NSG 430 Adult Health Nursing II Final Exam Practice
Guide Actual 2026/2027 with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
SECTION 1: COMPLEX CARDIOVASCULAR DISORDERS (12
Questions)
Q1: A client with heart failure has a new prescription for sacubitril/valsartan
(Entresto). The nurse should hold the medication and notify the provider if which
laboratory value is present?
A. Serum potassium of 4.2 mEq/L
B. Serum creatinine of 1.0 mg/dL
C. Blood urea nitrogen of 18 mg/dL
D. Serum potassium of 5.8 mEq/L [CORRECT]
Correct Answer: D
Rationale: Correct because sacubitril/valsartan is contraindicated with hyperkalemia
(>5.4 mEq/L) due to risk of life-threatening cardiac arrhythmias, and the neprilysin
inhibition component can further elevate potassium levels.
Q2: A client admitted with acute coronary syndrome is receiving heparin infusion.
The nurse notes the aPTT is 95 seconds (therapeutic range 60–80 seconds). What is
the nurse's priority action?
A. Continue the infusion at the current rate
,B. Increase the infusion rate per protocol
C. Decrease the infusion rate per protocol [CORRECT]
D. Discontinue the infusion immediately
Correct Answer: C
Rationale: Correct because an aPTT of 95 seconds indicates supratherapeutic
anticoagulation; the nurse must decrease the infusion rate per protocol to prevent
bleeding complications while maintaining therapeutic effect.
Q3: A client with atrial fibrillation is prescribed warfarin. The nurse is teaching about
dietary restrictions. Which client statement indicates understanding?
A. "I should avoid all green vegetables completely."
B. "I need to maintain consistent vitamin K intake." [CORRECT]
C. "I can eat as much spinach as I want now."
D. "Vitamin K will enhance the effect of my warfarin."
Correct Answer: B
Rationale: Correct because maintaining consistent daily vitamin K intake allows for
stable warfarin dosing; sudden increases or decreases in vitamin K alter INR
unpredictably.
Q4: A client with a thoracic aortic aneurysm reports sudden, tearing chest pain
radiating to the back. Blood pressure is 180/110 mmHg. What is the nurse's first
action?
A. Administer sublingual nitroglycerin
,B. Obtain a 12-lead ECG
C. Administer IV beta-blockade per protocol [CORRECT]
D. Prepare the client for immediate surgery
Correct Answer: C
Rationale: Correct because IV beta-blockade (e.g., labetalol or esmolol) reduces
shear stress on the aortic wall by lowering heart rate and blood pressure, which is
the immediate priority to prevent aneurysm rupture or dissection extension.
Q5: A client with severe aortic stenosis becomes hypotensive and develops acute
pulmonary edema. Which intervention is contraindicated?
A. Supplemental oxygen via non-rebreather mask
B. IV diuretic administration
C. Vasodilator therapy [CORRECT]
D. Upright positioning with legs dependent
Correct Answer: C
Rationale: Correct because vasodilators reduce afterload, which in aortic stenosis
causes critical reduction in coronary perfusion pressure and can precipitate
cardiovascular collapse due to fixed outflow obstruction.
Q6: A client with acute decompensated heart failure has the following vital signs: BP
88/52 mmHg, HR 118 bpm, RR 28/min, SpO₂ 89% on 2L NC. Which medication
should the nurse question?
A. Furosemide 40 mg IV push [CORRECT]
, B. Digoxin 0.25 mg PO
C. Carvedilol 6.25 mg PO
D. Enalapril 5 mg PO
Correct Answer: A
Rationale: Correct because aggressive diuresis with furosemide in hypotensive heart
failure can worsen hypoperfusion and precipitate cardiogenic shock; inotropes and
afterload reduction take priority in this presentation.
Q7: A client post-MI develops ventricular tachycardia with a pulse. The nurse has
already confirmed responsiveness and called for help. What is the next appropriate
action?
A. Begin CPR immediately
B. Defibrillate with 200 joules biphasic
C. Administer amiodarone 150 mg IV push over 10 minutes [CORRECT]
D. Administer epinephrine 1 mg IV push
Correct Answer: C
Rationale: Correct because stable ventricular tachycardia with a pulse is managed
with antiarrhythmic medication per ACLS protocol; amiodarone is the first-line
pharmacologic intervention for monomorphic VT with preserved perfusion.
Q8: A client with infective endocarditis is being discharged on IV antibiotics. Which
statement by the client requires immediate nurse intervention?
A. "I will keep my PICC line dry during showers."
Guide Actual 2026/2027 with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
SECTION 1: COMPLEX CARDIOVASCULAR DISORDERS (12
Questions)
Q1: A client with heart failure has a new prescription for sacubitril/valsartan
(Entresto). The nurse should hold the medication and notify the provider if which
laboratory value is present?
A. Serum potassium of 4.2 mEq/L
B. Serum creatinine of 1.0 mg/dL
C. Blood urea nitrogen of 18 mg/dL
D. Serum potassium of 5.8 mEq/L [CORRECT]
Correct Answer: D
Rationale: Correct because sacubitril/valsartan is contraindicated with hyperkalemia
(>5.4 mEq/L) due to risk of life-threatening cardiac arrhythmias, and the neprilysin
inhibition component can further elevate potassium levels.
Q2: A client admitted with acute coronary syndrome is receiving heparin infusion.
The nurse notes the aPTT is 95 seconds (therapeutic range 60–80 seconds). What is
the nurse's priority action?
A. Continue the infusion at the current rate
,B. Increase the infusion rate per protocol
C. Decrease the infusion rate per protocol [CORRECT]
D. Discontinue the infusion immediately
Correct Answer: C
Rationale: Correct because an aPTT of 95 seconds indicates supratherapeutic
anticoagulation; the nurse must decrease the infusion rate per protocol to prevent
bleeding complications while maintaining therapeutic effect.
Q3: A client with atrial fibrillation is prescribed warfarin. The nurse is teaching about
dietary restrictions. Which client statement indicates understanding?
A. "I should avoid all green vegetables completely."
B. "I need to maintain consistent vitamin K intake." [CORRECT]
C. "I can eat as much spinach as I want now."
D. "Vitamin K will enhance the effect of my warfarin."
Correct Answer: B
Rationale: Correct because maintaining consistent daily vitamin K intake allows for
stable warfarin dosing; sudden increases or decreases in vitamin K alter INR
unpredictably.
Q4: A client with a thoracic aortic aneurysm reports sudden, tearing chest pain
radiating to the back. Blood pressure is 180/110 mmHg. What is the nurse's first
action?
A. Administer sublingual nitroglycerin
,B. Obtain a 12-lead ECG
C. Administer IV beta-blockade per protocol [CORRECT]
D. Prepare the client for immediate surgery
Correct Answer: C
Rationale: Correct because IV beta-blockade (e.g., labetalol or esmolol) reduces
shear stress on the aortic wall by lowering heart rate and blood pressure, which is
the immediate priority to prevent aneurysm rupture or dissection extension.
Q5: A client with severe aortic stenosis becomes hypotensive and develops acute
pulmonary edema. Which intervention is contraindicated?
A. Supplemental oxygen via non-rebreather mask
B. IV diuretic administration
C. Vasodilator therapy [CORRECT]
D. Upright positioning with legs dependent
Correct Answer: C
Rationale: Correct because vasodilators reduce afterload, which in aortic stenosis
causes critical reduction in coronary perfusion pressure and can precipitate
cardiovascular collapse due to fixed outflow obstruction.
Q6: A client with acute decompensated heart failure has the following vital signs: BP
88/52 mmHg, HR 118 bpm, RR 28/min, SpO₂ 89% on 2L NC. Which medication
should the nurse question?
A. Furosemide 40 mg IV push [CORRECT]
, B. Digoxin 0.25 mg PO
C. Carvedilol 6.25 mg PO
D. Enalapril 5 mg PO
Correct Answer: A
Rationale: Correct because aggressive diuresis with furosemide in hypotensive heart
failure can worsen hypoperfusion and precipitate cardiogenic shock; inotropes and
afterload reduction take priority in this presentation.
Q7: A client post-MI develops ventricular tachycardia with a pulse. The nurse has
already confirmed responsiveness and called for help. What is the next appropriate
action?
A. Begin CPR immediately
B. Defibrillate with 200 joules biphasic
C. Administer amiodarone 150 mg IV push over 10 minutes [CORRECT]
D. Administer epinephrine 1 mg IV push
Correct Answer: C
Rationale: Correct because stable ventricular tachycardia with a pulse is managed
with antiarrhythmic medication per ACLS protocol; amiodarone is the first-line
pharmacologic intervention for monomorphic VT with preserved perfusion.
Q8: A client with infective endocarditis is being discharged on IV antibiotics. Which
statement by the client requires immediate nurse intervention?
A. "I will keep my PICC line dry during showers."
