ADULT HEALTH NURSING
COMPREHENSIVE PRACTICE EXAM
ORIGINAL PRACTICE EXAMINATION | 2026–2027
CURRICULUM ALIGNMENT
EXAM INSTRUCTIONS
This 100-question comprehensive practice examination covers the major content areas of
adult-health nursing. Questions are designed to reflect the cognitive levels and clinical-
judgment emphasis of contemporary nursing licensure preparation. Approximately 30% of
items are foundational (recall and comprehension), 50% are application-level, and 20% require
advanced clinical judgment.
Question Types Included: Multiple choice, select-all-that-apply (SATA), prioritization,
delegation, medication safety, patient education, and case-based clinical judgment.
Disclaimer: This is an original, faculty-developed practice examination. It is not derived from, nor
does it represent, any actual licensing examination or proprietary test bank.
SECTION I: CARDIOVASCULAR
1. A client with heart failure is prescribed furosemide 40 mg IV. Which assessment finding
best indicates the medication is effective?
A. Weight gain of 1 kg over 24 hours
B. Decreased ankle edema with urine output of 180 mL/hr
,C. Blood pressure increase from 110/70 to 138/88 mm Hg
D. Serum potassium of 2.9 mEq/L
Correct Answer: B
Rationale: Furosemide is a loop diuretic that reduces fluid overload. Effective diuresis produces
decreased peripheral edema and increased urine output. Option A indicates fluid retention
(worsening). Option C is not a therapeutic goal and may reflect worsening cardiac workload.
Option D indicates hypokalemia, an adverse effect requiring intervention, not therapeutic
effectiveness.
Key Concept: Loop diuretics for heart failure — expected outcomes include diuresis, reduced
edema, and decreased pulmonary congestion.
Clinical Judgment Tip: When evaluating medication effectiveness, identify the assessment
finding that directly reflects the drug's intended mechanism.
2. A client with atrial fibrillation is prescribed apixaban. Which statement indicates correct
understanding of the medication?
A. "I should stop the medication whenever my heart rhythm feels normal."
B. "This medication reduces my risk of stroke from blood clots."
C. "I should take aspirin whenever I miss a dose."
D. "I need weekly INR testing to adjust this medication."
Correct Answer: B
Rationale: Apixaban is a direct oral anticoagulant (DOAC) used to prevent stroke in nonvalvular
atrial fibrillation by reducing clot formation. Option A is incorrect — anticoagulation must be
continuous. Option C is incorrect — aspirin is not a substitute and increases bleeding risk.
Option D is incorrect — DOACs do not require routine INR monitoring.
Key Concept: DOAC patient education — take consistently, do not require INR monitoring,
report signs of bleeding.
,Clinical Judgment Tip: Patient-education questions often hinge on medication mechanism and
monitoring requirements.
3. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client with chronic COPD reporting fatigue
B. A client awaiting discharge paperwork
C. A client with postoperative hemorrhage and BP 84/52 mm Hg
D. A client requesting pain medication rated 6/10
Correct Answer: C
Rationale: The client with hemorrhage and hypotension is displaying signs of hypovolemic
shock. Using ABCs and Maslow's hierarchy, this client requires immediate assessment and
intervention. Option A is a chronic stable finding. Option B is nonurgent. Option D is important
but not life-threatening.
Key Concept: Prioritization — unstable clients with signs of shock take precedence over stable
or comfort needs.
Clinical Judgment Tip: Hypotension plus active bleeding equals impending shock; act
immediately.
4. A client taking warfarin reports black, tarry stools. What is the priority nursing action?
A. Reassure the client that this finding is expected.
B. Notify the provider promptly because this may indicate GI bleeding.
C. Recommend doubling the warfarin dose.
D. Encourage the client to take aspirin for comfort.
Correct Answer: B
, Rationale: Melena indicates upper gastrointestinal bleeding. Anticoagulated clients are at high
risk for serious hemorrhage and require prompt evaluation and possible reversal. Options A and
C are unsafe. Option D adds another anticoagulant/antiplatelet, worsening bleeding risk.
Key Concept: Warfarin adverse effects — bleeding is the primary risk; melena is a red flag.
Clinical Judgment Tip: Any sign of bleeding in an anticoagulated client warrants urgent provider
notification.
5. A client with a mechanical heart valve is prescribed warfarin. Which laboratory value
monitors therapeutic effect?
A. aPTT
B. INR
C. Troponin
D. D-dimer
Correct Answer: B
Rationale: Warfarin therapy is monitored using the prothrombin time expressed as the
international normalized ratio (INR). Target ranges vary by indication; mechanical valves often
require INR 2.5–3.5. aPTT monitors heparin. Troponin assesses myocardial injury. D-dimer
assesses clot breakdown.
Key Concept: Anticoagulation monitoring — INR for warfarin, aPTT for unfractionated heparin.
Clinical Judgment Tip: Match the laboratory test to the specific anticoagulant.
SECTION II: RESPIRATORY
6. A client with acute respiratory distress syndrome (ARDS) has severe hypoxemia despite
high-flow oxygen. Which intervention may improve oxygenation by recruiting dependent
alveoli?
COMPREHENSIVE PRACTICE EXAM
ORIGINAL PRACTICE EXAMINATION | 2026–2027
CURRICULUM ALIGNMENT
EXAM INSTRUCTIONS
This 100-question comprehensive practice examination covers the major content areas of
adult-health nursing. Questions are designed to reflect the cognitive levels and clinical-
judgment emphasis of contemporary nursing licensure preparation. Approximately 30% of
items are foundational (recall and comprehension), 50% are application-level, and 20% require
advanced clinical judgment.
Question Types Included: Multiple choice, select-all-that-apply (SATA), prioritization,
delegation, medication safety, patient education, and case-based clinical judgment.
Disclaimer: This is an original, faculty-developed practice examination. It is not derived from, nor
does it represent, any actual licensing examination or proprietary test bank.
SECTION I: CARDIOVASCULAR
1. A client with heart failure is prescribed furosemide 40 mg IV. Which assessment finding
best indicates the medication is effective?
A. Weight gain of 1 kg over 24 hours
B. Decreased ankle edema with urine output of 180 mL/hr
,C. Blood pressure increase from 110/70 to 138/88 mm Hg
D. Serum potassium of 2.9 mEq/L
Correct Answer: B
Rationale: Furosemide is a loop diuretic that reduces fluid overload. Effective diuresis produces
decreased peripheral edema and increased urine output. Option A indicates fluid retention
(worsening). Option C is not a therapeutic goal and may reflect worsening cardiac workload.
Option D indicates hypokalemia, an adverse effect requiring intervention, not therapeutic
effectiveness.
Key Concept: Loop diuretics for heart failure — expected outcomes include diuresis, reduced
edema, and decreased pulmonary congestion.
Clinical Judgment Tip: When evaluating medication effectiveness, identify the assessment
finding that directly reflects the drug's intended mechanism.
2. A client with atrial fibrillation is prescribed apixaban. Which statement indicates correct
understanding of the medication?
A. "I should stop the medication whenever my heart rhythm feels normal."
B. "This medication reduces my risk of stroke from blood clots."
C. "I should take aspirin whenever I miss a dose."
D. "I need weekly INR testing to adjust this medication."
Correct Answer: B
Rationale: Apixaban is a direct oral anticoagulant (DOAC) used to prevent stroke in nonvalvular
atrial fibrillation by reducing clot formation. Option A is incorrect — anticoagulation must be
continuous. Option C is incorrect — aspirin is not a substitute and increases bleeding risk.
Option D is incorrect — DOACs do not require routine INR monitoring.
Key Concept: DOAC patient education — take consistently, do not require INR monitoring,
report signs of bleeding.
,Clinical Judgment Tip: Patient-education questions often hinge on medication mechanism and
monitoring requirements.
3. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client with chronic COPD reporting fatigue
B. A client awaiting discharge paperwork
C. A client with postoperative hemorrhage and BP 84/52 mm Hg
D. A client requesting pain medication rated 6/10
Correct Answer: C
Rationale: The client with hemorrhage and hypotension is displaying signs of hypovolemic
shock. Using ABCs and Maslow's hierarchy, this client requires immediate assessment and
intervention. Option A is a chronic stable finding. Option B is nonurgent. Option D is important
but not life-threatening.
Key Concept: Prioritization — unstable clients with signs of shock take precedence over stable
or comfort needs.
Clinical Judgment Tip: Hypotension plus active bleeding equals impending shock; act
immediately.
4. A client taking warfarin reports black, tarry stools. What is the priority nursing action?
A. Reassure the client that this finding is expected.
B. Notify the provider promptly because this may indicate GI bleeding.
C. Recommend doubling the warfarin dose.
D. Encourage the client to take aspirin for comfort.
Correct Answer: B
, Rationale: Melena indicates upper gastrointestinal bleeding. Anticoagulated clients are at high
risk for serious hemorrhage and require prompt evaluation and possible reversal. Options A and
C are unsafe. Option D adds another anticoagulant/antiplatelet, worsening bleeding risk.
Key Concept: Warfarin adverse effects — bleeding is the primary risk; melena is a red flag.
Clinical Judgment Tip: Any sign of bleeding in an anticoagulated client warrants urgent provider
notification.
5. A client with a mechanical heart valve is prescribed warfarin. Which laboratory value
monitors therapeutic effect?
A. aPTT
B. INR
C. Troponin
D. D-dimer
Correct Answer: B
Rationale: Warfarin therapy is monitored using the prothrombin time expressed as the
international normalized ratio (INR). Target ranges vary by indication; mechanical valves often
require INR 2.5–3.5. aPTT monitors heparin. Troponin assesses myocardial injury. D-dimer
assesses clot breakdown.
Key Concept: Anticoagulation monitoring — INR for warfarin, aPTT for unfractionated heparin.
Clinical Judgment Tip: Match the laboratory test to the specific anticoagulant.
SECTION II: RESPIRATORY
6. A client with acute respiratory distress syndrome (ARDS) has severe hypoxemia despite
high-flow oxygen. Which intervention may improve oxygenation by recruiting dependent
alveoli?
