NSG 4100 EXAM 4 FINAL EXAM PREP QUESTIONS AND
ANSWERS | ALL PRACTICE Q&A 2026/2027 | A+
GRADED | COMPREHENSIVE EXAM GUIDE 2026&2027
1. A client with acute heart failure reports increasing dyspnea and suddenly becomes
unable to lie flat. Which assessment finding requires the nurse's most immediate
intervention?
A. Bilateral ankle edema
B. Oxygen saturation of 86%
C. Heart rate of 104/min
D. Weight gain of 1 kg over 3 days
An oxygen saturation of 86% indicates significant hypoxemia and requires immediate
intervention. The other findings are important manifestations of worsening heart failure but
are less immediately life-threatening.
2. A client taking furosemide for heart failure has a serum potassium level of 2.9 mEq/L.
Which assessment finding should the nurse anticipate?
A. Hyperactive bowel sounds
B. Bounding peripheral pulses
C. Muscle weakness and dysrhythmias
D. Increased deep tendon reflexes
Loop diuretics can cause potassium loss. Significant hypokalemia can produce muscle
weakness and potentially life-threatening cardiac dysrhythmias.
3. A client with chronic obstructive pulmonary disease is receiving oxygen therapy. Which
oxygen prescription should the nurse question?
A. Oxygen at 2 L/min by nasal cannula
B. Oxygen titrated to the prescribed target saturation
C. Oxygen at 10 L/min by nonrebreather mask for persistent severe hypoxemia
D. Oxygen at 8 L/min by simple face mask for routine long-term therapy
High-flow oxygen through a simple mask is not appropriate for routine long-term COPD
management. Oxygen should be carefully titrated according to the client's condition and
prescribed target saturation.
4. A client with asthma develops severe wheezing followed by markedly diminished breath
sounds. What should the nurse recognize?
A. The asthma attack is resolving.
B. The client has developed pulmonary edema.
C. Airflow obstruction may have become critically severe.
D. The bronchodilator has produced the expected response.
,Markedly diminished breath sounds after severe wheezing can indicate minimal airflow,
sometimes called a silent chest, and represents a potentially life-threatening asthma
exacerbation.
5. A client with pneumonia has a respiratory rate of 32/min, temperature of 39.2°C, and
new confusion. Which action is the priority?
A. Encourage oral fluids.
B. Obtain a routine sputum specimen.
C. Assess oxygenation and initiate prescribed oxygen therapy.
D. Encourage the client to ambulate.
Confusion and tachypnea may indicate impaired oxygenation or systemic deterioration.
Airway and breathing take priority over routine diagnostic or mobility interventions.
6. A client with a pulmonary embolism suddenly reports sharp chest pain and shortness of
breath. Which additional finding is most concerning?
A. Oxygen saturation of 89%
B. Heart rate of 88/min
C. Blood pressure of 138/82 mmHg
D. Respiratory rate of 18/min
An oxygen saturation of 89% indicates impaired oxygenation and is especially concerning in a
client with a suspected pulmonary embolism.
7. A client receiving heparin therapy develops bleeding from the gums. Which laboratory
value is most important for the nurse to review?
A. Hemoglobin A1C
B. aPTT or anti-Xa level, according to the monitoring protocol
C. Serum sodium
D. Serum creatinine kinase
Unfractionated heparin is commonly monitored using aPTT or an anti-Xa assay depending on
institutional protocol. Unexpected bleeding warrants evaluation of anticoagulation intensity.
8. A client with a deep vein thrombosis asks why the nurse discourages vigorous massage of
the affected leg. What is the best response?
A. Massage increases arterial circulation too rapidly.
B. Massage can cause excessive muscle fatigue.
C. Massage may dislodge the thrombus and cause embolization.
D. Massage causes permanent venous valve damage.
Manipulation of an extremity with an acute venous thrombus may dislodge the clot,
potentially resulting in a pulmonary embolism.
,9. A client with acute coronary syndrome reports persistent chest pressure despite
prescribed sublingual nitroglycerin. What is the nurse's priority action?
A. Encourage the client to walk to improve circulation.
B. Reassess pain in 4 hours.
C. Notify the appropriate provider or emergency response team immediately.
D. Administer an antacid.
Persistent chest pain despite initial therapy may indicate ongoing myocardial ischemia or
infarction and requires immediate evaluation and escalation.
10. A client taking nitroglycerin asks which medication combination is unsafe. Which
response is correct?
A. Nitroglycerin and acetaminophen
B. Nitroglycerin and sildenafil
C. Nitroglycerin and aspirin
D. Nitroglycerin and atorvastatin
Phosphodiesterase-5 inhibitors such as sildenafil can markedly potentiate the hypotensive
effects of nitrates and may cause severe, potentially dangerous hypotension.
11. A client recovering from myocardial infarction suddenly develops ventricular
tachycardia with a pulse. Which assessment should guide immediate treatment?
A. Whether the rhythm is regular
B. Whether the client is hemodynamically stable
C. Whether the client has eaten recently
D. Whether the client has peripheral edema
Management of ventricular tachycardia depends heavily on whether the client has a pulse
and whether the rhythm is causing hemodynamic instability.
12. A client with atrial fibrillation is prescribed an anticoagulant. What is the primary
therapeutic purpose?
A. To lower the heart rate
B. To restore sinus rhythm
C. To prevent thromboembolic stroke
D. To increase ventricular contractility
Atrial fibrillation promotes blood stasis in the atria, increasing thrombus formation and
embolic stroke risk. Anticoagulation reduces that risk.
13. A client taking digoxin reports nausea, anorexia, and yellow-green visual disturbances.
Which action is most appropriate?
A. Administer the next dose with food.
B. Hold the medication and notify the provider.
C. Encourage additional potassium-free fluids.
D. Reassure the client that these are expected effects.
, Nausea, anorexia, and visual disturbances can indicate digoxin toxicity. The medication
should be withheld and the client promptly evaluated.
14. Which electrolyte abnormality increases the risk of digoxin toxicity?
A. Hypokalemia
B. Hypernatremia
C. Hyperchloremia
D. Hypermagnesemia
Low potassium increases myocardial sensitivity to digoxin and increases the risk of toxicity.
15. A client with heart failure has gained 2.5 kg in 4 days. Which interpretation is most
appropriate?
A. The weight change is primarily an increase in muscle mass.
B. The client likely has significant fluid retention.
C. The client is responding normally to therapy.
D. The finding indicates dehydration.
Rapid weight gain in heart failure is usually associated with fluid accumulation rather than
tissue growth.
16. A client with left-sided heart failure develops crackles and severe dyspnea. Which
complication is the nurse most concerned about?
A. Pulmonary edema
B. Peripheral neuropathy
C. Deep vein thrombosis
D. Liver failure
Left ventricular failure causes pulmonary venous congestion, which can progress to
pulmonary edema and severe respiratory compromise.
17. A client with peripheral arterial disease reports severe leg pain while walking that
improves with rest. How should the nurse interpret this finding?
A. Venous stasis
B. Intermittent claudication
C. Neuropathic pain
D. Acute compartment syndrome
Answer: B
Intermittent claudication is exertional muscle pain caused by inadequate arterial blood flow
and typically improves with rest.
18. A client with peripheral arterial disease asks how to protect the feet. Which instruction
is most appropriate?
A. Walk barefoot indoors to strengthen the feet.
ANSWERS | ALL PRACTICE Q&A 2026/2027 | A+
GRADED | COMPREHENSIVE EXAM GUIDE 2026&2027
1. A client with acute heart failure reports increasing dyspnea and suddenly becomes
unable to lie flat. Which assessment finding requires the nurse's most immediate
intervention?
A. Bilateral ankle edema
B. Oxygen saturation of 86%
C. Heart rate of 104/min
D. Weight gain of 1 kg over 3 days
An oxygen saturation of 86% indicates significant hypoxemia and requires immediate
intervention. The other findings are important manifestations of worsening heart failure but
are less immediately life-threatening.
2. A client taking furosemide for heart failure has a serum potassium level of 2.9 mEq/L.
Which assessment finding should the nurse anticipate?
A. Hyperactive bowel sounds
B. Bounding peripheral pulses
C. Muscle weakness and dysrhythmias
D. Increased deep tendon reflexes
Loop diuretics can cause potassium loss. Significant hypokalemia can produce muscle
weakness and potentially life-threatening cardiac dysrhythmias.
3. A client with chronic obstructive pulmonary disease is receiving oxygen therapy. Which
oxygen prescription should the nurse question?
A. Oxygen at 2 L/min by nasal cannula
B. Oxygen titrated to the prescribed target saturation
C. Oxygen at 10 L/min by nonrebreather mask for persistent severe hypoxemia
D. Oxygen at 8 L/min by simple face mask for routine long-term therapy
High-flow oxygen through a simple mask is not appropriate for routine long-term COPD
management. Oxygen should be carefully titrated according to the client's condition and
prescribed target saturation.
4. A client with asthma develops severe wheezing followed by markedly diminished breath
sounds. What should the nurse recognize?
A. The asthma attack is resolving.
B. The client has developed pulmonary edema.
C. Airflow obstruction may have become critically severe.
D. The bronchodilator has produced the expected response.
,Markedly diminished breath sounds after severe wheezing can indicate minimal airflow,
sometimes called a silent chest, and represents a potentially life-threatening asthma
exacerbation.
5. A client with pneumonia has a respiratory rate of 32/min, temperature of 39.2°C, and
new confusion. Which action is the priority?
A. Encourage oral fluids.
B. Obtain a routine sputum specimen.
C. Assess oxygenation and initiate prescribed oxygen therapy.
D. Encourage the client to ambulate.
Confusion and tachypnea may indicate impaired oxygenation or systemic deterioration.
Airway and breathing take priority over routine diagnostic or mobility interventions.
6. A client with a pulmonary embolism suddenly reports sharp chest pain and shortness of
breath. Which additional finding is most concerning?
A. Oxygen saturation of 89%
B. Heart rate of 88/min
C. Blood pressure of 138/82 mmHg
D. Respiratory rate of 18/min
An oxygen saturation of 89% indicates impaired oxygenation and is especially concerning in a
client with a suspected pulmonary embolism.
7. A client receiving heparin therapy develops bleeding from the gums. Which laboratory
value is most important for the nurse to review?
A. Hemoglobin A1C
B. aPTT or anti-Xa level, according to the monitoring protocol
C. Serum sodium
D. Serum creatinine kinase
Unfractionated heparin is commonly monitored using aPTT or an anti-Xa assay depending on
institutional protocol. Unexpected bleeding warrants evaluation of anticoagulation intensity.
8. A client with a deep vein thrombosis asks why the nurse discourages vigorous massage of
the affected leg. What is the best response?
A. Massage increases arterial circulation too rapidly.
B. Massage can cause excessive muscle fatigue.
C. Massage may dislodge the thrombus and cause embolization.
D. Massage causes permanent venous valve damage.
Manipulation of an extremity with an acute venous thrombus may dislodge the clot,
potentially resulting in a pulmonary embolism.
,9. A client with acute coronary syndrome reports persistent chest pressure despite
prescribed sublingual nitroglycerin. What is the nurse's priority action?
A. Encourage the client to walk to improve circulation.
B. Reassess pain in 4 hours.
C. Notify the appropriate provider or emergency response team immediately.
D. Administer an antacid.
Persistent chest pain despite initial therapy may indicate ongoing myocardial ischemia or
infarction and requires immediate evaluation and escalation.
10. A client taking nitroglycerin asks which medication combination is unsafe. Which
response is correct?
A. Nitroglycerin and acetaminophen
B. Nitroglycerin and sildenafil
C. Nitroglycerin and aspirin
D. Nitroglycerin and atorvastatin
Phosphodiesterase-5 inhibitors such as sildenafil can markedly potentiate the hypotensive
effects of nitrates and may cause severe, potentially dangerous hypotension.
11. A client recovering from myocardial infarction suddenly develops ventricular
tachycardia with a pulse. Which assessment should guide immediate treatment?
A. Whether the rhythm is regular
B. Whether the client is hemodynamically stable
C. Whether the client has eaten recently
D. Whether the client has peripheral edema
Management of ventricular tachycardia depends heavily on whether the client has a pulse
and whether the rhythm is causing hemodynamic instability.
12. A client with atrial fibrillation is prescribed an anticoagulant. What is the primary
therapeutic purpose?
A. To lower the heart rate
B. To restore sinus rhythm
C. To prevent thromboembolic stroke
D. To increase ventricular contractility
Atrial fibrillation promotes blood stasis in the atria, increasing thrombus formation and
embolic stroke risk. Anticoagulation reduces that risk.
13. A client taking digoxin reports nausea, anorexia, and yellow-green visual disturbances.
Which action is most appropriate?
A. Administer the next dose with food.
B. Hold the medication and notify the provider.
C. Encourage additional potassium-free fluids.
D. Reassure the client that these are expected effects.
, Nausea, anorexia, and visual disturbances can indicate digoxin toxicity. The medication
should be withheld and the client promptly evaluated.
14. Which electrolyte abnormality increases the risk of digoxin toxicity?
A. Hypokalemia
B. Hypernatremia
C. Hyperchloremia
D. Hypermagnesemia
Low potassium increases myocardial sensitivity to digoxin and increases the risk of toxicity.
15. A client with heart failure has gained 2.5 kg in 4 days. Which interpretation is most
appropriate?
A. The weight change is primarily an increase in muscle mass.
B. The client likely has significant fluid retention.
C. The client is responding normally to therapy.
D. The finding indicates dehydration.
Rapid weight gain in heart failure is usually associated with fluid accumulation rather than
tissue growth.
16. A client with left-sided heart failure develops crackles and severe dyspnea. Which
complication is the nurse most concerned about?
A. Pulmonary edema
B. Peripheral neuropathy
C. Deep vein thrombosis
D. Liver failure
Left ventricular failure causes pulmonary venous congestion, which can progress to
pulmonary edema and severe respiratory compromise.
17. A client with peripheral arterial disease reports severe leg pain while walking that
improves with rest. How should the nurse interpret this finding?
A. Venous stasis
B. Intermittent claudication
C. Neuropathic pain
D. Acute compartment syndrome
Answer: B
Intermittent claudication is exertional muscle pain caused by inadequate arterial blood flow
and typically improves with rest.
18. A client with peripheral arterial disease asks how to protect the feet. Which instruction
is most appropriate?
A. Walk barefoot indoors to strengthen the feet.
