NR341 CMS Review Exam 2026 | Complex Adult Health | Chamberlain University
NR341 / NR341 CMS Review (Latest 2026 /
2027)
Complex Adult Health - Chamberlain University
Questions with 100% Correct Answers | Verified | Latest Update
100 Questions | 8 Sections | Scenario-Based & Clinical Judgment
Content Mastery Series (CMS) Review Aligned
Table of Contents
Section 1: Cardiovascular Critical Care (ACS, Heart Failure, Dysrhythmias, Post-Cardiac Surgery) - Q1-Q20
Section 2: Respiratory Critical Care (ARDS, Mechanical Ventilation, COPD, Pneumonia, PE) - Q21-Q33
Section 3: Neurological Critical Care (Stroke, Head Injury, SCI, Autonomic Dysreflexia) - Q34-Q46
Section 4: Renal and Metabolic Critical Care (AKI, Fluid/Electrolyte, Acid-Base) - Q47-Q60
Section 5: Endocrine Emergencies (DKA, Thyroid Storm, Adrenal Crisis, SIADH/DI) - Q61-Q70
Section 6: Shock States and Multisystem Organ Dysfunction - Q71-Q82
Section 7: Emergency and Trauma Nursing - Q83-Q92
Section 8: Palliative Care, End-of-Life, and Ethical Considerations - Q93-Q100
Page 1
,NR341 CMS Review Exam 2026 | Complex Adult Health | Chamberlain University
Section 1: Cardiovascular Critical Care (ACS, Heart Failure,
Dysrhythmias, & Post-Cardiac Surgery) [Q1-Q20]
Q1. A patient arrives in the emergency department with crushing substernal chest pain radiating to the left
arm. The provider diagnoses acute coronary syndrome (ACS). Which intervention is the first priority in the
MONA protocol for this patient?
A. Administer morphine sulfate IV for pain relief
B. Administer aspirin 325 mg chewed immediately [CORRECT]
C. Apply supplemental oxygen at 2 L/min via nasal cannula
D. Administer nitroglycerin sublingually to reduce cardiac workload
Correct Answer: B
Rationale: Aspirin is the first medication administered in the MONA protocol for ACS because it inhibits platelet aggregation, preventing
further thrombus formation in the coronary artery. Morphine is given for pain not relieved by nitroglycerin. Oxygen is administered only if
SpO2 is below 94%. Nitroglycerin is given after aspirin to reduce preload and myocardial oxygen demand. The CMS review emphasizes
that aspirin is the single most important initial intervention to preserve myocardium.
Q2. A nurse is caring for a patient receiving a beta-blocker (metoprolol) following a myocardial infarction.
Which assessment finding requires the nurse to hold the medication and notify the provider?
A. Heart rate 68 bpm and blood pressure 118/76 mmHg
B. Heart rate 48 bpm and blood pressure 88/54 mmHg [CORRECT]
C. Respiratory rate 18 breaths/min with SpO2 96%
D. Blood glucose 142 mg/dL with no prior history of diabetes
Correct Answer: B
Rationale: Beta-blockers slow conduction through the AV node and decrease myocardial contractility. A heart rate of 48 bpm and blood
pressure of 88/54 mmHg indicate significant bradycardia and hypotension, requiring the nurse to hold the medication and notify the
provider. CMS review prioritizes monitoring heart rate and blood pressure before administering beta-blockers; hold if heart rate is below
60 bpm or systolic blood pressure is below 100 mmHg. Normal respiratory rate and mildly elevated glucose do not warrant withholding
the medication.
Q3. The nurse is reviewing cardiac enzyme results for a patient with suspected myocardial infarction. Which
biomarker is the most specific indicator of myocardial injury and should be the priority for the nurse to
monitor?
A. Creatine kinase-MB (CK-MB)
B. Troponin I [CORRECT]
C. Myoglobin
D. B-type natriuretic peptide (BNP)
Correct Answer: B
Rationale: Troponin I is the most specific and sensitive cardiac biomarker for myocardial injury because it is released exclusively from
damaged myocardial cells. Troponin levels rise within 3-4 hours of injury, peak at 12-24 hours, and remain elevated for 7-10 days.
CK-MB is less specific because it is also found in skeletal muscle. Myoglobin rises early but is nonspecific. BNP reflects heart failure, not
acute myocardial injury. Troponin is the gold standard for MI diagnosis per CMS review guidelines.
Q4. A patient with heart failure reports increasing shortness of breath and has frothy pink sputum. Which
finding indicates left-sided heart failure?
A. Peripheral edema in bilateral lower extremities
Page 2
, NR341 CMS Review Exam 2026 | Complex Adult Health | Chamberlain University
B. Frothy pink sputum and crackles in the lung fields [CORRECT]
C. Jugular venous distention and hepatomegaly
D. Weight gain of 3 pounds over the past week
Correct Answer: B
Rationale: Frothy pink sputum (pulmonary edema) and crackles in the lung fields are classic indicators of left-sided heart failure because
the left ventricle cannot effectively pump blood forward, causing fluid backup into the pulmonary circulation. Peripheral edema, jugular
venous distention, and hepatomegaly are signs of right-sided heart failure due to systemic venous congestion. Weight gain reflects total
fluid retention and can occur in both left and right heart failure but is not specific to left-sided failure.
Q5. The nurse is providing discharge teaching for a patient with heart failure. Which statement by the patient
indicates effective teaching regarding dietary modifications?
A. 'I should limit my sodium intake to 4 grams per day.'
B. 'I should limit my sodium intake to 2 grams per day.' [CORRECT]
C. 'I should increase my fluid intake to 3 liters per day.'
D. 'I should use salt substitutes to flavor my food instead of table salt.'
Correct Answer: B
Rationale: Heart failure management requires strict sodium restriction to 2 grams per day to reduce fluid retention and decrease cardiac
workload. A 4-gram limit is too permissive and would not adequately control fluid overload. Increasing fluid to 3 liters would worsen fluid
overload and is contraindicated. Salt substitutes are often contraindicated in heart failure patients because many contain potassium
chloride, which can cause hyperkalemia especially when combined with ACE inhibitors or potassium-sparing diuretics. CMS review
emphasizes the 2g/day sodium restriction as a core teaching point.
Q6. A patient returns from cardiac catheterization via the right femoral artery. Which nursing intervention is
the priority for post-procedure care?
A. Maintain the affected extremity in extension and assess CMS every 2 hours [CORRECT]
B. Encourage the patient to ambulate within 1 hour to prevent DVT
C. Apply a cold compress to the insertion site to reduce swelling
D. Administer prescribed antiplatelet therapy immediately
Correct Answer: A
Rationale: Following cardiac catheterization via femoral artery, the priority intervention is to maintain the affected extremity in extension
(straight) to prevent bleeding from the arterial puncture site, and perform CMS checks (Color, Movement, Sensation) every 2 hours to
assess distal perfusion. Early ambulation is contraindicated for 4-8 hours post-procedure due to bleeding risk. Cold compresses are not
standard care and could mask hematoma formation. Antiplatelet therapy is given but is not the priority over direct vascular site assessment.
Q7. A patient post-cardiac catheterization develops hypotension (BP 82/50 mmHg). What should the nurse
assess first?
A. The cardiac catheterization report for contrast volume used
B. The access site for bleeding or hematoma formation [CORRECT]
C. The patient's neurological status and level of consciousness
D. The patient's most recent potassium level
Correct Answer: B
Rationale: When a patient develops hypotension after cardiac catheterization, the nurse must first assess the access site for bleeding or
hematoma formation because arterial bleeding is the most common and immediately life-threatening complication. Hypovolemia from
retroperitoneal or groin bleeding can cause rapid hemodynamic compromise. While neurological assessment, contrast volume review, and
potassium levels are important, the access site is the first priority per CMS review guidelines because it represents a potentially reversible
cause of the hypotension.
Page 3
NR341 / NR341 CMS Review (Latest 2026 /
2027)
Complex Adult Health - Chamberlain University
Questions with 100% Correct Answers | Verified | Latest Update
100 Questions | 8 Sections | Scenario-Based & Clinical Judgment
Content Mastery Series (CMS) Review Aligned
Table of Contents
Section 1: Cardiovascular Critical Care (ACS, Heart Failure, Dysrhythmias, Post-Cardiac Surgery) - Q1-Q20
Section 2: Respiratory Critical Care (ARDS, Mechanical Ventilation, COPD, Pneumonia, PE) - Q21-Q33
Section 3: Neurological Critical Care (Stroke, Head Injury, SCI, Autonomic Dysreflexia) - Q34-Q46
Section 4: Renal and Metabolic Critical Care (AKI, Fluid/Electrolyte, Acid-Base) - Q47-Q60
Section 5: Endocrine Emergencies (DKA, Thyroid Storm, Adrenal Crisis, SIADH/DI) - Q61-Q70
Section 6: Shock States and Multisystem Organ Dysfunction - Q71-Q82
Section 7: Emergency and Trauma Nursing - Q83-Q92
Section 8: Palliative Care, End-of-Life, and Ethical Considerations - Q93-Q100
Page 1
,NR341 CMS Review Exam 2026 | Complex Adult Health | Chamberlain University
Section 1: Cardiovascular Critical Care (ACS, Heart Failure,
Dysrhythmias, & Post-Cardiac Surgery) [Q1-Q20]
Q1. A patient arrives in the emergency department with crushing substernal chest pain radiating to the left
arm. The provider diagnoses acute coronary syndrome (ACS). Which intervention is the first priority in the
MONA protocol for this patient?
A. Administer morphine sulfate IV for pain relief
B. Administer aspirin 325 mg chewed immediately [CORRECT]
C. Apply supplemental oxygen at 2 L/min via nasal cannula
D. Administer nitroglycerin sublingually to reduce cardiac workload
Correct Answer: B
Rationale: Aspirin is the first medication administered in the MONA protocol for ACS because it inhibits platelet aggregation, preventing
further thrombus formation in the coronary artery. Morphine is given for pain not relieved by nitroglycerin. Oxygen is administered only if
SpO2 is below 94%. Nitroglycerin is given after aspirin to reduce preload and myocardial oxygen demand. The CMS review emphasizes
that aspirin is the single most important initial intervention to preserve myocardium.
Q2. A nurse is caring for a patient receiving a beta-blocker (metoprolol) following a myocardial infarction.
Which assessment finding requires the nurse to hold the medication and notify the provider?
A. Heart rate 68 bpm and blood pressure 118/76 mmHg
B. Heart rate 48 bpm and blood pressure 88/54 mmHg [CORRECT]
C. Respiratory rate 18 breaths/min with SpO2 96%
D. Blood glucose 142 mg/dL with no prior history of diabetes
Correct Answer: B
Rationale: Beta-blockers slow conduction through the AV node and decrease myocardial contractility. A heart rate of 48 bpm and blood
pressure of 88/54 mmHg indicate significant bradycardia and hypotension, requiring the nurse to hold the medication and notify the
provider. CMS review prioritizes monitoring heart rate and blood pressure before administering beta-blockers; hold if heart rate is below
60 bpm or systolic blood pressure is below 100 mmHg. Normal respiratory rate and mildly elevated glucose do not warrant withholding
the medication.
Q3. The nurse is reviewing cardiac enzyme results for a patient with suspected myocardial infarction. Which
biomarker is the most specific indicator of myocardial injury and should be the priority for the nurse to
monitor?
A. Creatine kinase-MB (CK-MB)
B. Troponin I [CORRECT]
C. Myoglobin
D. B-type natriuretic peptide (BNP)
Correct Answer: B
Rationale: Troponin I is the most specific and sensitive cardiac biomarker for myocardial injury because it is released exclusively from
damaged myocardial cells. Troponin levels rise within 3-4 hours of injury, peak at 12-24 hours, and remain elevated for 7-10 days.
CK-MB is less specific because it is also found in skeletal muscle. Myoglobin rises early but is nonspecific. BNP reflects heart failure, not
acute myocardial injury. Troponin is the gold standard for MI diagnosis per CMS review guidelines.
Q4. A patient with heart failure reports increasing shortness of breath and has frothy pink sputum. Which
finding indicates left-sided heart failure?
A. Peripheral edema in bilateral lower extremities
Page 2
, NR341 CMS Review Exam 2026 | Complex Adult Health | Chamberlain University
B. Frothy pink sputum and crackles in the lung fields [CORRECT]
C. Jugular venous distention and hepatomegaly
D. Weight gain of 3 pounds over the past week
Correct Answer: B
Rationale: Frothy pink sputum (pulmonary edema) and crackles in the lung fields are classic indicators of left-sided heart failure because
the left ventricle cannot effectively pump blood forward, causing fluid backup into the pulmonary circulation. Peripheral edema, jugular
venous distention, and hepatomegaly are signs of right-sided heart failure due to systemic venous congestion. Weight gain reflects total
fluid retention and can occur in both left and right heart failure but is not specific to left-sided failure.
Q5. The nurse is providing discharge teaching for a patient with heart failure. Which statement by the patient
indicates effective teaching regarding dietary modifications?
A. 'I should limit my sodium intake to 4 grams per day.'
B. 'I should limit my sodium intake to 2 grams per day.' [CORRECT]
C. 'I should increase my fluid intake to 3 liters per day.'
D. 'I should use salt substitutes to flavor my food instead of table salt.'
Correct Answer: B
Rationale: Heart failure management requires strict sodium restriction to 2 grams per day to reduce fluid retention and decrease cardiac
workload. A 4-gram limit is too permissive and would not adequately control fluid overload. Increasing fluid to 3 liters would worsen fluid
overload and is contraindicated. Salt substitutes are often contraindicated in heart failure patients because many contain potassium
chloride, which can cause hyperkalemia especially when combined with ACE inhibitors or potassium-sparing diuretics. CMS review
emphasizes the 2g/day sodium restriction as a core teaching point.
Q6. A patient returns from cardiac catheterization via the right femoral artery. Which nursing intervention is
the priority for post-procedure care?
A. Maintain the affected extremity in extension and assess CMS every 2 hours [CORRECT]
B. Encourage the patient to ambulate within 1 hour to prevent DVT
C. Apply a cold compress to the insertion site to reduce swelling
D. Administer prescribed antiplatelet therapy immediately
Correct Answer: A
Rationale: Following cardiac catheterization via femoral artery, the priority intervention is to maintain the affected extremity in extension
(straight) to prevent bleeding from the arterial puncture site, and perform CMS checks (Color, Movement, Sensation) every 2 hours to
assess distal perfusion. Early ambulation is contraindicated for 4-8 hours post-procedure due to bleeding risk. Cold compresses are not
standard care and could mask hematoma formation. Antiplatelet therapy is given but is not the priority over direct vascular site assessment.
Q7. A patient post-cardiac catheterization develops hypotension (BP 82/50 mmHg). What should the nurse
assess first?
A. The cardiac catheterization report for contrast volume used
B. The access site for bleeding or hematoma formation [CORRECT]
C. The patient's neurological status and level of consciousness
D. The patient's most recent potassium level
Correct Answer: B
Rationale: When a patient develops hypotension after cardiac catheterization, the nurse must first assess the access site for bleeding or
hematoma formation because arterial bleeding is the most common and immediately life-threatening complication. Hypovolemia from
retroperitoneal or groin bleeding can cause rapid hemodynamic compromise. While neurological assessment, contrast volume review, and
potassium levels are important, the access site is the first priority per CMS review guidelines because it represents a potentially reversible
cause of the hypotension.
Page 3
