Adult Health Nursing II – 150 Practice
Questions & Comprehensive Exam Review
Question 1:
A client with hypertrophic cardiomyopathy reports increasing exertional dyspnea
and two episodes of near-syncope. Which assessment finding requires the nurse's
immediate attention?
A. Heart rate of 88/min
B. Blood pressure of 118/72 mmHg
C. New onset of sustained ventricular tachycardia
D. Mild bilateral ankle edema
Correct Answer: C. New onset of sustained ventricular tachycardia
Rationale: Hypertrophic cardiomyopathy can cause life-threatening ventricular
dysrhythmias and sudden cardiac death. Sustained ventricular tachycardia
compromises cardiac output and may rapidly deteriorate into ventricular
fibrillation. The nurse should immediately assess the client and initiate emergency
dysrhythmia management according to institutional protocols.
Question 2:
A client with severe aortic stenosis is being evaluated for valve replacement.
Which symptom most strongly indicates progression of the disease?
,A. Exertional syncope
B. Occasional palpitations at rest
C. Mild dependent edema after standing
D. Heartburn after large meals
Correct Answer: A. Exertional syncope
Rationale: Aortic stenosis obstructs left ventricular outflow. During exertion, the
heart cannot sufficiently increase cardiac output, potentially causing cerebral
hypoperfusion and syncope. Exertional syncope in a client with severe aortic
stenosis is a significant clinical finding associated with advanced disease and
requires prompt evaluation.
Question 3:
A client with mitral regurgitation develops worsening fatigue, orthopnea, and
pulmonary crackles. Which pathophysiologic change best explains these findings?
A. Reduced venous return to the right atrium
B. Backflow of blood into the left atrium during systole
C. Obstruction of blood flow through the pulmonary artery
D. Reduced blood flow from the left atrium into the ventricle
Correct Answer: B. Backflow of blood into the left atrium during systole
Rationale: In mitral regurgitation, the mitral valve fails to close completely during
ventricular systole, allowing blood to flow backward into the left atrium. Increased
,left atrial and pulmonary pressures can produce pulmonary congestion, crackles,
dyspnea, and orthopnea as the condition progresses.
Question 4:
A client is recovering after transcatheter aortic valve replacement. Which finding
should the nurse report immediately?
A. Mild incisional discomfort
B. Heart rate of 82/min
C. New onset of complete heart block
D. Temperature of 37.2°C
Correct Answer: C. New onset of complete heart block
Rationale: Conduction abnormalities, including complete heart block, can occur
after aortic valve procedures because the conduction system lies near the aortic
valve. Complete heart block can cause profound bradycardia and decreased cardiac
output and may require urgent pacing intervention.
Question 5:
A client with infective endocarditis suddenly develops severe left-sided weakness
and difficulty speaking. Which complication should the nurse suspect?
A. Pulmonary edema
B. Septic embolization to the brain
C. Acute pancreatitis
D. Nephrotic syndrome
, Correct Answer: B. Septic embolization to the brain
Rationale: Vegetations associated with infective endocarditis can fragment and
travel through systemic circulation. Embolization to cerebral vessels can cause an
ischemic stroke, producing sudden neurological deficits such as unilateral
weakness, aphasia, facial asymmetry, or altered consciousness.
Question 6:
A client with pulmonary hypertension reports worsening exertional dyspnea and
chest pressure. Which assessment finding is most concerning?
A. Oxygen saturation of 96% at rest
B. Mild fatigue after walking
C. New syncope during exertion
D. Respiratory rate of 18/min
Correct Answer: C. New syncope during exertion
Rationale: Syncope in pulmonary hypertension may indicate severe limitation of
right ventricular output during exertion. It can reflect advanced disease and
inadequate cerebral perfusion. New exertional syncope requires prompt evaluation
because it may indicate significant hemodynamic deterioration.
Question 7:
A client with dilated cardiomyopathy has an ejection fraction of 25%. Which
prescription should the nurse question?
Questions & Comprehensive Exam Review
Question 1:
A client with hypertrophic cardiomyopathy reports increasing exertional dyspnea
and two episodes of near-syncope. Which assessment finding requires the nurse's
immediate attention?
A. Heart rate of 88/min
B. Blood pressure of 118/72 mmHg
C. New onset of sustained ventricular tachycardia
D. Mild bilateral ankle edema
Correct Answer: C. New onset of sustained ventricular tachycardia
Rationale: Hypertrophic cardiomyopathy can cause life-threatening ventricular
dysrhythmias and sudden cardiac death. Sustained ventricular tachycardia
compromises cardiac output and may rapidly deteriorate into ventricular
fibrillation. The nurse should immediately assess the client and initiate emergency
dysrhythmia management according to institutional protocols.
Question 2:
A client with severe aortic stenosis is being evaluated for valve replacement.
Which symptom most strongly indicates progression of the disease?
,A. Exertional syncope
B. Occasional palpitations at rest
C. Mild dependent edema after standing
D. Heartburn after large meals
Correct Answer: A. Exertional syncope
Rationale: Aortic stenosis obstructs left ventricular outflow. During exertion, the
heart cannot sufficiently increase cardiac output, potentially causing cerebral
hypoperfusion and syncope. Exertional syncope in a client with severe aortic
stenosis is a significant clinical finding associated with advanced disease and
requires prompt evaluation.
Question 3:
A client with mitral regurgitation develops worsening fatigue, orthopnea, and
pulmonary crackles. Which pathophysiologic change best explains these findings?
A. Reduced venous return to the right atrium
B. Backflow of blood into the left atrium during systole
C. Obstruction of blood flow through the pulmonary artery
D. Reduced blood flow from the left atrium into the ventricle
Correct Answer: B. Backflow of blood into the left atrium during systole
Rationale: In mitral regurgitation, the mitral valve fails to close completely during
ventricular systole, allowing blood to flow backward into the left atrium. Increased
,left atrial and pulmonary pressures can produce pulmonary congestion, crackles,
dyspnea, and orthopnea as the condition progresses.
Question 4:
A client is recovering after transcatheter aortic valve replacement. Which finding
should the nurse report immediately?
A. Mild incisional discomfort
B. Heart rate of 82/min
C. New onset of complete heart block
D. Temperature of 37.2°C
Correct Answer: C. New onset of complete heart block
Rationale: Conduction abnormalities, including complete heart block, can occur
after aortic valve procedures because the conduction system lies near the aortic
valve. Complete heart block can cause profound bradycardia and decreased cardiac
output and may require urgent pacing intervention.
Question 5:
A client with infective endocarditis suddenly develops severe left-sided weakness
and difficulty speaking. Which complication should the nurse suspect?
A. Pulmonary edema
B. Septic embolization to the brain
C. Acute pancreatitis
D. Nephrotic syndrome
, Correct Answer: B. Septic embolization to the brain
Rationale: Vegetations associated with infective endocarditis can fragment and
travel through systemic circulation. Embolization to cerebral vessels can cause an
ischemic stroke, producing sudden neurological deficits such as unilateral
weakness, aphasia, facial asymmetry, or altered consciousness.
Question 6:
A client with pulmonary hypertension reports worsening exertional dyspnea and
chest pressure. Which assessment finding is most concerning?
A. Oxygen saturation of 96% at rest
B. Mild fatigue after walking
C. New syncope during exertion
D. Respiratory rate of 18/min
Correct Answer: C. New syncope during exertion
Rationale: Syncope in pulmonary hypertension may indicate severe limitation of
right ventricular output during exertion. It can reflect advanced disease and
inadequate cerebral perfusion. New exertional syncope requires prompt evaluation
because it may indicate significant hemodynamic deterioration.
Question 7:
A client with dilated cardiomyopathy has an ejection fraction of 25%. Which
prescription should the nurse question?
