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NRSG 3420 – ADVANCED ADULT HEALTH
NURSING COMPREHENSIVE ACTUAL EXAM
PREP 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK |NEW AND REVISED
1. A nurse is caring for a client admitted with acute decompensated heart
failure. The client reports severe shortness of breath and is visibly
anxious. Vital signs are: BP 168/94 mm Hg, HR 118 bpm, RR 32/min,
SpO₂ 86% on room air. Which nursing action should be
implemented first?
A. Administer intravenous furosemide as prescribed.
B. Position the client in high-Fowler's position and apply
supplemental oxygen.
C. Obtain a 12-lead electrocardiogram.
D. Document the findings and notify the provider.
Rationale: The priority in acute decompensated heart failure with
hypoxemia is to improve oxygenation and reduce venous return to the
heart. High-Fowler's positioning and oxygen administration directly
address the immediate physiological threat before pharmacological or
diagnostic interventions. ABC (Airway, Breathing, Circulation)
prioritization governs this decision.
2. A client with a history of atrial fibrillation is prescribed warfarin. The
client's most recent INR is 6.8. Which intervention should the nurse
anticipate?
A. Administer vitamin K (phytonadione) as prescribed.
B. Hold the warfarin dose and prepare to administer vitamin K
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(phytonadione).
C. Increase the warfarin dose to achieve therapeutic range.
D. Administer protamine sulfate as prescribed.
Rationale: An INR of 6.8 is significantly above the therapeutic range
of 2.0–3.0 for atrial fibrillation, indicating a high risk of bleeding. The
nurse should hold the warfarin and anticipate administration of
vitamin K to reverse the anticoagulant effect. Protamine sulfate
reverses heparin, not warfarin.
3. A nurse is assessing a client with suspected acute myocardial
infarction (MI). Which finding should the nurse recognize as most
consistent with an inferior wall MI?
A. ST elevation in leads V1–V4
B. ST elevation in leads II, III, and aVF
C. ST depression in leads I and aVL
D. Tall, peaked T waves in leads V5–V6
Rationale: Inferior wall MI is identified by ST elevation in the inferior
leads: II, III, and aVF. Leads V1–V4 reflect anterior wall MI.
Reciprocal ST depression may occur in lateral leads but is not the
primary diagnostic indicator.
4. A client is admitted with a diagnosis of acute respiratory distress
syndrome (ARDS). Which ventilator strategy should the nurse
anticipate?
A. High tidal volumes to maximize oxygenation
B. Low tidal volumes (6 mL/kg of predicted body weight) to prevent
ventilator-induced lung injury
C. High peak inspiratory pressures to recruit collapsed alveoli
D. Permissive hypercapnia with high respiratory rates
Rationale: Lung-protective ventilation with low tidal volumes (6 mL/kg
of predicted body weight) is the evidence-based standard for ARDS,
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reducing mortality by preventing volutrauma and barotrauma. High
tidal volumes exacerbate lung injury.
5. A nurse is caring for a client with chronic obstructive pulmonary
disease (COPD) who is receiving oxygen therapy. The client's oxygen
saturation is 88%. Which action should the nurse take?
A. Increase oxygen flow rate to maintain SpO₂ above 95%.
B. Maintain oxygen flow rate to target SpO₂ between 88% and 92%.
C. Discontinue oxygen therapy immediately.
D. Administer a bronchodilator nebulizer treatment before adjusting
oxygen.
Rationale: In COPD, the target SpO₂ is 88–92% to avoid suppressing
the hypoxic drive that stimulates respiration. Over-oxygenation can
lead to carbon dioxide retention and respiratory depression.
6. A client with increased intracranial pressure (ICP) from a traumatic
brain injury is being monitored. Which nursing intervention
is contraindicated?
A. Elevating the head of the bed to 30 degrees
B. Performing vigorous endotracheal suctioning
C. Maintaining normothermia
D. Administering mannitol as prescribed
Rationale: Vigorous suctioning increases intrathoracic pressure,
which impedes cerebral venous return and raises ICP. Suctioning
should be limited to 10 seconds and preceded by hyperoxygenation.
Head elevation, normothermia, and mannitol administration are
appropriate ICP management strategies.
7. A nurse is assessing a client with a spinal cord injury at the T6 level.
The client suddenly develops a severe headache, hypertension (BP
210/120 mm Hg), and bradycardia. Which condition should the nurse
suspect?
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A. Spinal shock
B. Autonomic dysreflexia
C. Neurogenic shock
D. Septic shock
Rationale: Autonomic dysreflexia is a life-threatening emergency in
clients with spinal cord injuries at or above T6. It presents with severe
hypertension, pounding headache, and bradycardia due to unchecked
sympathetic stimulation. Immediate intervention includes elevating the
head of the bed and identifying the triggering stimulus (commonly
bladder distension).
8. A client with acute kidney injury (AKI) has the following laboratory
values: potassium 6.8 mEq/L, BUN 68 mg/dL, creatinine 4.2 mg/dL.
Which intervention should the nurse anticipate first?
A. Administering a loop diuretic
B. Administering intravenous calcium gluconate
C. Initiating hemodialysis
D. Restricting dietary potassium
Rationale: Hyperkalemia (potassium >6.5 mEq/L) is a life-threatening
emergency that can cause fatal cardiac dysrhythmias. Intravenous
calcium gluconate is the first-line treatment to stabilize myocardial cell
membranes, followed by insulin/glucose, sodium bicarbonate, and
kayexalate.
9. A nurse is providing education to a client with chronic kidney disease
(CKD) about dietary modifications. Which statement by the client
indicates understanding?
A. "I should increase my intake of high-potassium foods like bananas
and oranges."
B. "I should limit my phosphorus intake by avoiding dairy products
and dark colas."
NRSG 3420 – ADVANCED ADULT HEALTH
NURSING COMPREHENSIVE ACTUAL EXAM
PREP 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK |NEW AND REVISED
1. A nurse is caring for a client admitted with acute decompensated heart
failure. The client reports severe shortness of breath and is visibly
anxious. Vital signs are: BP 168/94 mm Hg, HR 118 bpm, RR 32/min,
SpO₂ 86% on room air. Which nursing action should be
implemented first?
A. Administer intravenous furosemide as prescribed.
B. Position the client in high-Fowler's position and apply
supplemental oxygen.
C. Obtain a 12-lead electrocardiogram.
D. Document the findings and notify the provider.
Rationale: The priority in acute decompensated heart failure with
hypoxemia is to improve oxygenation and reduce venous return to the
heart. High-Fowler's positioning and oxygen administration directly
address the immediate physiological threat before pharmacological or
diagnostic interventions. ABC (Airway, Breathing, Circulation)
prioritization governs this decision.
2. A client with a history of atrial fibrillation is prescribed warfarin. The
client's most recent INR is 6.8. Which intervention should the nurse
anticipate?
A. Administer vitamin K (phytonadione) as prescribed.
B. Hold the warfarin dose and prepare to administer vitamin K
,2|Page
(phytonadione).
C. Increase the warfarin dose to achieve therapeutic range.
D. Administer protamine sulfate as prescribed.
Rationale: An INR of 6.8 is significantly above the therapeutic range
of 2.0–3.0 for atrial fibrillation, indicating a high risk of bleeding. The
nurse should hold the warfarin and anticipate administration of
vitamin K to reverse the anticoagulant effect. Protamine sulfate
reverses heparin, not warfarin.
3. A nurse is assessing a client with suspected acute myocardial
infarction (MI). Which finding should the nurse recognize as most
consistent with an inferior wall MI?
A. ST elevation in leads V1–V4
B. ST elevation in leads II, III, and aVF
C. ST depression in leads I and aVL
D. Tall, peaked T waves in leads V5–V6
Rationale: Inferior wall MI is identified by ST elevation in the inferior
leads: II, III, and aVF. Leads V1–V4 reflect anterior wall MI.
Reciprocal ST depression may occur in lateral leads but is not the
primary diagnostic indicator.
4. A client is admitted with a diagnosis of acute respiratory distress
syndrome (ARDS). Which ventilator strategy should the nurse
anticipate?
A. High tidal volumes to maximize oxygenation
B. Low tidal volumes (6 mL/kg of predicted body weight) to prevent
ventilator-induced lung injury
C. High peak inspiratory pressures to recruit collapsed alveoli
D. Permissive hypercapnia with high respiratory rates
Rationale: Lung-protective ventilation with low tidal volumes (6 mL/kg
of predicted body weight) is the evidence-based standard for ARDS,
,3|Page
reducing mortality by preventing volutrauma and barotrauma. High
tidal volumes exacerbate lung injury.
5. A nurse is caring for a client with chronic obstructive pulmonary
disease (COPD) who is receiving oxygen therapy. The client's oxygen
saturation is 88%. Which action should the nurse take?
A. Increase oxygen flow rate to maintain SpO₂ above 95%.
B. Maintain oxygen flow rate to target SpO₂ between 88% and 92%.
C. Discontinue oxygen therapy immediately.
D. Administer a bronchodilator nebulizer treatment before adjusting
oxygen.
Rationale: In COPD, the target SpO₂ is 88–92% to avoid suppressing
the hypoxic drive that stimulates respiration. Over-oxygenation can
lead to carbon dioxide retention and respiratory depression.
6. A client with increased intracranial pressure (ICP) from a traumatic
brain injury is being monitored. Which nursing intervention
is contraindicated?
A. Elevating the head of the bed to 30 degrees
B. Performing vigorous endotracheal suctioning
C. Maintaining normothermia
D. Administering mannitol as prescribed
Rationale: Vigorous suctioning increases intrathoracic pressure,
which impedes cerebral venous return and raises ICP. Suctioning
should be limited to 10 seconds and preceded by hyperoxygenation.
Head elevation, normothermia, and mannitol administration are
appropriate ICP management strategies.
7. A nurse is assessing a client with a spinal cord injury at the T6 level.
The client suddenly develops a severe headache, hypertension (BP
210/120 mm Hg), and bradycardia. Which condition should the nurse
suspect?
, 4|Page
A. Spinal shock
B. Autonomic dysreflexia
C. Neurogenic shock
D. Septic shock
Rationale: Autonomic dysreflexia is a life-threatening emergency in
clients with spinal cord injuries at or above T6. It presents with severe
hypertension, pounding headache, and bradycardia due to unchecked
sympathetic stimulation. Immediate intervention includes elevating the
head of the bed and identifying the triggering stimulus (commonly
bladder distension).
8. A client with acute kidney injury (AKI) has the following laboratory
values: potassium 6.8 mEq/L, BUN 68 mg/dL, creatinine 4.2 mg/dL.
Which intervention should the nurse anticipate first?
A. Administering a loop diuretic
B. Administering intravenous calcium gluconate
C. Initiating hemodialysis
D. Restricting dietary potassium
Rationale: Hyperkalemia (potassium >6.5 mEq/L) is a life-threatening
emergency that can cause fatal cardiac dysrhythmias. Intravenous
calcium gluconate is the first-line treatment to stabilize myocardial cell
membranes, followed by insulin/glucose, sodium bicarbonate, and
kayexalate.
9. A nurse is providing education to a client with chronic kidney disease
(CKD) about dietary modifications. Which statement by the client
indicates understanding?
A. "I should increase my intake of high-potassium foods like bananas
and oranges."
B. "I should limit my phosphorus intake by avoiding dairy products
and dark colas."
