NSG 430 Exam 3 Adult Health
Nursing II Review 2026/2027 –
Questions & Answers with
Detailed Rationales Guaranteed
Pass (GRADED A+)
Question 1
A client with heart failure reports increasing shortness of breath
and a 3-kg weight gain over the past week. Which finding
requires the nurse's priority attention?
A. Mild fatigue
B. Increased appetite
C. Bilateral crackles and dyspnea at rest
D. Occasional nighttime cough
Answer: C. Bilateral crackles and dyspnea at rest
Rationale: Crackles and dyspnea at rest suggest worsening
pulmonary congestion and possible acute decompensated heart
failure. This finding threatens oxygenation and requires prompt
assessment and intervention.
Question 2
,A client taking digoxin for heart failure reports nausea, loss of
appetite, and seeing yellow-green halos around lights. What
should the nurse do first?
A. Administer the next dose with food
B. Hold the medication and notify the provider
C. Encourage increased potassium intake
D. Reassure the client that these effects are expected
Answer: B. Hold the medication and notify the provider
Rationale: Nausea, anorexia, and visual disturbances can
indicate digoxin toxicity. The medication should be withheld and
the provider notified for further evaluation, including
assessment of the serum digoxin level and electrolytes.
Question 3
A client with chronic obstructive pulmonary disease is receiving
oxygen therapy. Which oxygen saturation target is generally
appropriate for a client at risk for chronic carbon dioxide
retention?
A. 70%–75%
B. 80%–85%
C. 88%–92%
D. 98%–100%
Answer: C. 88%–92%
Rationale: Many clients with COPD who are at risk for
hypercapnic respiratory failure are managed with a target
,oxygen saturation of approximately 88%–92%, unless a
different individualized target is prescribed.
Question 4
Which assessment finding is most characteristic of a
pneumothorax?
A. Bilateral crackles
B. Absent or markedly diminished breath sounds on one side
C. Productive cough with thick sputum
D. Dependent peripheral edema
Answer: B. Absent or markedly diminished breath sounds on
one side
Rationale: Air entering the pleural space can cause partial or
complete lung collapse, producing unilateral decreased or
absent breath sounds.
Question 5
A client develops sudden dyspnea, pleuritic chest pain,
tachycardia, and anxiety after prolonged immobility. Which
condition should the nurse suspect?
A. Pulmonary embolism
B. Stable angina
C. Pleural effusion
D. Chronic bronchitis
, _Answer: A. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia,
and anxiety are classic manifestations associated with
pulmonary embolism, particularly in a client with risk factors
for venous thromboembolism.
Question 6
A client receiving warfarin therapy asks which laboratory test is
used to monitor the medication's therapeutic effect. Which
response is correct?
A. Troponin
B. INR
C. BNP
D. Serum creatinine kinase
_Answer: B. INR
Rationale: Warfarin therapy is monitored primarily with the
international normalized ratio (INR), which evaluates the
anticoagulant effect and helps guide dosing.
Question 7
A client with myocardial infarction reports crushing substernal
chest pain radiating to the left arm. Which action has the highest
priority?
Nursing II Review 2026/2027 –
Questions & Answers with
Detailed Rationales Guaranteed
Pass (GRADED A+)
Question 1
A client with heart failure reports increasing shortness of breath
and a 3-kg weight gain over the past week. Which finding
requires the nurse's priority attention?
A. Mild fatigue
B. Increased appetite
C. Bilateral crackles and dyspnea at rest
D. Occasional nighttime cough
Answer: C. Bilateral crackles and dyspnea at rest
Rationale: Crackles and dyspnea at rest suggest worsening
pulmonary congestion and possible acute decompensated heart
failure. This finding threatens oxygenation and requires prompt
assessment and intervention.
Question 2
,A client taking digoxin for heart failure reports nausea, loss of
appetite, and seeing yellow-green halos around lights. What
should the nurse do first?
A. Administer the next dose with food
B. Hold the medication and notify the provider
C. Encourage increased potassium intake
D. Reassure the client that these effects are expected
Answer: B. Hold the medication and notify the provider
Rationale: Nausea, anorexia, and visual disturbances can
indicate digoxin toxicity. The medication should be withheld and
the provider notified for further evaluation, including
assessment of the serum digoxin level and electrolytes.
Question 3
A client with chronic obstructive pulmonary disease is receiving
oxygen therapy. Which oxygen saturation target is generally
appropriate for a client at risk for chronic carbon dioxide
retention?
A. 70%–75%
B. 80%–85%
C. 88%–92%
D. 98%–100%
Answer: C. 88%–92%
Rationale: Many clients with COPD who are at risk for
hypercapnic respiratory failure are managed with a target
,oxygen saturation of approximately 88%–92%, unless a
different individualized target is prescribed.
Question 4
Which assessment finding is most characteristic of a
pneumothorax?
A. Bilateral crackles
B. Absent or markedly diminished breath sounds on one side
C. Productive cough with thick sputum
D. Dependent peripheral edema
Answer: B. Absent or markedly diminished breath sounds on
one side
Rationale: Air entering the pleural space can cause partial or
complete lung collapse, producing unilateral decreased or
absent breath sounds.
Question 5
A client develops sudden dyspnea, pleuritic chest pain,
tachycardia, and anxiety after prolonged immobility. Which
condition should the nurse suspect?
A. Pulmonary embolism
B. Stable angina
C. Pleural effusion
D. Chronic bronchitis
, _Answer: A. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia,
and anxiety are classic manifestations associated with
pulmonary embolism, particularly in a client with risk factors
for venous thromboembolism.
Question 6
A client receiving warfarin therapy asks which laboratory test is
used to monitor the medication's therapeutic effect. Which
response is correct?
A. Troponin
B. INR
C. BNP
D. Serum creatinine kinase
_Answer: B. INR
Rationale: Warfarin therapy is monitored primarily with the
international normalized ratio (INR), which evaluates the
anticoagulant effect and helps guide dosing.
Question 7
A client with myocardial infarction reports crushing substernal
chest pain radiating to the left arm. Which action has the highest
priority?
