NR 341 COMPLEX ADULT HEALTH PRACTICE EXAM
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES
SECTION 1: CARDIOVASCULAR (Questions 130)
1. A patient with acute decompensated heart failure (ADHF) has a pulmonary
artery wedge pressure (PAWP) of 28 mmHg. Which medication does the nurse
anticipate administering to reduce preload?
A) Dobutamine
B) Norepinephrine
C) Furosemide
D) Epinephrine
Correct Answer: C
Rationale: Furosemide is a loop diuretic that reduces preload by decreasing
venous return and fluid volume. A PAWP of 28 mmHg (normal 4–12) indicates
fluid overload. Dobutamine and epinephrine increase cardiac contractility but do
not primarily reduce preload. Norepinephrine increases afterload.
2. The nurse is caring for a patient with a pulmonary artery catheter. Which
finding indicates a leftsided heart failure?
A) Elevated central venous pressure (CVP)
,B) Decreased cardiac output
C) Elevated PAWP
D) Decreased systemic vascular resistance (SVR)
Correct Answer: C
Rationale: PAWP reflects left ventricular enddiastolic pressure. An elevated PAWP
indicates leftsided heart failure. CVP reflects rightsided pressures. Decreased
cardiac output can occur in both types of failure. SVR is not directly indicative of
leftsided failure.
3. A patient with a diagnosis of unstable angina is receiving continuous IV
nitroglycerin. Which assessment finding is the priority?
A) Headache
B) Hypotension
C) Flushing
D) Tachycardia
Correct Answer: B
Rationale: IV nitroglycerin is a potent vasodilator that can cause severe
hypotension. Headache and flushing are common side effects but are not
immediately lifethreatening. Tachycardia is a compensatory response to
hypotension; the primary concern is the drop in blood pressure.
4. The nurse is assessing a patient who had a percutaneous coronary intervention
(PCI) via the femoral artery 2 hours ago. Which finding requires immediate action?
A) Hematoma at the puncture site
B) Pedal pulses 2+ bilaterally
C) Numbness and tingling in the right foot
,D) Heart rate of 80 beats/min
Correct Answer: C
Rationale: Numbness and tingling indicate possible neurovascular compromise or
compartment syndrome. A hematoma should be monitored but is not
immediately emergent unless expanding. 2+ pulses are normal.
5. Which laboratory value is most indicative of acute myocardial infarction (AMI)?
A) Troponin I of 5.2 ng/mL
B) CKMB of 5%
C) Myoglobin of 50 mcg/L
D) AST of 40 U/L
Correct Answer: A
Rationale: Troponin I is highly specific to cardiac muscle and remains elevated for
days. Normal is <0.03 ng/mL; 5.2 indicates significant myocardial necrosis. CKMB
can be elevated in skeletal muscle injury. Myoglobin is nonspecific.
6. A patient with heart failure is prescribed carvedilol. What is the primary
therapeutic effect of this medication?
A) Increased heart rate
B) Decreased myocardial oxygen demand
C) Increased contractility
D) Vasoconstriction
Correct Answer: B
, Rationale: Carvedilol is a betablocker that decreases heart rate, contractility, and
afterload, thereby reducing myocardial oxygen demand. It does not increase heart
rate or contractility.
7. The nurse notes a sudden onset of pleuritic chest pain, dyspnea, and
tachycardia in a patient who is 24 hours postknee replacement surgery. What is
the priority nursing action?
A) Administer PRN morphine
B) Apply oxygen and prepare for a V/Q scan
C) Encourage deep breathing
D) Notify the family
Correct Answer: B
Rationale: The symptoms suggest a pulmonary embolism (PE). Applying oxygen
and preparing for a V/Q scan or CT angiography is the priority. Morphine may be
given later for pain, but it does not address the underlying PE.
8. Which ECG change is most characteristic of pericarditis?
A) STsegment elevation in all leads
B) STsegment depression in leads V1V3
C) Pathologic Q waves
D) Prolonged PR interval
Correct Answer: A
Rationale: Pericarditis causes diffuse STsegment elevation in all leads due to global
epicardial inflammation. ST depression is seen in ischemia. Pathologic Q waves are
seen in infarction.
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES
SECTION 1: CARDIOVASCULAR (Questions 130)
1. A patient with acute decompensated heart failure (ADHF) has a pulmonary
artery wedge pressure (PAWP) of 28 mmHg. Which medication does the nurse
anticipate administering to reduce preload?
A) Dobutamine
B) Norepinephrine
C) Furosemide
D) Epinephrine
Correct Answer: C
Rationale: Furosemide is a loop diuretic that reduces preload by decreasing
venous return and fluid volume. A PAWP of 28 mmHg (normal 4–12) indicates
fluid overload. Dobutamine and epinephrine increase cardiac contractility but do
not primarily reduce preload. Norepinephrine increases afterload.
2. The nurse is caring for a patient with a pulmonary artery catheter. Which
finding indicates a leftsided heart failure?
A) Elevated central venous pressure (CVP)
,B) Decreased cardiac output
C) Elevated PAWP
D) Decreased systemic vascular resistance (SVR)
Correct Answer: C
Rationale: PAWP reflects left ventricular enddiastolic pressure. An elevated PAWP
indicates leftsided heart failure. CVP reflects rightsided pressures. Decreased
cardiac output can occur in both types of failure. SVR is not directly indicative of
leftsided failure.
3. A patient with a diagnosis of unstable angina is receiving continuous IV
nitroglycerin. Which assessment finding is the priority?
A) Headache
B) Hypotension
C) Flushing
D) Tachycardia
Correct Answer: B
Rationale: IV nitroglycerin is a potent vasodilator that can cause severe
hypotension. Headache and flushing are common side effects but are not
immediately lifethreatening. Tachycardia is a compensatory response to
hypotension; the primary concern is the drop in blood pressure.
4. The nurse is assessing a patient who had a percutaneous coronary intervention
(PCI) via the femoral artery 2 hours ago. Which finding requires immediate action?
A) Hematoma at the puncture site
B) Pedal pulses 2+ bilaterally
C) Numbness and tingling in the right foot
,D) Heart rate of 80 beats/min
Correct Answer: C
Rationale: Numbness and tingling indicate possible neurovascular compromise or
compartment syndrome. A hematoma should be monitored but is not
immediately emergent unless expanding. 2+ pulses are normal.
5. Which laboratory value is most indicative of acute myocardial infarction (AMI)?
A) Troponin I of 5.2 ng/mL
B) CKMB of 5%
C) Myoglobin of 50 mcg/L
D) AST of 40 U/L
Correct Answer: A
Rationale: Troponin I is highly specific to cardiac muscle and remains elevated for
days. Normal is <0.03 ng/mL; 5.2 indicates significant myocardial necrosis. CKMB
can be elevated in skeletal muscle injury. Myoglobin is nonspecific.
6. A patient with heart failure is prescribed carvedilol. What is the primary
therapeutic effect of this medication?
A) Increased heart rate
B) Decreased myocardial oxygen demand
C) Increased contractility
D) Vasoconstriction
Correct Answer: B
, Rationale: Carvedilol is a betablocker that decreases heart rate, contractility, and
afterload, thereby reducing myocardial oxygen demand. It does not increase heart
rate or contractility.
7. The nurse notes a sudden onset of pleuritic chest pain, dyspnea, and
tachycardia in a patient who is 24 hours postknee replacement surgery. What is
the priority nursing action?
A) Administer PRN morphine
B) Apply oxygen and prepare for a V/Q scan
C) Encourage deep breathing
D) Notify the family
Correct Answer: B
Rationale: The symptoms suggest a pulmonary embolism (PE). Applying oxygen
and preparing for a V/Q scan or CT angiography is the priority. Morphine may be
given later for pain, but it does not address the underlying PE.
8. Which ECG change is most characteristic of pericarditis?
A) STsegment elevation in all leads
B) STsegment depression in leads V1V3
C) Pathologic Q waves
D) Prolonged PR interval
Correct Answer: A
Rationale: Pericarditis causes diffuse STsegment elevation in all leads due to global
epicardial inflammation. ST depression is seen in ischemia. Pathologic Q waves are
seen in infarction.
