NSG 430 Exam 2 – Adult Health Nursing II – (2026)
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Section 1: Heart Failure & Acute Decompensated Heart Failure (ADHF)
Question 1
A nurse is assessing a patient with left-sided heart failure. Which finding is most
indicative of this condition?
A. Jugular venous distention (JVD)
B. Peripheral edema
C. Hepatomegaly
D. Pulmonary crackles
Answer: D. Pulmonary crackles
Rationale: Left-sided heart failure causes fluid to back up into the pulmonary
circulation. This results in pulmonary congestion and edema, which presents as
crackles (rales) on auscultation. JVD, peripheral edema, and hepatomegaly are
signs of right-sided heart failure, where fluid backs up into the systemic venous
system.
Question 2
A patient with chronic heart failure (HFrEF) is being discharged. Which statement
indicates a correct understanding of daily weight monitoring?
A. "I will weigh myself once a week."
B. "I will weigh myself daily at the same time, before breakfast and after voiding."
C. "I should expect my weight to fluctuate by 5 pounds daily."
D. "I only need to weigh myself if I feel short of breath."
Answer: B. "I will weigh myself daily at the same time, before breakfast and
after voiding."
Rationale: Daily weights are the best indicator of fluid retention. The patient
should use the same scale, at the same time each day (usually morning, after
voiding, before eating), with the same amount of clothing. A weight gain of more
than 2–3 lbs in a day or 5 lbs in a week should be reported to the provider.
,Question 3
A patient with heart failure is prescribed lisinopril. The nurse should monitor for
which potential adverse effect?
A. Hyperkalemia
B. Hypokalemia
C. Tachycardia
D. Hypoglycemia
Answer: A. Hyperkalemia
Rationale: Lisinopril is an ACE inhibitor. ACE inhibitors can cause hyperkalemia by
reducing aldosterone secretion, which decreases potassium excretion. They also
commonly cause a dry cough due to bradykinin accumulation. ARBs (like losartan)
do not cause cough.
Question 4
A patient is admitted with acute decompensated heart failure (ADHF). Which
finding requires the most immediate action?
A. Crackles in the lower lung fields
B. Oxygen saturation of 88%
C. 2+ pedal edema
D. Heart rate of 104 beats/min
Answer: B. Oxygen saturation of 88%
Rationale: An SpO₂ of 88% indicates significant hypoxemia. In ADHF, impaired gas
exchange due to pulmonary edema is life-threatening. Improving oxygenation is
the top priority. Crackles, edema, and tachycardia are serious but less
immediately life-threatening than severe hypoxemia.
Question 5
The hallmark of systolic heart failure is:
A. Decreased ejection fraction (normal is 50%)
B. Increased ejection fraction
C. Normal ejection fraction
D. Decreased BNP levels
,Answer: A. Decreased ejection fraction (normal is 50%)
Rationale: Systolic HF is characterized by reduced left ventricular ejection fraction
(LVEF). The normal ejection fraction is 50% or higher. BNP levels correlate
positively with the degree of LV failure. Indicators of decreased perfusion include
hypotension, decreased urine output, cool extremities, altered mentation, and
worsening renal and liver function tests.
Question 6
A patient with heart failure is on digoxin and furosemide. The patient develops
nausea, vomiting, and blurred vision. The nurse suspects:
A. Furosemide toxicity
B. Digoxin toxicity
C. Hyperkalemia
D. Hyponatremia
Answer: B. Digoxin toxicity
Rationale: Furosemide is a loop diuretic that causes potassium loss. Hypokalemia
increases the risk of digoxin toxicity. Signs of digoxin toxicity include GI symptoms
(nausea, vomiting, anorexia), visual disturbances (blurred vision, halos around
lights), and cardiac dysrhythmias.
Question 7
IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary
edema. During the first hours of administration, the nurse will need to titrate the
rate if the patient develops:
A. Bradycardia <55 bpm
B. A systolic BP <90 mm Hg
C. Urine output >100 mL/hr
D. Heart rate >110 bpm
Answer: B. A systolic BP <90 mm Hg
Rationale: Nitroprusside is a potent arterial and venous vasodilator. It rapidly
reduces blood pressure. A systolic BP under 90 mm Hg indicates excessive
hypotension and requires immediate rate reduction or discontinuation.
, Question 8
A patient who is receiving dobutamine (Dobutrex) for ADHF has the following
nursing interventions included in the plan of care. Which action is most
appropriate for the RN to delegate to an experienced LPN/LVN?
A. Titrate the dobutamine infusion rate
B. Educate the patient about dobutamine therapy
C. Monitor the patient's vital signs and report changes
D. Assess the patient's cardiac rhythm continuously
Answer: C. Monitor the patient's vital signs and report changes
Rationale: The LPN/LVN scope of practice includes obtaining and documenting
vital signs and reporting abnormalities to the RN. Titrating IV infusions, providing
patient education, and assessing cardiac rhythms require RN-level assessment
and critical thinking.
Question 9
The nurse knows that beta-blockers reduce angina by:
A. Decreasing myocardial oxygen demand
B. Increasing myocardial contractility
C. Dilating coronary arteries
D. Reducing preload
Answer: A. Decreasing myocardial oxygen demand
Rationale: Beta-blockers reduce heart rate and myocardial contractility, which
decreases the workload of the heart and myocardial oxygen demand. They are
not primary vasodilators.
Question 10
A patient with heart failure has a history of COPD. Which beta-blocker is
considered safest for this patient?
A. Propranolol
B. Nadolol
C. Metoprolol succinate
D. Carvedilol
Actual Questions & Answers (GCU) 100% Guarantee
Pass
Section 1: Heart Failure & Acute Decompensated Heart Failure (ADHF)
Question 1
A nurse is assessing a patient with left-sided heart failure. Which finding is most
indicative of this condition?
A. Jugular venous distention (JVD)
B. Peripheral edema
C. Hepatomegaly
D. Pulmonary crackles
Answer: D. Pulmonary crackles
Rationale: Left-sided heart failure causes fluid to back up into the pulmonary
circulation. This results in pulmonary congestion and edema, which presents as
crackles (rales) on auscultation. JVD, peripheral edema, and hepatomegaly are
signs of right-sided heart failure, where fluid backs up into the systemic venous
system.
Question 2
A patient with chronic heart failure (HFrEF) is being discharged. Which statement
indicates a correct understanding of daily weight monitoring?
A. "I will weigh myself once a week."
B. "I will weigh myself daily at the same time, before breakfast and after voiding."
C. "I should expect my weight to fluctuate by 5 pounds daily."
D. "I only need to weigh myself if I feel short of breath."
Answer: B. "I will weigh myself daily at the same time, before breakfast and
after voiding."
Rationale: Daily weights are the best indicator of fluid retention. The patient
should use the same scale, at the same time each day (usually morning, after
voiding, before eating), with the same amount of clothing. A weight gain of more
than 2–3 lbs in a day or 5 lbs in a week should be reported to the provider.
,Question 3
A patient with heart failure is prescribed lisinopril. The nurse should monitor for
which potential adverse effect?
A. Hyperkalemia
B. Hypokalemia
C. Tachycardia
D. Hypoglycemia
Answer: A. Hyperkalemia
Rationale: Lisinopril is an ACE inhibitor. ACE inhibitors can cause hyperkalemia by
reducing aldosterone secretion, which decreases potassium excretion. They also
commonly cause a dry cough due to bradykinin accumulation. ARBs (like losartan)
do not cause cough.
Question 4
A patient is admitted with acute decompensated heart failure (ADHF). Which
finding requires the most immediate action?
A. Crackles in the lower lung fields
B. Oxygen saturation of 88%
C. 2+ pedal edema
D. Heart rate of 104 beats/min
Answer: B. Oxygen saturation of 88%
Rationale: An SpO₂ of 88% indicates significant hypoxemia. In ADHF, impaired gas
exchange due to pulmonary edema is life-threatening. Improving oxygenation is
the top priority. Crackles, edema, and tachycardia are serious but less
immediately life-threatening than severe hypoxemia.
Question 5
The hallmark of systolic heart failure is:
A. Decreased ejection fraction (normal is 50%)
B. Increased ejection fraction
C. Normal ejection fraction
D. Decreased BNP levels
,Answer: A. Decreased ejection fraction (normal is 50%)
Rationale: Systolic HF is characterized by reduced left ventricular ejection fraction
(LVEF). The normal ejection fraction is 50% or higher. BNP levels correlate
positively with the degree of LV failure. Indicators of decreased perfusion include
hypotension, decreased urine output, cool extremities, altered mentation, and
worsening renal and liver function tests.
Question 6
A patient with heart failure is on digoxin and furosemide. The patient develops
nausea, vomiting, and blurred vision. The nurse suspects:
A. Furosemide toxicity
B. Digoxin toxicity
C. Hyperkalemia
D. Hyponatremia
Answer: B. Digoxin toxicity
Rationale: Furosemide is a loop diuretic that causes potassium loss. Hypokalemia
increases the risk of digoxin toxicity. Signs of digoxin toxicity include GI symptoms
(nausea, vomiting, anorexia), visual disturbances (blurred vision, halos around
lights), and cardiac dysrhythmias.
Question 7
IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary
edema. During the first hours of administration, the nurse will need to titrate the
rate if the patient develops:
A. Bradycardia <55 bpm
B. A systolic BP <90 mm Hg
C. Urine output >100 mL/hr
D. Heart rate >110 bpm
Answer: B. A systolic BP <90 mm Hg
Rationale: Nitroprusside is a potent arterial and venous vasodilator. It rapidly
reduces blood pressure. A systolic BP under 90 mm Hg indicates excessive
hypotension and requires immediate rate reduction or discontinuation.
, Question 8
A patient who is receiving dobutamine (Dobutrex) for ADHF has the following
nursing interventions included in the plan of care. Which action is most
appropriate for the RN to delegate to an experienced LPN/LVN?
A. Titrate the dobutamine infusion rate
B. Educate the patient about dobutamine therapy
C. Monitor the patient's vital signs and report changes
D. Assess the patient's cardiac rhythm continuously
Answer: C. Monitor the patient's vital signs and report changes
Rationale: The LPN/LVN scope of practice includes obtaining and documenting
vital signs and reporting abnormalities to the RN. Titrating IV infusions, providing
patient education, and assessing cardiac rhythms require RN-level assessment
and critical thinking.
Question 9
The nurse knows that beta-blockers reduce angina by:
A. Decreasing myocardial oxygen demand
B. Increasing myocardial contractility
C. Dilating coronary arteries
D. Reducing preload
Answer: A. Decreasing myocardial oxygen demand
Rationale: Beta-blockers reduce heart rate and myocardial contractility, which
decreases the workload of the heart and myocardial oxygen demand. They are
not primary vasodilators.
Question 10
A patient with heart failure has a history of COPD. Which beta-blocker is
considered safest for this patient?
A. Propranolol
B. Nadolol
C. Metoprolol succinate
D. Carvedilol
