NUR 417 NURSING CARE OF THE ADULT 2
FINAL EXAM REVIEW: 300 REAL
QUESTIONS & RATIONALES \|NUR 417
FINAL EXAM ||ADULT HEALTH NURSING 2
QUESTIONS
Questions 1–25: Cardiovascular Disorders
1. A client with acute heart failure develops severe dyspnea, crackles, and pink, frothy
sputum. Which action should the nurse take first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Obtain a daily weight
D. Administer a potassium supplement
Answer: B. Place the client in high-Fowler's position.
Rationale: High-Fowler's positioning decreases venous return and improves lung expansion,
helping reduce pulmonary congestion and respiratory distress.
2. A client with myocardial infarction reports sudden severe chest pain that is not
relieved by rest. Which assessment finding requires immediate intervention?
A. Heart rate of 88/min
B. Blood pressure of 138/82 mm Hg
C. Oxygen saturation of 89%
D. Respiratory rate of 18/min
Answer: C. Oxygen saturation of 89%.
Rationale: Hypoxemia is an immediate priority because inadequate oxygenation can worsen
myocardial ischemia and tissue injury.
3. Which assessment finding is most consistent with left-sided heart failure?
A. Jugular venous distention
B. Dependent peripheral edema
C. Pulmonary crackles
D. Enlarged liver
Answer: C. Pulmonary crackles.
,Rationale: Left-sided heart failure causes pulmonary congestion, producing crackles,
dyspnea, orthopnea, and pulmonary edema.
4. A client taking furosemide should be monitored closely for which laboratory
abnormality?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B. Hypokalemia.
Rationale: Furosemide is a loop diuretic that increases urinary potassium excretion and can
cause hypokalemia.
5. A client receiving digoxin has an apical pulse of 52/min. What should the nurse do?
A. Administer the medication
B. Give the medication with food
C. Hold the medication and notify the provider
D. Give an additional dose
Answer: C. Hold the medication and notify the provider.
Rationale: Bradycardia can indicate digoxin toxicity or excessive therapeutic effect. The
medication should be withheld and the provider notified.
6. Which finding is most concerning in a client with atrial fibrillation?
A. Irregular pulse
B. Fatigue
C. Sudden unilateral weakness
D. Heart rate of 92/min
Answer: C. Sudden unilateral weakness.
Rationale: Atrial fibrillation increases the risk of thromboembolism and ischemic stroke.
Sudden neurologic deficits require immediate evaluation.
7. Which lifestyle modification is most appropriate for a client with hypertension?
A. Increase sodium intake
B. Stop all physical activity
C. Reduce sodium intake
D. Increase saturated-fat intake
Answer: C. Reduce sodium intake.
Rationale: Limiting sodium can reduce fluid retention and support blood-pressure control.
,8. A client taking warfarin has an INR of 5.8. Which action is most appropriate?
A. Administer the next dose
B. Hold the medication and notify the provider
C. Encourage foods high in vitamin K immediately
D. Give aspirin
Answer: B. Hold the medication and notify the provider.
Rationale: A markedly elevated INR increases bleeding risk. The medication should be held
and the result reported promptly.
9. Which finding suggests peripheral arterial disease rather than venous disease?
A. Warm skin
B. Brown pigmentation around the ankles
C. Diminished peripheral pulses
D. Dependent edema
Answer: C. Diminished peripheral pulses.
Rationale: Arterial disease decreases blood flow and commonly causes diminished pulses,
cool extremities, pallor, and ischemic pain.
10. A client with suspected deep-vein thrombosis reports unilateral calf pain and
swelling. Which action should the nurse take?
A. Massage the calf
B. Encourage vigorous ambulation
C. Notify the provider
D. Apply deep pressure to the calf
Answer: C. Notify the provider.
Rationale: DVT can embolize to the lungs and cause pulmonary embolism. The client
requires prompt evaluation and treatment.
11. Which symptom is most characteristic of stable angina?
A. Chest pain occurring predictably with exertion
B. Chest pain lasting continuously for several hours
C. Pain occurring only during sleep
D. Sudden severe pain unrelated to activity
Answer: A. Chest pain occurring predictably with exertion.
Rationale: Stable angina typically occurs with exertion or emotional stress and improves
with rest or prescribed nitroglycerin.
, 12. A client taking nitroglycerin reports a mild headache. How should the nurse
respond?
A. Tell the client to stop the medication permanently
B. Explain that headache can occur because of vasodilation
C. Tell the client that headache indicates an allergic reaction
D. Administer an additional dose immediately
Answer: B. Explain that headache can occur because of vasodilation.
Rationale: Headache is a common effect of nitroglycerin because the medication causes
vasodilation.
13. Which finding in a client with heart failure should the nurse report promptly?
A. Weight gain of 2 kg over several days
B. Heart rate of 76/min
C. Clear lung sounds
D. Improved exercise tolerance
Answer: A. Weight gain of 2 kg over several days.
Rationale: Rapid weight gain may indicate fluid retention and worsening heart failure.
14. Which assessment finding is expected in right-sided heart failure?
A. Pulmonary edema only
B. Peripheral edema
C. Hemoptysis
D. Severe wheezing only
Answer: B. Peripheral edema.
Rationale: Right-sided heart failure causes systemic venous congestion, resulting in
peripheral edema, jugular venous distention, and hepatic congestion.
15. Which medication is commonly used to reduce platelet aggregation after acute
coronary syndrome?
A. Aspirin
B. Acetaminophen
C. Calcium carbonate
D. Diphenhydramine
Answer: A. Aspirin.
Rationale: Aspirin inhibits platelet aggregation and is commonly used in acute coronary
syndromes unless contraindicated.
FINAL EXAM REVIEW: 300 REAL
QUESTIONS & RATIONALES \|NUR 417
FINAL EXAM ||ADULT HEALTH NURSING 2
QUESTIONS
Questions 1–25: Cardiovascular Disorders
1. A client with acute heart failure develops severe dyspnea, crackles, and pink, frothy
sputum. Which action should the nurse take first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Obtain a daily weight
D. Administer a potassium supplement
Answer: B. Place the client in high-Fowler's position.
Rationale: High-Fowler's positioning decreases venous return and improves lung expansion,
helping reduce pulmonary congestion and respiratory distress.
2. A client with myocardial infarction reports sudden severe chest pain that is not
relieved by rest. Which assessment finding requires immediate intervention?
A. Heart rate of 88/min
B. Blood pressure of 138/82 mm Hg
C. Oxygen saturation of 89%
D. Respiratory rate of 18/min
Answer: C. Oxygen saturation of 89%.
Rationale: Hypoxemia is an immediate priority because inadequate oxygenation can worsen
myocardial ischemia and tissue injury.
3. Which assessment finding is most consistent with left-sided heart failure?
A. Jugular venous distention
B. Dependent peripheral edema
C. Pulmonary crackles
D. Enlarged liver
Answer: C. Pulmonary crackles.
,Rationale: Left-sided heart failure causes pulmonary congestion, producing crackles,
dyspnea, orthopnea, and pulmonary edema.
4. A client taking furosemide should be monitored closely for which laboratory
abnormality?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B. Hypokalemia.
Rationale: Furosemide is a loop diuretic that increases urinary potassium excretion and can
cause hypokalemia.
5. A client receiving digoxin has an apical pulse of 52/min. What should the nurse do?
A. Administer the medication
B. Give the medication with food
C. Hold the medication and notify the provider
D. Give an additional dose
Answer: C. Hold the medication and notify the provider.
Rationale: Bradycardia can indicate digoxin toxicity or excessive therapeutic effect. The
medication should be withheld and the provider notified.
6. Which finding is most concerning in a client with atrial fibrillation?
A. Irregular pulse
B. Fatigue
C. Sudden unilateral weakness
D. Heart rate of 92/min
Answer: C. Sudden unilateral weakness.
Rationale: Atrial fibrillation increases the risk of thromboembolism and ischemic stroke.
Sudden neurologic deficits require immediate evaluation.
7. Which lifestyle modification is most appropriate for a client with hypertension?
A. Increase sodium intake
B. Stop all physical activity
C. Reduce sodium intake
D. Increase saturated-fat intake
Answer: C. Reduce sodium intake.
Rationale: Limiting sodium can reduce fluid retention and support blood-pressure control.
,8. A client taking warfarin has an INR of 5.8. Which action is most appropriate?
A. Administer the next dose
B. Hold the medication and notify the provider
C. Encourage foods high in vitamin K immediately
D. Give aspirin
Answer: B. Hold the medication and notify the provider.
Rationale: A markedly elevated INR increases bleeding risk. The medication should be held
and the result reported promptly.
9. Which finding suggests peripheral arterial disease rather than venous disease?
A. Warm skin
B. Brown pigmentation around the ankles
C. Diminished peripheral pulses
D. Dependent edema
Answer: C. Diminished peripheral pulses.
Rationale: Arterial disease decreases blood flow and commonly causes diminished pulses,
cool extremities, pallor, and ischemic pain.
10. A client with suspected deep-vein thrombosis reports unilateral calf pain and
swelling. Which action should the nurse take?
A. Massage the calf
B. Encourage vigorous ambulation
C. Notify the provider
D. Apply deep pressure to the calf
Answer: C. Notify the provider.
Rationale: DVT can embolize to the lungs and cause pulmonary embolism. The client
requires prompt evaluation and treatment.
11. Which symptom is most characteristic of stable angina?
A. Chest pain occurring predictably with exertion
B. Chest pain lasting continuously for several hours
C. Pain occurring only during sleep
D. Sudden severe pain unrelated to activity
Answer: A. Chest pain occurring predictably with exertion.
Rationale: Stable angina typically occurs with exertion or emotional stress and improves
with rest or prescribed nitroglycerin.
, 12. A client taking nitroglycerin reports a mild headache. How should the nurse
respond?
A. Tell the client to stop the medication permanently
B. Explain that headache can occur because of vasodilation
C. Tell the client that headache indicates an allergic reaction
D. Administer an additional dose immediately
Answer: B. Explain that headache can occur because of vasodilation.
Rationale: Headache is a common effect of nitroglycerin because the medication causes
vasodilation.
13. Which finding in a client with heart failure should the nurse report promptly?
A. Weight gain of 2 kg over several days
B. Heart rate of 76/min
C. Clear lung sounds
D. Improved exercise tolerance
Answer: A. Weight gain of 2 kg over several days.
Rationale: Rapid weight gain may indicate fluid retention and worsening heart failure.
14. Which assessment finding is expected in right-sided heart failure?
A. Pulmonary edema only
B. Peripheral edema
C. Hemoptysis
D. Severe wheezing only
Answer: B. Peripheral edema.
Rationale: Right-sided heart failure causes systemic venous congestion, resulting in
peripheral edema, jugular venous distention, and hepatic congestion.
15. Which medication is commonly used to reduce platelet aggregation after acute
coronary syndrome?
A. Aspirin
B. Acetaminophen
C. Calcium carbonate
D. Diphenhydramine
Answer: A. Aspirin.
Rationale: Aspirin inhibits platelet aggregation and is commonly used in acute coronary
syndromes unless contraindicated.
