NRSG 3320 EXAM 1 CARE OF ADULTS 1
EXAM
CORE DOMAINS
• Cardiovascular Disorders and Heart Failure Management
• Fluid and Electrolyte Imbalances
• Perioperative Nursing Care
• Respiratory System Disorders
• Musculoskeletal and Connective Tissue Disorders
• Neurological and Sensory Disorders
• Older Adult Care and Geriatric Considerations
• Hypertension and Peripheral Vascular Disease
INTRODUCTION
The NRSG 3320 Exam 1 Care of Adults 1 examination is designed to evaluate the nursing
student's competency in providing safe, effective care to adult clients with acute and
chronic medical-surgical conditions. The assessment addresses essential knowledge across
core domains, including cardiovascular disorders, fluid and electrolyte imbalances,
perioperative nursing care, respiratory conditions, and musculoskeletal disorders. The
exam structure utilizes multiple-choice and scenario-based questions that require clinical
judgment, prioritization, and decision-making skills. Candidates must demonstrate the
ability to recognize clinical manifestations, interpret laboratory data, apply evidence-based
interventions, and prioritize care in real-world adult health settings. This comprehensive
evaluation ensures readiness for professional practice in adult medical-surgical nursing.
SECTION ONE: QUESTIONS 1–100
1. A client with chronic heart failure suddenly develops severe dyspnea, bilateral
crackles, and pink frothy sputum. What is the nurse's priority action?
,A. Place the client upright.
B. Encourage oral fluids.
C. Obtain a daily weight.
D. Place the client supine.
A. Place the client upright.
RATIONALE: The client is experiencing acute pulmonary edema, a life-threatening
complication of heart failure. Placing the client in an upright position (high-Fowler's)
promotes lung expansion and reduces venous return, improving oxygenation. Supine
positioning would worsen respiratory distress.
2. A client taking furosemide for heart failure has a potassium level of 2.8 mEq/L.
Which finding requires the most immediate attention?
A. Muscle cramps
B. Increased urination
C. Irregular pulse
D. Dry mouth
C. Irregular pulse
RATIONALE: Hypokalemia can cause life-threatening cardiac dysrhythmias. An
irregular pulse indicates cardiac irritability and requires immediate intervention. Muscle
cramps and increased urination are expected findings with furosemide therapy.
3. A client with heart failure has gained 2.5 kg over 3 days. Which finding best
explains the weight gain?
A. Increased muscle mass
B. Fluid retention
C. Increased bone density
D. Reduced metabolic rate
B. Fluid retention
RATIONALE: Rapid weight gain in heart failure indicates fluid retention due to
inadequate cardiac output and venous congestion. A gain of 2–3 pounds in one day or 5
pounds in one week warrants provider notification.
,4. A client with hypertension has a blood pressure of 186/118 mm Hg and reports
new blurred vision and severe headache. Which action is the priority?
A. Recheck the pressure tomorrow.
B. Encourage ambulation.
C. Assess for target-organ injury.
D. Offer a low-sodium meal.
C. Assess for target-organ injury.
RATIONALE: The client is experiencing hypertensive crisis with signs of target-organ
damage (blurred vision, severe headache). The priority is to assess for end-organ injury,
including neurological, cardiac, and renal involvement.
5. A postoperative client becomes restless and confused 30 minutes after returning
to the unit. Respirations are shallow at 9/min. What should the nurse do first?
A. Assess oxygenation and airway.
B. Administer prescribed analgesic.
C. Document the findings.
D. Assist the client to ambulate.
A. Assess oxygenation and airway.
RATIONALE: Using the ABC (Airway, Breathing, Circulation) framework, the priority
is to assess oxygenation and airway patency. Shallow respirations at 9/min indicate
respiratory depression requiring immediate intervention.
6. Before surgery, which finding should the nurse report immediately?
A. Mild anxiety
B. Allergy to latex
C. Request for family visitation
D. Question about postoperative pain
B. Allergy to latex
, RATIONALE: A latex allergy is a critical safety concern that must be reported
immediately to prevent anaphylactic reactions during surgery. Mild anxiety and questions
about postoperative care are expected findings.
7. A postoperative client suddenly reports unilateral calf pain and shortness of
breath. Which complication should the nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Urinary retention
B. Pulmonary embolism
RATIONALE: Unilateral calf pain suggests deep vein thrombosis, and the sudden onset
of shortness of breath indicates the clot has embolized to the lungs. This is a life-
threatening emergency requiring immediate intervention.
8. Which intervention is most effective for reducing postoperative atelectasis?
A. Limiting activity
B. Incentive spirometry
C. Restricting fluids
D. Maintaining supine positioning
B. Incentive spirometry
RATIONALE: Incentive spirometry encourages deep breathing and lung expansion,
preventing alveolar collapse. Early ambulation is also essential for preventing atelectasis.
9. A client returns from abdominal surgery with a respiratory rate of 28/min,
oxygen saturation of 88%, and increasing anxiety. Which action should the nurse
take first?
A. Assess airway and breathing.
B. Offer oral analgesia.
C. Document the findings.
D. Encourage ambulation.
EXAM
CORE DOMAINS
• Cardiovascular Disorders and Heart Failure Management
• Fluid and Electrolyte Imbalances
• Perioperative Nursing Care
• Respiratory System Disorders
• Musculoskeletal and Connective Tissue Disorders
• Neurological and Sensory Disorders
• Older Adult Care and Geriatric Considerations
• Hypertension and Peripheral Vascular Disease
INTRODUCTION
The NRSG 3320 Exam 1 Care of Adults 1 examination is designed to evaluate the nursing
student's competency in providing safe, effective care to adult clients with acute and
chronic medical-surgical conditions. The assessment addresses essential knowledge across
core domains, including cardiovascular disorders, fluid and electrolyte imbalances,
perioperative nursing care, respiratory conditions, and musculoskeletal disorders. The
exam structure utilizes multiple-choice and scenario-based questions that require clinical
judgment, prioritization, and decision-making skills. Candidates must demonstrate the
ability to recognize clinical manifestations, interpret laboratory data, apply evidence-based
interventions, and prioritize care in real-world adult health settings. This comprehensive
evaluation ensures readiness for professional practice in adult medical-surgical nursing.
SECTION ONE: QUESTIONS 1–100
1. A client with chronic heart failure suddenly develops severe dyspnea, bilateral
crackles, and pink frothy sputum. What is the nurse's priority action?
,A. Place the client upright.
B. Encourage oral fluids.
C. Obtain a daily weight.
D. Place the client supine.
A. Place the client upright.
RATIONALE: The client is experiencing acute pulmonary edema, a life-threatening
complication of heart failure. Placing the client in an upright position (high-Fowler's)
promotes lung expansion and reduces venous return, improving oxygenation. Supine
positioning would worsen respiratory distress.
2. A client taking furosemide for heart failure has a potassium level of 2.8 mEq/L.
Which finding requires the most immediate attention?
A. Muscle cramps
B. Increased urination
C. Irregular pulse
D. Dry mouth
C. Irregular pulse
RATIONALE: Hypokalemia can cause life-threatening cardiac dysrhythmias. An
irregular pulse indicates cardiac irritability and requires immediate intervention. Muscle
cramps and increased urination are expected findings with furosemide therapy.
3. A client with heart failure has gained 2.5 kg over 3 days. Which finding best
explains the weight gain?
A. Increased muscle mass
B. Fluid retention
C. Increased bone density
D. Reduced metabolic rate
B. Fluid retention
RATIONALE: Rapid weight gain in heart failure indicates fluid retention due to
inadequate cardiac output and venous congestion. A gain of 2–3 pounds in one day or 5
pounds in one week warrants provider notification.
,4. A client with hypertension has a blood pressure of 186/118 mm Hg and reports
new blurred vision and severe headache. Which action is the priority?
A. Recheck the pressure tomorrow.
B. Encourage ambulation.
C. Assess for target-organ injury.
D. Offer a low-sodium meal.
C. Assess for target-organ injury.
RATIONALE: The client is experiencing hypertensive crisis with signs of target-organ
damage (blurred vision, severe headache). The priority is to assess for end-organ injury,
including neurological, cardiac, and renal involvement.
5. A postoperative client becomes restless and confused 30 minutes after returning
to the unit. Respirations are shallow at 9/min. What should the nurse do first?
A. Assess oxygenation and airway.
B. Administer prescribed analgesic.
C. Document the findings.
D. Assist the client to ambulate.
A. Assess oxygenation and airway.
RATIONALE: Using the ABC (Airway, Breathing, Circulation) framework, the priority
is to assess oxygenation and airway patency. Shallow respirations at 9/min indicate
respiratory depression requiring immediate intervention.
6. Before surgery, which finding should the nurse report immediately?
A. Mild anxiety
B. Allergy to latex
C. Request for family visitation
D. Question about postoperative pain
B. Allergy to latex
, RATIONALE: A latex allergy is a critical safety concern that must be reported
immediately to prevent anaphylactic reactions during surgery. Mild anxiety and questions
about postoperative care are expected findings.
7. A postoperative client suddenly reports unilateral calf pain and shortness of
breath. Which complication should the nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Urinary retention
B. Pulmonary embolism
RATIONALE: Unilateral calf pain suggests deep vein thrombosis, and the sudden onset
of shortness of breath indicates the clot has embolized to the lungs. This is a life-
threatening emergency requiring immediate intervention.
8. Which intervention is most effective for reducing postoperative atelectasis?
A. Limiting activity
B. Incentive spirometry
C. Restricting fluids
D. Maintaining supine positioning
B. Incentive spirometry
RATIONALE: Incentive spirometry encourages deep breathing and lung expansion,
preventing alveolar collapse. Early ambulation is also essential for preventing atelectasis.
9. A client returns from abdominal surgery with a respiratory rate of 28/min,
oxygen saturation of 88%, and increasing anxiety. Which action should the nurse
take first?
A. Assess airway and breathing.
B. Offer oral analgesia.
C. Document the findings.
D. Encourage ambulation.
