medication should the nurse anticipate
administering first?
A. Digoxin 0.25 mg IV push
B. Furosemide 40 mg IV push [CORRECT]
C. Carvedilol 12.5 mg PO
D. Enalapril 5 mg PO
Correct Answer: B
Rationale: IV furosemide is the priority in acute pulmonary edema because it
produces rapid venodilation (reducing preload within minutes) followed by diuresis,
relieving pulmonary congestion and improving oxygenation before other
interventions.
Q2: A client with ST-elevation myocardial infarction (STEMI) is receiving reperfusion
therapy with alteplase (tPA). Which assessment finding requires immediate
intervention?
A. Blood pressure of 148/92 mmHg
B. Bleeding from the IV insertion site with hematoma expansion [CORRECT]
C. Heart rate of 88 bpm with regular rhythm
D. Mild headache rated 2/10
Correct Answer: B
Rationale: Alteplase is a fibrinolytic agent that carries significant bleeding risk;
expanding hematoma indicates active hemorrhage requiring immediate pressure,
,discontinuation of the infusion, and physician notification to prevent life-threatening
bleeding.
Q3: A client with atrial fibrillation has a new onset of slurred speech and right-sided
weakness. Which complication has most likely occurred?
A. Digoxin toxicity
B. Cerebral embolism from left atrial thrombus [CORRECT]
C. Hypertensive encephalopathy
D. Transient ischemic attack without clinical significance
Correct Answer: B
Rationale: Atrial fibrillation causes blood stasis in the left atrial appendage,
promoting thrombus formation; embolization to the cerebral circulation causes
stroke, manifesting as focal neurologic deficits such as aphasia and hemiparesis.
Q4: A client with a thoracic aortic aneurysm reports sudden, tearing chest pain
radiating to the back. Blood pressure is 190/110 mmHg in the right arm and 140/88
mmHg in the left arm. Which intervention is the priority?
A. Administering aspirin 325 mg PO
B. Initiating IV beta-blockade to reduce shear stress and blood pressure [CORRECT]
C. Preparing the client for immediate coronary angiography
D. Administering thrombolytic therapy
Correct Answer: B
Rationale: Acute aortic dissection requires immediate beta-blockade (esmolol or
labetalol) to reduce heart rate, blood pressure, and dP/dt (shear stress), preventing
extension of the dissection; aspirin and thrombolytics are contraindicated.
Q5: A client with heart failure has a serum BNP of 1,850 pg/mL. Which clinical
finding is most consistent with this laboratory value?
A. Improved cardiac function with reduced ventricular stretch
B. Severe volume overload and ventricular wall stress [CORRECT]
C. Normal compensatory response to mild fluid retention
D. Artifact from concurrent ACE inhibitor therapy
Correct Answer: B
Rationale: B-type natriuretic peptide (BNP) is released from ventricular myocardium
in response to stretch; levels >400 pg/mL indicate severe heart failure with
significant volume overload and elevated ventricular filling pressures.
, Q6: A client with third-degree AV block has a heart rate of 32 bpm, syncope, and
hypotension. Which intervention is most appropriate?
A. Atropine 0.5 mg IV push
B. Transcutaneous pacing [CORRECT]
C. Dopamine infusion at 2 mcg/kg/min
D. Defibrillation at 200 joules
Correct Answer: B
Rationale: Third-degree AV block with hemodynamic instability (syncope,
hypotension) requires immediate transcutaneous pacing to maintain adequate
cardiac output; atropine is often ineffective in complete heart block, and defibrillation
is for pulseless rhythms.
Q7: A client post-cardiac catheterization via the femoral artery develops a groin
hematoma and absent distal pulses. Which complication is suspected?
A. Contrast-induced nephropathy
B. Arterial occlusion from retroperitoneal bleeding or thrombosis [CORRECT]
C. Vasovagal response to the procedure
D. Allergic reaction to the local anesthetic
Correct Answer: B
Rationale: Absent distal pulses with groin hematoma after femoral catheterization
indicates arterial compromise from either expanding retroperitoneal hemorrhage
compressing the vessel or thrombus formation at the access site, requiring
immediate vascular surgery consultation.
Q8: A client with hypertrophic cardiomyopathy (HCM) experiences syncope during
exertion. Which teaching is most important?
A. "Increase your fluid intake to improve preload."
B. "Avoid strenuous exercise and competitive sports." [CORRECT]
C. "Take your diuretic before exercise to reduce afterload."
D. "Use isometric exercises to strengthen your heart muscle."
Correct Answer: B
Rationale: HCM causes dynamic left ventricular outflow tract obstruction that
worsens with exertion, increasing risk of sudden cardiac death; clients must avoid
strenuous activity and competitive sports, which are the most common triggers for
fatal arrhythmias.
