TABLE OF CONTENTS
SECTION 1: CARDIOVASCULAR DISORDERS ...... Questions 1-18
SECTION 2: RESPIRATORY DISORDERS ...... Questions 19-28
SECTION 3: NEUROLOGICAL DISORDERS ...... Questions 29-38
SECTION 4: GASTROINTESTINAL DISORDERS ...... Questions 39-50
SECTION 5: RENAL AND URINARY DISORDERS ...... Questions 51-58
SECTION 6: ENDOCRINE DISORDERS ...... Questions 59-68
SECTION 7: MUSCULOSKELETAL DISORDERS ...... Questions 69-76
SECTION 8: HEMATOLOGIC AND IMMUNOLOGIC DISORDERS ...... Questions 77-84
SECTION 9: ONCOLOGY AND PALLIATIVE CARE ...... Questions 85-90
SECTION 10: EMERGENCY AND CRITICAL CARE ...... Questions 91-95
SECTION 11: INTEGRATED NGN CLINICAL SCENARIOS ...... Questions 96-100
,SECTION 1: CARDIOVASCULAR DISORDERS
Questions 1-18
1. A PN is caring for a client with heart failure who is receiving furosemide (Lasix) IV. Which of the
following findings should the nurse identify as an adverse effect of this medication?
A. Bradycardia
B. Hypokalemia [CORRECT]
C. Hypernatremia
D. Increased blood pressure
Correct Answer: B
Rationale: Furosemide is a loop diuretic that promotes the excretion of sodium, water, and potassium. Hypokalemia is a
common and potentially dangerous adverse effect because low potassium levels increase the risk of cardiac dysrhythmias,
particularly in clients with heart failure who may also be taking digoxin. The PN should monitor serum potassium levels
closely and ensure the client receives potassium supplementation or potassium-rich foods as prescribed. Bradycardia is not
associated with furosemide. Furosemide causes sodium depletion (hyponatremia risk), not hypernatremia. It typically lowers
blood pressure due to volume reduction, not increases it.
2. A client with coronary artery disease (CAD) reports chest pain that occurs at rest and is not
relieved by sublingual nitroglycerin. The PN should recognize this as which of the following?
A. Stable angina
B. Unstable angina [CORRECT]
C. Prinzmetal angina
D. Silent ischemia
Correct Answer: B
Rationale: Unstable angina is characterized by chest pain that occurs at rest, is more severe, lasts longer than stable angina,
and is not relieved by rest or nitroglycerin. It represents a medical emergency because it indicates that atherosclerotic plaque
has become unstable, potentially leading to partial or complete thrombosis of the coronary artery. The PN should
immediately notify the healthcare provider and prepare for interventions such as continuous cardiac monitoring, oxygen
therapy, and possible anticoagulant therapy. Stable angina is relieved by rest and nitroglycerin. Prinzmetal angina is caused
by coronary vasospasm and typically responds to nitroglycerin. Silent ischemia occurs without chest pain.
3. A PN is reviewing the laboratory results of a client who has been receiving heparin therapy for deep
vein thrombosis (DVT). Which of the following results indicates that the heparin therapy is effective?
A. Prothrombin time (PT) 12 seconds
B. Activated partial thromboplastin time (aPTT) 60 seconds [CORRECT]
C. International normalized ratio (INR) 2.5
D. Platelet count 400,000/mm3
Correct Answer: B
Rationale: The activated partial thromboplastin time (aPTT) is the primary laboratory test used to monitor heparin therapy.
For therapeutic effectiveness, the aPTT should be approximately 1.5 to 2.5 times the normal control value. A normal aPTT is
about 30-40 seconds, so a result of 60 seconds falls within the therapeutic range. PT and INR are used to monitor warfarin
therapy, not heparin. Platelet count is monitored for heparin-induced thrombocytopenia (HIT), not for therapeutic
effectiveness.
2
,4. A client with heart failure is prescribed digoxin (Lanoxin). Which of the following statements by the
client indicates a need for further teaching?
A. I will check my pulse before taking each dose.
B. I will eat foods high in potassium every day.
C. I will take the medication with an antacid if I have stomach upset. [CORRECT]
D. I will report any visual disturbances to my provider.
Correct Answer: C
Rationale: The client should not take digoxin with antacids because antacids can decrease the absorption of digoxin from the
gastrointestinal tract. If an antacid is needed, it should be administered at least 2 hours apart from the digoxin dose.
Checking the pulse before each dose (hold if below 60 bpm) is correct. Eating potassium-rich foods is correct because
hypokalemia potentiates digoxin toxicity. Reporting visual disturbances (yellow-green halos) is essential because these are
classic signs of digoxin toxicity.
5. A PN is caring for a client who has just returned from cardiac catheterization. Which of the
following interventions should the nurse implement?
A. Encourage the client to ambulate within 1 hour of the procedure.
B. Maintain strict bed rest with the affected extremity straight for 4-6 hours. [CORRECT]
C. Apply a warm compress to the insertion site to promote circulation.
D. Instruct the client to flex the affected knee every 30 minutes.
Correct Answer: B
Rationale: Following cardiac catheterization, the client must remain on strict bed rest for 4-6 hours with the affected
extremity kept straight to prevent bleeding from the arterial or venous puncture site. Early ambulation or flexing the affected
extremity can dislodge the clot that has formed at the insertion site, leading to hemorrhage. The PN should check the
insertion site for bleeding or hematoma formation, assess distal pulses, and monitor vital signs.
6. A client with a history of hypertension is prescribed enalapril (Vasotec), an ACE inhibitor. Which
of the following side effects should the PN instruct the client to report?
A. Mild dry cough [CORRECT]
B. Increased urinary output
C. Weight gain of 1 lb in a week
D. Slight dizziness when standing quickly
Correct Answer: A
Rationale: A persistent dry cough is a common side effect of ACE inhibitors, occurring in up to 20% of patients. It results
from the accumulation of bradykinin in the respiratory tract because ACE also functions as kininase II, which normally
breaks down bradykinin. While the cough is not dangerous, it can be bothersome enough to require a switch to an
angiotensin II receptor blocker (ARB). The PN should instruct the client to report this so the provider can evaluate whether a
medication change is needed.
7. A PN is assessing a client with peripheral arterial disease (PAD). Which of the following findings is
consistent with this condition?
A. Edema of the ankles that worsens throughout the day
B. Pain in the calves that occurs during walking and is relieved by rest [CORRECT]
C. Warm, flushed skin on the affected extremity
3
, D. Visible, dilated veins in the lower extremities
Correct Answer: B
Rationale: Intermittent claudication is the classic symptom of peripheral arterial disease (PAD). It manifests as pain,
cramping, or aching in the calves that occurs during walking or exercise and is relieved by rest. Edema, warm flushed skin,
and dilated veins are more consistent with venous insufficiency, not arterial disease. In PAD, the affected extremity is
typically cool, pale, and may have diminished or absent pulses.
8. A client is being discharged after an acute myocardial infarction (MI). Which of the following
statements by the client indicates that discharge teaching has been effective?
A. I can return to my usual activities within 1 week.
B. I will take my nitroglycerin tablets every day at the same time to prevent chest pain.
C. I will call 911 if my chest pain is not relieved by one nitroglycerin tablet. [CORRECT]
D. I should avoid exercise because it will strain my heart.
Correct Answer: C
Rationale: After an MI, clients should be instructed to call 911 if chest pain is not relieved by one sublingual nitroglycerin
tablet because this may indicate ongoing ischemia, reinfarction, or other complications requiring emergency intervention.
Nitroglycerin is used PRN for acute chest pain, not on a scheduled daily basis. Most clients can resume normal activities
within 4-6 weeks with provider approval. Exercise is an important part of cardiac recovery and should be gradually resumed.
9. A PN is caring for a client with aortic stenosis. Which of the following assessments is the priority for
the nurse to monitor?
A. Respiratory rate and oxygen saturation
B. Blood pressure for hypotension [CORRECT]
C. Bowel sounds and abdominal distention
D. Level of consciousness and orientation
Correct Answer: B
Rationale: Aortic stenosis causes a fixed cardiac output due to obstruction of blood flow from the left ventricle. The
narrowed valve prevents adequate forward flow, which leads to decreased cardiac output and subsequent hypotension.
Monitoring blood pressure is the priority because severe hypotension can indicate critical obstruction, decreased tissue
perfusion, and potential cardiovascular collapse. The PN should also monitor for syncope, angina, and signs of heart failure,
which are the classic triad of aortic stenosis symptoms.
10. A client with endocarditis is receiving IV vancomycin. The PN should monitor the client for which
of the following adverse effects?
A. Ototoxicity and nephrotoxicity [CORRECT]
B. Hepatotoxicity and jaundice
C. Constipation and abdominal cramping
D. Tachycardia and palpitations
Correct Answer: A
Rationale: Vancomycin is a glycopeptide antibiotic that carries significant risks of ototoxicity (hearing loss, tinnitus, vertigo)
and nephrotoxicity (elevated BUN and creatinine). These adverse effects are dose-related and more likely with prolonged
therapy or concurrent use of other nephrotoxic medications. The PN should monitor serum vancomycin trough levels, renal
function tests, and assess for signs of hearing changes. Infusion-related reactions (Red Man Syndrome) can occur if
vancomycin is infused too rapidly, so it should be administered over at least 60 minutes.
4
SECTION 1: CARDIOVASCULAR DISORDERS ...... Questions 1-18
SECTION 2: RESPIRATORY DISORDERS ...... Questions 19-28
SECTION 3: NEUROLOGICAL DISORDERS ...... Questions 29-38
SECTION 4: GASTROINTESTINAL DISORDERS ...... Questions 39-50
SECTION 5: RENAL AND URINARY DISORDERS ...... Questions 51-58
SECTION 6: ENDOCRINE DISORDERS ...... Questions 59-68
SECTION 7: MUSCULOSKELETAL DISORDERS ...... Questions 69-76
SECTION 8: HEMATOLOGIC AND IMMUNOLOGIC DISORDERS ...... Questions 77-84
SECTION 9: ONCOLOGY AND PALLIATIVE CARE ...... Questions 85-90
SECTION 10: EMERGENCY AND CRITICAL CARE ...... Questions 91-95
SECTION 11: INTEGRATED NGN CLINICAL SCENARIOS ...... Questions 96-100
,SECTION 1: CARDIOVASCULAR DISORDERS
Questions 1-18
1. A PN is caring for a client with heart failure who is receiving furosemide (Lasix) IV. Which of the
following findings should the nurse identify as an adverse effect of this medication?
A. Bradycardia
B. Hypokalemia [CORRECT]
C. Hypernatremia
D. Increased blood pressure
Correct Answer: B
Rationale: Furosemide is a loop diuretic that promotes the excretion of sodium, water, and potassium. Hypokalemia is a
common and potentially dangerous adverse effect because low potassium levels increase the risk of cardiac dysrhythmias,
particularly in clients with heart failure who may also be taking digoxin. The PN should monitor serum potassium levels
closely and ensure the client receives potassium supplementation or potassium-rich foods as prescribed. Bradycardia is not
associated with furosemide. Furosemide causes sodium depletion (hyponatremia risk), not hypernatremia. It typically lowers
blood pressure due to volume reduction, not increases it.
2. A client with coronary artery disease (CAD) reports chest pain that occurs at rest and is not
relieved by sublingual nitroglycerin. The PN should recognize this as which of the following?
A. Stable angina
B. Unstable angina [CORRECT]
C. Prinzmetal angina
D. Silent ischemia
Correct Answer: B
Rationale: Unstable angina is characterized by chest pain that occurs at rest, is more severe, lasts longer than stable angina,
and is not relieved by rest or nitroglycerin. It represents a medical emergency because it indicates that atherosclerotic plaque
has become unstable, potentially leading to partial or complete thrombosis of the coronary artery. The PN should
immediately notify the healthcare provider and prepare for interventions such as continuous cardiac monitoring, oxygen
therapy, and possible anticoagulant therapy. Stable angina is relieved by rest and nitroglycerin. Prinzmetal angina is caused
by coronary vasospasm and typically responds to nitroglycerin. Silent ischemia occurs without chest pain.
3. A PN is reviewing the laboratory results of a client who has been receiving heparin therapy for deep
vein thrombosis (DVT). Which of the following results indicates that the heparin therapy is effective?
A. Prothrombin time (PT) 12 seconds
B. Activated partial thromboplastin time (aPTT) 60 seconds [CORRECT]
C. International normalized ratio (INR) 2.5
D. Platelet count 400,000/mm3
Correct Answer: B
Rationale: The activated partial thromboplastin time (aPTT) is the primary laboratory test used to monitor heparin therapy.
For therapeutic effectiveness, the aPTT should be approximately 1.5 to 2.5 times the normal control value. A normal aPTT is
about 30-40 seconds, so a result of 60 seconds falls within the therapeutic range. PT and INR are used to monitor warfarin
therapy, not heparin. Platelet count is monitored for heparin-induced thrombocytopenia (HIT), not for therapeutic
effectiveness.
2
,4. A client with heart failure is prescribed digoxin (Lanoxin). Which of the following statements by the
client indicates a need for further teaching?
A. I will check my pulse before taking each dose.
B. I will eat foods high in potassium every day.
C. I will take the medication with an antacid if I have stomach upset. [CORRECT]
D. I will report any visual disturbances to my provider.
Correct Answer: C
Rationale: The client should not take digoxin with antacids because antacids can decrease the absorption of digoxin from the
gastrointestinal tract. If an antacid is needed, it should be administered at least 2 hours apart from the digoxin dose.
Checking the pulse before each dose (hold if below 60 bpm) is correct. Eating potassium-rich foods is correct because
hypokalemia potentiates digoxin toxicity. Reporting visual disturbances (yellow-green halos) is essential because these are
classic signs of digoxin toxicity.
5. A PN is caring for a client who has just returned from cardiac catheterization. Which of the
following interventions should the nurse implement?
A. Encourage the client to ambulate within 1 hour of the procedure.
B. Maintain strict bed rest with the affected extremity straight for 4-6 hours. [CORRECT]
C. Apply a warm compress to the insertion site to promote circulation.
D. Instruct the client to flex the affected knee every 30 minutes.
Correct Answer: B
Rationale: Following cardiac catheterization, the client must remain on strict bed rest for 4-6 hours with the affected
extremity kept straight to prevent bleeding from the arterial or venous puncture site. Early ambulation or flexing the affected
extremity can dislodge the clot that has formed at the insertion site, leading to hemorrhage. The PN should check the
insertion site for bleeding or hematoma formation, assess distal pulses, and monitor vital signs.
6. A client with a history of hypertension is prescribed enalapril (Vasotec), an ACE inhibitor. Which
of the following side effects should the PN instruct the client to report?
A. Mild dry cough [CORRECT]
B. Increased urinary output
C. Weight gain of 1 lb in a week
D. Slight dizziness when standing quickly
Correct Answer: A
Rationale: A persistent dry cough is a common side effect of ACE inhibitors, occurring in up to 20% of patients. It results
from the accumulation of bradykinin in the respiratory tract because ACE also functions as kininase II, which normally
breaks down bradykinin. While the cough is not dangerous, it can be bothersome enough to require a switch to an
angiotensin II receptor blocker (ARB). The PN should instruct the client to report this so the provider can evaluate whether a
medication change is needed.
7. A PN is assessing a client with peripheral arterial disease (PAD). Which of the following findings is
consistent with this condition?
A. Edema of the ankles that worsens throughout the day
B. Pain in the calves that occurs during walking and is relieved by rest [CORRECT]
C. Warm, flushed skin on the affected extremity
3
, D. Visible, dilated veins in the lower extremities
Correct Answer: B
Rationale: Intermittent claudication is the classic symptom of peripheral arterial disease (PAD). It manifests as pain,
cramping, or aching in the calves that occurs during walking or exercise and is relieved by rest. Edema, warm flushed skin,
and dilated veins are more consistent with venous insufficiency, not arterial disease. In PAD, the affected extremity is
typically cool, pale, and may have diminished or absent pulses.
8. A client is being discharged after an acute myocardial infarction (MI). Which of the following
statements by the client indicates that discharge teaching has been effective?
A. I can return to my usual activities within 1 week.
B. I will take my nitroglycerin tablets every day at the same time to prevent chest pain.
C. I will call 911 if my chest pain is not relieved by one nitroglycerin tablet. [CORRECT]
D. I should avoid exercise because it will strain my heart.
Correct Answer: C
Rationale: After an MI, clients should be instructed to call 911 if chest pain is not relieved by one sublingual nitroglycerin
tablet because this may indicate ongoing ischemia, reinfarction, or other complications requiring emergency intervention.
Nitroglycerin is used PRN for acute chest pain, not on a scheduled daily basis. Most clients can resume normal activities
within 4-6 weeks with provider approval. Exercise is an important part of cardiac recovery and should be gradually resumed.
9. A PN is caring for a client with aortic stenosis. Which of the following assessments is the priority for
the nurse to monitor?
A. Respiratory rate and oxygen saturation
B. Blood pressure for hypotension [CORRECT]
C. Bowel sounds and abdominal distention
D. Level of consciousness and orientation
Correct Answer: B
Rationale: Aortic stenosis causes a fixed cardiac output due to obstruction of blood flow from the left ventricle. The
narrowed valve prevents adequate forward flow, which leads to decreased cardiac output and subsequent hypotension.
Monitoring blood pressure is the priority because severe hypotension can indicate critical obstruction, decreased tissue
perfusion, and potential cardiovascular collapse. The PN should also monitor for syncope, angina, and signs of heart failure,
which are the classic triad of aortic stenosis symptoms.
10. A client with endocarditis is receiving IV vancomycin. The PN should monitor the client for which
of the following adverse effects?
A. Ototoxicity and nephrotoxicity [CORRECT]
B. Hepatotoxicity and jaundice
C. Constipation and abdominal cramping
D. Tachycardia and palpitations
Correct Answer: A
Rationale: Vancomycin is a glycopeptide antibiotic that carries significant risks of ototoxicity (hearing loss, tinnitus, vertigo)
and nephrotoxicity (elevated BUN and creatinine). These adverse effects are dose-related and more likely with prolonged
therapy or concurrent use of other nephrotoxic medications. The PN should monitor serum vancomycin trough levels, renal
function tests, and assess for signs of hearing changes. Infusion-related reactions (Red Man Syndrome) can occur if
vancomycin is infused too rapidly, so it should be administered over at least 60 minutes.
4
