NURS 4581: Nursing of Adults with Complex
Needs — Comprehensive Final Exam with
verified answers and rationale graded
A+
SECTION 1: CARDIOVASCULAR COMPLEX NEEDS (Questions 1–25)
1. A patient with heart failure has an ejection fraction of 25%. The nurse understands this
indicates:
A. Diastolic heart failure
B. Systolic heart failure
C. Normal cardiac function
D. High-output heart failure
Answer: B
Rationale: Systolic heart failure (HFrEF) is characterized by impaired ventricular contraction with an
ejection fraction <40%. Diastolic heart failure (HFpEF) has a preserved ejection fraction >50% -9.
2. Which laboratory finding is the gold standard for diagnosing heart failure?
A. Troponin I
B. CK-MB
C. BNP (B-type natriuretic peptide)
D. CRP
Answer: C
Rationale: BNP is released from ventricular myocytes in response to increased wall tension or
stretch. A BNP >100 pg/mL suggests heart failure. Troponin and CK-MB indicate myocardial injury,
not failure -9.
3. A patient with angina is taking metoprolol. The nurse understands the primary therapeutic
effect of this medication is to:
A. Increase cardiac output
B. Decrease myocardial oxygen demand
C. Vasodilate coronary arteries
D. Prevent thrombus formation
Answer: B
Rationale: Metoprolol is a beta-1 selective adrenergic antagonist. It blocks the effects of epinephrine
and norepinephrine on the heart, leading to a slower heart rate and decreased force of myocardial
contraction, which decreases myocardial oxygen demand -9.
4. A patient with chronic hypertension develops left ventricular hypertrophy. This is an example of
which type of adaptation?
,A. Physiologic hypertrophy
B. Pathologic hypertrophy
C. Physiologic hyperplasia
D. Pathologic hyperplasia
Answer: B
Rationale: Left ventricular hypertrophy in response to chronic hypertension is pathologic
hypertrophy, as it increases the risk of heart failure, arrhythmias, and sudden cardiac death -9.
5. The nurse is caring for a client with a pulmonary artery catheter in place. The nurse notes that
the pulmonary artery wedge pressure (PAWP) is 18 mmHg. What action should the nurse take
first?
A. Assess the client for signs of fluid volume excess
B. Administer a diuretic immediately
C. Increase the IV fluid rate
D. Remove the pulmonary artery catheter
Answer: A
Rationale: Normal PAWP is 6–12 mmHg. A reading of 18 mmHg indicates elevated left ventricular
preload, consistent with fluid volume excess or left ventricular failure. The nurse must first assess
the client for clinical signs before administering interventions -2.
6. A patient with atrial fibrillation is at increased risk for which complication?
A. Myocardial infarction
B. Stroke
C. Heart failure
D. Pulmonary embolism
Answer: B
Rationale: Atrial fibrillation causes blood stasis in the atria, particularly the left atrial appendage,
leading to thrombus formation. These thrombi can embolize to the cerebral circulation, causing
stroke -9.
7. The nurse is caring for a client who suddenly becomes unresponsive. The bedside monitor
shows ventricular fibrillation. After calling for assistance, what action should the nurse take next?
A. Begin cardiopulmonary resuscitation (CPR)
B. Prepare for endotracheal intubation
C. Provide electrical cardioversion
D. Administer intravenous epinephrine
Answer: A
Rationale: For a pulseless, unresponsive patient in ventricular fibrillation, immediate CPR is the
priority while preparing for defibrillation. High-quality CPR maintains perfusion until a defibrillator is
available -9.
,8. The nurse is caring for a patient with an arterial line in the right femoral artery. What
assessment finding requires immediate action by the nurse?
A. Absence of the right pedal pulse
B. Presence of a small hematoma at the insertion site
C. Blood pressure reading of 110/70 mmHg
D. Mild discomfort at the insertion site
Answer: A
Rationale: Absence of the pedal pulse distal to the arterial line insertion site indicates possible
arterial occlusion or thrombosis, requiring immediate intervention -2.
9. A patient with heart failure has acute dyspnea and crackles in the lungs. What is the nurse's
priority action?
A. Administer a diuretic as ordered
B. Place the client in high-Fowler's position
C. Check oxygen saturation and apply oxygen
D. Obtain an echocardiogram
Answer: B
Rationale: Positioning the client in high-Fowler's position reduces venous return and pulmonary
congestion, which is a priority to relieve dyspnea. Oxygen should be applied after positioning -9.
10. A patient with known coronary artery disease reports chest pain. Which characteristic is most
consistent with angina?
A. Sharp, stabbing pain that worsens with inspiration
B. Pressure-like pain that radiates to the left arm
C. Pain that is relieved by changing position
D. Pain accompanied by fever and cough
Answer: B
Rationale: Angina is typically described as pressure, squeezing, or tightness in the chest that may
radiate to the left arm, jaw, or back. It is often provoked by exertion or stress and relieved by rest or
nitroglycerin.
11. The nurse is teaching a patient about nitroglycerin. Which statement indicates correct
understanding?
A. "I should take one tablet every 5 minutes for up to 15 minutes."
B. "I should take one tablet every 5 minutes for up to 3 doses."
C. "I should take the medication only when the pain is severe."
D. "I should swallow the tablet whole with water."
, Answer: B
Rationale: For angina, sublingual nitroglycerin is taken as one tablet every 5 minutes for up to 3
doses. If pain persists after 3 doses, the patient should seek emergency care. Tablets should be
dissolved under the tongue, not swallowed.
12. A patient is prescribed furosemide (Lasix). Which laboratory value should the nurse monitor
most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium loss. Hypokalemia can lead to cardiac
arrhythmias and muscle weakness. Potassium levels should be monitored closely.
13. The nurse is caring for a patient with a new diagnosis of heart failure. Which dietary
instruction should the nurse include?
A. "Increase your fluid intake to 3 liters per day."
B. "Limit your sodium intake to 2-3 grams per day."
C. "Eat foods high in potassium."
D. "Avoid all dairy products."
Answer: B
Rationale: Sodium restriction (typically 2-3 grams per day) is standard for heart failure management
to prevent fluid retention. Fluid restriction may also be indicated but is patient-specific.
14. A patient with a history of myocardial infarction reports sudden onset of severe chest pain.
Which action should the nurse take first?
A. Administer nitroglycerin as ordered
B. Obtain a 12-lead ECG
C. Assess vital signs
D. Notify the physician
Answer: C
Rationale: Assessing vital signs is the first step to determine hemodynamic stability. If the patient is
hypotensive, nitroglycerin may be contraindicated. This assessment guides subsequent
interventions.
15. The nurse is monitoring a patient on a heparin infusion. Which laboratory value is used to
monitor therapeutic effect?
Needs — Comprehensive Final Exam with
verified answers and rationale graded
A+
SECTION 1: CARDIOVASCULAR COMPLEX NEEDS (Questions 1–25)
1. A patient with heart failure has an ejection fraction of 25%. The nurse understands this
indicates:
A. Diastolic heart failure
B. Systolic heart failure
C. Normal cardiac function
D. High-output heart failure
Answer: B
Rationale: Systolic heart failure (HFrEF) is characterized by impaired ventricular contraction with an
ejection fraction <40%. Diastolic heart failure (HFpEF) has a preserved ejection fraction >50% -9.
2. Which laboratory finding is the gold standard for diagnosing heart failure?
A. Troponin I
B. CK-MB
C. BNP (B-type natriuretic peptide)
D. CRP
Answer: C
Rationale: BNP is released from ventricular myocytes in response to increased wall tension or
stretch. A BNP >100 pg/mL suggests heart failure. Troponin and CK-MB indicate myocardial injury,
not failure -9.
3. A patient with angina is taking metoprolol. The nurse understands the primary therapeutic
effect of this medication is to:
A. Increase cardiac output
B. Decrease myocardial oxygen demand
C. Vasodilate coronary arteries
D. Prevent thrombus formation
Answer: B
Rationale: Metoprolol is a beta-1 selective adrenergic antagonist. It blocks the effects of epinephrine
and norepinephrine on the heart, leading to a slower heart rate and decreased force of myocardial
contraction, which decreases myocardial oxygen demand -9.
4. A patient with chronic hypertension develops left ventricular hypertrophy. This is an example of
which type of adaptation?
,A. Physiologic hypertrophy
B. Pathologic hypertrophy
C. Physiologic hyperplasia
D. Pathologic hyperplasia
Answer: B
Rationale: Left ventricular hypertrophy in response to chronic hypertension is pathologic
hypertrophy, as it increases the risk of heart failure, arrhythmias, and sudden cardiac death -9.
5. The nurse is caring for a client with a pulmonary artery catheter in place. The nurse notes that
the pulmonary artery wedge pressure (PAWP) is 18 mmHg. What action should the nurse take
first?
A. Assess the client for signs of fluid volume excess
B. Administer a diuretic immediately
C. Increase the IV fluid rate
D. Remove the pulmonary artery catheter
Answer: A
Rationale: Normal PAWP is 6–12 mmHg. A reading of 18 mmHg indicates elevated left ventricular
preload, consistent with fluid volume excess or left ventricular failure. The nurse must first assess
the client for clinical signs before administering interventions -2.
6. A patient with atrial fibrillation is at increased risk for which complication?
A. Myocardial infarction
B. Stroke
C. Heart failure
D. Pulmonary embolism
Answer: B
Rationale: Atrial fibrillation causes blood stasis in the atria, particularly the left atrial appendage,
leading to thrombus formation. These thrombi can embolize to the cerebral circulation, causing
stroke -9.
7. The nurse is caring for a client who suddenly becomes unresponsive. The bedside monitor
shows ventricular fibrillation. After calling for assistance, what action should the nurse take next?
A. Begin cardiopulmonary resuscitation (CPR)
B. Prepare for endotracheal intubation
C. Provide electrical cardioversion
D. Administer intravenous epinephrine
Answer: A
Rationale: For a pulseless, unresponsive patient in ventricular fibrillation, immediate CPR is the
priority while preparing for defibrillation. High-quality CPR maintains perfusion until a defibrillator is
available -9.
,8. The nurse is caring for a patient with an arterial line in the right femoral artery. What
assessment finding requires immediate action by the nurse?
A. Absence of the right pedal pulse
B. Presence of a small hematoma at the insertion site
C. Blood pressure reading of 110/70 mmHg
D. Mild discomfort at the insertion site
Answer: A
Rationale: Absence of the pedal pulse distal to the arterial line insertion site indicates possible
arterial occlusion or thrombosis, requiring immediate intervention -2.
9. A patient with heart failure has acute dyspnea and crackles in the lungs. What is the nurse's
priority action?
A. Administer a diuretic as ordered
B. Place the client in high-Fowler's position
C. Check oxygen saturation and apply oxygen
D. Obtain an echocardiogram
Answer: B
Rationale: Positioning the client in high-Fowler's position reduces venous return and pulmonary
congestion, which is a priority to relieve dyspnea. Oxygen should be applied after positioning -9.
10. A patient with known coronary artery disease reports chest pain. Which characteristic is most
consistent with angina?
A. Sharp, stabbing pain that worsens with inspiration
B. Pressure-like pain that radiates to the left arm
C. Pain that is relieved by changing position
D. Pain accompanied by fever and cough
Answer: B
Rationale: Angina is typically described as pressure, squeezing, or tightness in the chest that may
radiate to the left arm, jaw, or back. It is often provoked by exertion or stress and relieved by rest or
nitroglycerin.
11. The nurse is teaching a patient about nitroglycerin. Which statement indicates correct
understanding?
A. "I should take one tablet every 5 minutes for up to 15 minutes."
B. "I should take one tablet every 5 minutes for up to 3 doses."
C. "I should take the medication only when the pain is severe."
D. "I should swallow the tablet whole with water."
, Answer: B
Rationale: For angina, sublingual nitroglycerin is taken as one tablet every 5 minutes for up to 3
doses. If pain persists after 3 doses, the patient should seek emergency care. Tablets should be
dissolved under the tongue, not swallowed.
12. A patient is prescribed furosemide (Lasix). Which laboratory value should the nurse monitor
most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium loss. Hypokalemia can lead to cardiac
arrhythmias and muscle weakness. Potassium levels should be monitored closely.
13. The nurse is caring for a patient with a new diagnosis of heart failure. Which dietary
instruction should the nurse include?
A. "Increase your fluid intake to 3 liters per day."
B. "Limit your sodium intake to 2-3 grams per day."
C. "Eat foods high in potassium."
D. "Avoid all dairy products."
Answer: B
Rationale: Sodium restriction (typically 2-3 grams per day) is standard for heart failure management
to prevent fluid retention. Fluid restriction may also be indicated but is patient-specific.
14. A patient with a history of myocardial infarction reports sudden onset of severe chest pain.
Which action should the nurse take first?
A. Administer nitroglycerin as ordered
B. Obtain a 12-lead ECG
C. Assess vital signs
D. Notify the physician
Answer: C
Rationale: Assessing vital signs is the first step to determine hemodynamic stability. If the patient is
hypotensive, nitroglycerin may be contraindicated. This assessment guides subsequent
interventions.
15. The nurse is monitoring a patient on a heparin infusion. Which laboratory value is used to
monitor therapeutic effect?
