NURS 230 – FUNDAMENTALS & ADVANCED NURSING
CONCEPTS
COMPREHENSIVE PRACTICE EXAM 3
EDITION
BSN-Level Nursing | 100 Questions | 7 Content Sections
Aligned with 2026–2027 NCLEX-RN Test Plan & Evidence-Based Clinical Guidelines
Multiple Choice (A–D) | Correct answers marked ✓
,SECTION 1: Cardiovascular & Respiratory Nursing – Heart Failure, MI,
Dysrhythmias, COPD, Asthma, Pneumonia (Q1–Q25)
Q1. A patient with acute decompensated heart failure presents with SpO₂ of 84%, bilateral
crackles, and frothy pink sputum. What is the nurse's FIRST priority intervention?
A. Obtain a 12-lead ECG
B. Administer furosemide 40 mg IV
C. Elevate the head of bed to 90° and apply supplemental oxygen ✓
D. Insert a Foley catheter to monitor urine output
Correct Answer: C | Rationale: Severe hypoxia (SpO₂ 84%) is immediately life-threatening;
positioning upright reduces preload and work of breathing while oxygen corrects hypoxemia.
Furosemide and ECG are important but oxygen and positioning take precedence to prevent respiratory
arrest.
Q2. A patient is admitted with an STEMI. Which intervention is the HIGHEST priority within the
first 90 minutes?
A. Administer aspirin 325 mg PO and prepare for primary percutaneous coronary
intervention (PCI) ✓
B. Begin continuous heparin infusion and obtain cardiac enzyme levels every 6 hours
C. Administer morphine sulfate 4 mg IV and prepare for cardiac catheterization in 24
hours
D. Apply cardiac monitor and notify the cardiologist for evaluation in the morning
Correct Answer: A | Rationale: The goal for STEMI management is door-to-balloon time ≤90
minutes. Aspirin is given immediately (antiplatelet effect) and primary PCI is the preferred reperfusion
strategy. Delayed catheterization and routine monitoring without urgent intervention are not
acceptable in STEMI management.
Q3. A patient on the telemetry unit develops sudden-onset wide-complex, monomorphic
tachycardia at 180 bpm. The patient is pulseless. The nurse's immediate action is to:
A. Administer amiodarone 300 mg IV push
B. Prepare for synchronized cardioversion at 200 J
C. Call a code and initiate CPR with defibrillation ✓
D. Obtain a 12-lead ECG and notify the physician
Correct Answer: C | Rationale: Pulseless ventricular tachycardia is treated identically to ventricular
fibrillation — CPR and immediate unsynchronized defibrillation per ACLS protocol. Synchronized
cardioversion is used for patients WITH a pulse. Amiodarone is given after defibrillation attempts, not as
the first action.
Q4. A patient with newly diagnosed atrial fibrillation has a ventricular rate of 138 bpm and is
hemodynamically stable. Which medication does the nurse anticipate administering first?
, A. Digoxin 0.25 mg IV
B. Metoprolol 5 mg IV for rate control ✓
C. Amiodarone 300 mg IV push
D. Adenosine 6 mg rapid IV push
Correct Answer: B | Rationale: Beta-blockers (metoprolol) and calcium channel blockers are first-
line for rate control in hemodynamically stable atrial fibrillation. Digoxin is slower-acting and less
effective for active rate control. Amiodarone is a rhythm-control agent. Adenosine is used for
supraventricular tachycardia, not A-fib.
Q5. A patient with COPD is receiving oxygen via nasal cannula at 2 L/min. The ABG shows pH
7.32, PaCO₂ 68 mmHg, PaO₂ 54 mmHg, HCO₃ 34 mEq/L. The nurse should:
A. Increase oxygen to 6 L/min immediately to correct hypoxemia
B. Maintain oxygen at the lowest flow that achieves SpO₂ 88–92% and notify the
provider of rising CO₂ ✓
C. Remove oxygen to stimulate the hypoxic drive
D. Administer sodium bicarbonate IV to correct the metabolic alkalosis
Correct Answer: B | Rationale: COPD patients rely on a hypoxic drive; the target SpO₂ is 88–92%.
Increasing O₂ excessively suppresses the drive and worsens CO₂ retention. The rising PaCO ₂ with
compensation (high HCO₃) indicates chronic respiratory acidosis with an acute component — the
provider must be notified.
Q6. A patient with an acute asthma exacerbation has a peak flow of 38% of personal best. The
nurse correctly identifies this as:
A. Mild exacerbation — continue current inhaled bronchodilator schedule
B. Moderate exacerbation — add inhaled corticosteroids and reassess
C. Severe exacerbation requiring systemic corticosteroids, continuous nebulized
albuterol, and possible intubation ✓
D. Normal variation that does not require intervention
Correct Answer: C | Rationale: Peak flow <40% of personal best indicates a severe asthma
exacerbation. Management includes systemic corticosteroids, continuous nebulized albuterol,
ipratropium, supplemental oxygen, and preparation for intubation if no response. Mild-moderate
exacerbations have peak flows of 40–69% and >70%, respectively.
Q7. A nurse is caring for a patient with community-acquired pneumonia. Which assessment
finding indicates clinical deterioration requiring IMMEDIATE provider notification?
A. Temperature 38.2°C (100.8°F)
B. Productive cough with yellow sputum
C. Respiratory rate 32 breaths/min, SpO₂ 88%, and confusion ✓
D. WBC count of 13,000/mm³
Correct Answer: C | Rationale: Rapid respiratory rate >30, SpO₂ <90%, and new-onset confusion are
CURB-65 severity criteria and signs of sepsis/respiratory failure requiring immediate escalation. Fever,
, productive cough, and mild leukocytosis are expected findings in pneumonia without indicating acute
deterioration.
Q8. A post-MI patient is started on carvedilol (Coreg). The nurse should instruct the patient to:
A. Take the medication only when experiencing chest pain
B. Stop the medication immediately if dizziness occurs
C. Take the medication with food to reduce GI side effects and not stop it abruptly
✓
D. Avoid taking the medication if heart rate is above 80 bpm
Correct Answer: C | Rationale: Carvedilol (a beta-blocker) should be taken with food to improve
bioavailability and reduce GI upset. Abrupt discontinuation causes rebound tachycardia and angina,
which can precipitate MI. It is taken daily (not PRN), and mild dizziness does not warrant stopping it.
Q9. A patient with pulmonary embolism is started on a heparin infusion. Which laboratory
value is used to monitor therapeutic effect?
A. PT/INR (target INR 2–3)
B. aPTT (target 60–100 seconds, or 1.5–2.5× control) ✓
C. Platelet count (target >150,000/mm³)
D. Anti-Xa level only for LMWH, not unfractionated heparin
Correct Answer: B | Rationale: Unfractionated heparin (UFH) is monitored with aPTT, targeting 60–
100 seconds (1.5–2.5× control). INR/PT monitors warfarin therapy. Platelet count is monitored to
detect heparin-induced thrombocytopenia (HIT) but does not measure anticoagulant effect. Anti-Xa is
used for LMWH.
Q10. A patient with heart failure has the following assessment: bilateral crackles, 3+ pitting
edema, weight gain of 4 lbs in 2 days, JVD present. The nurse identifies this as:
A. Right-sided heart failure only
B. Dehydration secondary to diuretic overuse
C. Acute decompensated heart failure with fluid volume excess ✓
D. Normal findings in a patient with chronic stable heart failure
Correct Answer: C | Rationale: Bilateral crackles (pulmonary edema = left-sided), 3+ pedal edema
and JVD (right-sided), and rapid weight gain (fluid retention) are hallmark signs of acute
decompensated heart failure. A 2-lb weight gain in 24 hours is a standard patient-education threshold
for calling the provider.
Q11. Which position is MOST therapeutic for a patient experiencing an acute episode of cardiac
tamponade while awaiting pericardiocentesis?
A. Supine with legs elevated 45°
B. Left lateral decubitus position
C. High Fowler's (60–90°) with legs dependent ✓
D. Prone position to relieve pericardial pressure
CONCEPTS
COMPREHENSIVE PRACTICE EXAM 3
EDITION
BSN-Level Nursing | 100 Questions | 7 Content Sections
Aligned with 2026–2027 NCLEX-RN Test Plan & Evidence-Based Clinical Guidelines
Multiple Choice (A–D) | Correct answers marked ✓
,SECTION 1: Cardiovascular & Respiratory Nursing – Heart Failure, MI,
Dysrhythmias, COPD, Asthma, Pneumonia (Q1–Q25)
Q1. A patient with acute decompensated heart failure presents with SpO₂ of 84%, bilateral
crackles, and frothy pink sputum. What is the nurse's FIRST priority intervention?
A. Obtain a 12-lead ECG
B. Administer furosemide 40 mg IV
C. Elevate the head of bed to 90° and apply supplemental oxygen ✓
D. Insert a Foley catheter to monitor urine output
Correct Answer: C | Rationale: Severe hypoxia (SpO₂ 84%) is immediately life-threatening;
positioning upright reduces preload and work of breathing while oxygen corrects hypoxemia.
Furosemide and ECG are important but oxygen and positioning take precedence to prevent respiratory
arrest.
Q2. A patient is admitted with an STEMI. Which intervention is the HIGHEST priority within the
first 90 minutes?
A. Administer aspirin 325 mg PO and prepare for primary percutaneous coronary
intervention (PCI) ✓
B. Begin continuous heparin infusion and obtain cardiac enzyme levels every 6 hours
C. Administer morphine sulfate 4 mg IV and prepare for cardiac catheterization in 24
hours
D. Apply cardiac monitor and notify the cardiologist for evaluation in the morning
Correct Answer: A | Rationale: The goal for STEMI management is door-to-balloon time ≤90
minutes. Aspirin is given immediately (antiplatelet effect) and primary PCI is the preferred reperfusion
strategy. Delayed catheterization and routine monitoring without urgent intervention are not
acceptable in STEMI management.
Q3. A patient on the telemetry unit develops sudden-onset wide-complex, monomorphic
tachycardia at 180 bpm. The patient is pulseless. The nurse's immediate action is to:
A. Administer amiodarone 300 mg IV push
B. Prepare for synchronized cardioversion at 200 J
C. Call a code and initiate CPR with defibrillation ✓
D. Obtain a 12-lead ECG and notify the physician
Correct Answer: C | Rationale: Pulseless ventricular tachycardia is treated identically to ventricular
fibrillation — CPR and immediate unsynchronized defibrillation per ACLS protocol. Synchronized
cardioversion is used for patients WITH a pulse. Amiodarone is given after defibrillation attempts, not as
the first action.
Q4. A patient with newly diagnosed atrial fibrillation has a ventricular rate of 138 bpm and is
hemodynamically stable. Which medication does the nurse anticipate administering first?
, A. Digoxin 0.25 mg IV
B. Metoprolol 5 mg IV for rate control ✓
C. Amiodarone 300 mg IV push
D. Adenosine 6 mg rapid IV push
Correct Answer: B | Rationale: Beta-blockers (metoprolol) and calcium channel blockers are first-
line for rate control in hemodynamically stable atrial fibrillation. Digoxin is slower-acting and less
effective for active rate control. Amiodarone is a rhythm-control agent. Adenosine is used for
supraventricular tachycardia, not A-fib.
Q5. A patient with COPD is receiving oxygen via nasal cannula at 2 L/min. The ABG shows pH
7.32, PaCO₂ 68 mmHg, PaO₂ 54 mmHg, HCO₃ 34 mEq/L. The nurse should:
A. Increase oxygen to 6 L/min immediately to correct hypoxemia
B. Maintain oxygen at the lowest flow that achieves SpO₂ 88–92% and notify the
provider of rising CO₂ ✓
C. Remove oxygen to stimulate the hypoxic drive
D. Administer sodium bicarbonate IV to correct the metabolic alkalosis
Correct Answer: B | Rationale: COPD patients rely on a hypoxic drive; the target SpO₂ is 88–92%.
Increasing O₂ excessively suppresses the drive and worsens CO₂ retention. The rising PaCO ₂ with
compensation (high HCO₃) indicates chronic respiratory acidosis with an acute component — the
provider must be notified.
Q6. A patient with an acute asthma exacerbation has a peak flow of 38% of personal best. The
nurse correctly identifies this as:
A. Mild exacerbation — continue current inhaled bronchodilator schedule
B. Moderate exacerbation — add inhaled corticosteroids and reassess
C. Severe exacerbation requiring systemic corticosteroids, continuous nebulized
albuterol, and possible intubation ✓
D. Normal variation that does not require intervention
Correct Answer: C | Rationale: Peak flow <40% of personal best indicates a severe asthma
exacerbation. Management includes systemic corticosteroids, continuous nebulized albuterol,
ipratropium, supplemental oxygen, and preparation for intubation if no response. Mild-moderate
exacerbations have peak flows of 40–69% and >70%, respectively.
Q7. A nurse is caring for a patient with community-acquired pneumonia. Which assessment
finding indicates clinical deterioration requiring IMMEDIATE provider notification?
A. Temperature 38.2°C (100.8°F)
B. Productive cough with yellow sputum
C. Respiratory rate 32 breaths/min, SpO₂ 88%, and confusion ✓
D. WBC count of 13,000/mm³
Correct Answer: C | Rationale: Rapid respiratory rate >30, SpO₂ <90%, and new-onset confusion are
CURB-65 severity criteria and signs of sepsis/respiratory failure requiring immediate escalation. Fever,
, productive cough, and mild leukocytosis are expected findings in pneumonia without indicating acute
deterioration.
Q8. A post-MI patient is started on carvedilol (Coreg). The nurse should instruct the patient to:
A. Take the medication only when experiencing chest pain
B. Stop the medication immediately if dizziness occurs
C. Take the medication with food to reduce GI side effects and not stop it abruptly
✓
D. Avoid taking the medication if heart rate is above 80 bpm
Correct Answer: C | Rationale: Carvedilol (a beta-blocker) should be taken with food to improve
bioavailability and reduce GI upset. Abrupt discontinuation causes rebound tachycardia and angina,
which can precipitate MI. It is taken daily (not PRN), and mild dizziness does not warrant stopping it.
Q9. A patient with pulmonary embolism is started on a heparin infusion. Which laboratory
value is used to monitor therapeutic effect?
A. PT/INR (target INR 2–3)
B. aPTT (target 60–100 seconds, or 1.5–2.5× control) ✓
C. Platelet count (target >150,000/mm³)
D. Anti-Xa level only for LMWH, not unfractionated heparin
Correct Answer: B | Rationale: Unfractionated heparin (UFH) is monitored with aPTT, targeting 60–
100 seconds (1.5–2.5× control). INR/PT monitors warfarin therapy. Platelet count is monitored to
detect heparin-induced thrombocytopenia (HIT) but does not measure anticoagulant effect. Anti-Xa is
used for LMWH.
Q10. A patient with heart failure has the following assessment: bilateral crackles, 3+ pitting
edema, weight gain of 4 lbs in 2 days, JVD present. The nurse identifies this as:
A. Right-sided heart failure only
B. Dehydration secondary to diuretic overuse
C. Acute decompensated heart failure with fluid volume excess ✓
D. Normal findings in a patient with chronic stable heart failure
Correct Answer: C | Rationale: Bilateral crackles (pulmonary edema = left-sided), 3+ pedal edema
and JVD (right-sided), and rapid weight gain (fluid retention) are hallmark signs of acute
decompensated heart failure. A 2-lb weight gain in 24 hours is a standard patient-education threshold
for calling the provider.
Q11. Which position is MOST therapeutic for a patient experiencing an acute episode of cardiac
tamponade while awaiting pericardiocentesis?
A. Supine with legs elevated 45°
B. Left lateral decubitus position
C. High Fowler's (60–90°) with legs dependent ✓
D. Prone position to relieve pericardial pressure
