NR 325 ADULT HEALTH II
Final Exam Study Guide
Chamberlain University
Course Code: NR 325
Course Name: Adult Health II
150 Questions with Correct Answers and Rationales
Section 1: Cardiovascular and Respiratory Alterations
1. A client arrives in the emergency department with chest pain suggestive of acute
coronary syndrome. What is the priority nursing action?
Correct Answer: Obtain a 12-lead ECG within 10 minutes of arrival.
Rationale: The ECG identifies ST-segment elevation (STEMI) so reperfusion can begin
quickly. Door-to-ECG time of 10 minutes or less is the standard.
2. Which cardiac biomarker is the most specific indicator of myocardial injury?
Correct Answer: Troponin I or T.
Rationale: Troponin is cardiac-specific, rises within 3 to 6 hours of injury, and stays
elevated for 7 to 14 days. CK-MB rises sooner but is less specific.
3. What is the first medication given to a client with suspected MI who has no aspirin
allergy?
Correct Answer: Aspirin 162 to 325 mg, chewed.
Rationale: Aspirin inhibits platelet aggregation and limits clot extension. Chewing speeds
absorption.
4. Nitroglycerin is contraindicated in a client who has taken which type of drug within the
past 24 to 48 hours?
Correct Answer: A phosphodiesterase-5 inhibitor such as sildenafil or tadalafil.
Rationale: The combination causes profound vasodilation and life-threatening hypotension.
5. What is the recommended door-to-balloon (PCI) time for a client with STEMI?
NR 325 Adult Health II Final Exam Study Guide | Page 1
, Correct Answer: 90 minutes or less.
Rationale: Rapid reperfusion limits infarct size and preserves myocardial muscle ("time is
muscle").
6. Which two assessments are priorities before and after giving IV morphine to a client
with MI?
Correct Answer: Blood pressure and respiratory rate.
Rationale: Morphine reduces pain, preload, and anxiety but can cause hypotension and
respiratory depression.
7. A client with left-sided heart failure is most likely to display which manifestations?
Correct Answer: Dyspnea, orthopnea, crackles, cough with frothy sputum, and fatigue.
Rationale: The failing left ventricle causes blood to back up into the pulmonary circulation,
producing pulmonary congestion.
8. Which findings are characteristic of right-sided heart failure?
Correct Answer: Peripheral edema, jugular vein distention, weight gain, hepatomegaly, and
ascites.
Rationale: The failing right ventricle causes blood to back up into the systemic venous
circulation.
9. Which electrolyte must the nurse monitor closely in a client receiving furosemide?
Correct Answer: Potassium (hypokalemia).
Rationale: Loop diuretics waste potassium. Low potassium causes dysrhythmias and
increases the risk of digoxin toxicity.
10. What is the therapeutic serum range for digoxin?
Correct Answer: 0.5 to 2.0 ng/mL.
Rationale: Levels above 2.0 ng/mL raise the risk of toxicity, especially when potassium is
low.
11. Which findings are early signs of digoxin toxicity?
Correct Answer: Anorexia, nausea, vomiting, visual changes (yellow-green halos), and
bradycardia.
Rationale: GI and visual symptoms often come first. Check the apical pulse for 1 full minute
and hold the dose if the rate is below 60 per minute.
12. A client with heart failure should report what amount of weight gain to the provider?
Correct Answer: More than 2 to 3 lb (1 to 1.5 kg) in 24 hours or 5 lb (2.3 kg) in 1 week.
Rationale: Rapid weight gain reflects fluid retention and worsening heart failure.
13. Which adverse effects of ACE inhibitors must the nurse teach the client to report?
Correct Answer: Persistent dry cough, angioedema, and hyperkalemia.
Rationale: Bradykinin accumulation causes cough and angioedema. Angioedema is an
emergency. Reduced aldosterone raises potassium.
NR 325 Adult Health II Final Exam Study Guide | Page 2
, 14. Why should a client never stop a beta-blocker abruptly?
Correct Answer: Abrupt withdrawal can cause rebound tachycardia, hypertension, angina,
or MI.
Rationale: Receptors become upregulated during therapy, so sudden cessation causes an
exaggerated sympathetic response. Taper the dose.
15. An ECG shows an irregularly irregular rhythm with no discernible P waves. What is
the rhythm and the major complication?
Correct Answer: Atrial fibrillation; stroke from atrial thrombus formation.
Rationale: Quivering atria allow blood to pool and clot. Clots can embolize to the brain.
16. What is the target INR for a client taking warfarin for atrial fibrillation?
Correct Answer: 2.0 to 3.0.
Rationale: This range prevents clotting without excessive bleeding risk.
17. What are the antidotes for warfarin and heparin?
Correct Answer: Warfarin: vitamin K. Heparin: protamine sulfate.
Rationale: Vitamin K restores clotting factor synthesis. Protamine binds and neutralizes
heparin.
18. What is the therapeutic aPTT range for a client on a heparin infusion?
Correct Answer: 1.5 to 2.5 times the control value (about 60 to 80 seconds).
Rationale: Values below range increase clot risk. Values above range increase bleeding risk.
19. A client in the cardiac unit suddenly becomes unresponsive and the monitor shows
ventricular fibrillation. What is the priority action?
Correct Answer: Begin CPR and defibrillate as soon as the defibrillator is available.
Rationale: VF is a lethal, unorganized rhythm and electrical defibrillation is the only
effective treatment.
20. What is the first intervention for a stable client with supraventricular tachycardia?
Correct Answer: Vagal maneuvers (bearing down, carotid massage by provider); then
adenosine 6 mg rapid IV push if unsuccessful.
Rationale: Vagal stimulation slows AV node conduction. Adenosine briefly blocks the AV
node and must be pushed rapidly followed by a saline flush.
21. Which drug is first-line for symptomatic bradycardia?
Correct Answer: Atropine.
Rationale: Atropine blocks vagal tone, increasing heart rate and AV conduction.
22. Which medication is given for pulseless arrest from asystole or PEA?
Correct Answer: Epinephrine 1 mg IV every 3 to 5 minutes.
Rationale: Epinephrine causes vasoconstriction, raising coronary and cerebral perfusion
pressure during CPR.
NR 325 Adult Health II Final Exam Study Guide | Page 3
Final Exam Study Guide
Chamberlain University
Course Code: NR 325
Course Name: Adult Health II
150 Questions with Correct Answers and Rationales
Section 1: Cardiovascular and Respiratory Alterations
1. A client arrives in the emergency department with chest pain suggestive of acute
coronary syndrome. What is the priority nursing action?
Correct Answer: Obtain a 12-lead ECG within 10 minutes of arrival.
Rationale: The ECG identifies ST-segment elevation (STEMI) so reperfusion can begin
quickly. Door-to-ECG time of 10 minutes or less is the standard.
2. Which cardiac biomarker is the most specific indicator of myocardial injury?
Correct Answer: Troponin I or T.
Rationale: Troponin is cardiac-specific, rises within 3 to 6 hours of injury, and stays
elevated for 7 to 14 days. CK-MB rises sooner but is less specific.
3. What is the first medication given to a client with suspected MI who has no aspirin
allergy?
Correct Answer: Aspirin 162 to 325 mg, chewed.
Rationale: Aspirin inhibits platelet aggregation and limits clot extension. Chewing speeds
absorption.
4. Nitroglycerin is contraindicated in a client who has taken which type of drug within the
past 24 to 48 hours?
Correct Answer: A phosphodiesterase-5 inhibitor such as sildenafil or tadalafil.
Rationale: The combination causes profound vasodilation and life-threatening hypotension.
5. What is the recommended door-to-balloon (PCI) time for a client with STEMI?
NR 325 Adult Health II Final Exam Study Guide | Page 1
, Correct Answer: 90 minutes or less.
Rationale: Rapid reperfusion limits infarct size and preserves myocardial muscle ("time is
muscle").
6. Which two assessments are priorities before and after giving IV morphine to a client
with MI?
Correct Answer: Blood pressure and respiratory rate.
Rationale: Morphine reduces pain, preload, and anxiety but can cause hypotension and
respiratory depression.
7. A client with left-sided heart failure is most likely to display which manifestations?
Correct Answer: Dyspnea, orthopnea, crackles, cough with frothy sputum, and fatigue.
Rationale: The failing left ventricle causes blood to back up into the pulmonary circulation,
producing pulmonary congestion.
8. Which findings are characteristic of right-sided heart failure?
Correct Answer: Peripheral edema, jugular vein distention, weight gain, hepatomegaly, and
ascites.
Rationale: The failing right ventricle causes blood to back up into the systemic venous
circulation.
9. Which electrolyte must the nurse monitor closely in a client receiving furosemide?
Correct Answer: Potassium (hypokalemia).
Rationale: Loop diuretics waste potassium. Low potassium causes dysrhythmias and
increases the risk of digoxin toxicity.
10. What is the therapeutic serum range for digoxin?
Correct Answer: 0.5 to 2.0 ng/mL.
Rationale: Levels above 2.0 ng/mL raise the risk of toxicity, especially when potassium is
low.
11. Which findings are early signs of digoxin toxicity?
Correct Answer: Anorexia, nausea, vomiting, visual changes (yellow-green halos), and
bradycardia.
Rationale: GI and visual symptoms often come first. Check the apical pulse for 1 full minute
and hold the dose if the rate is below 60 per minute.
12. A client with heart failure should report what amount of weight gain to the provider?
Correct Answer: More than 2 to 3 lb (1 to 1.5 kg) in 24 hours or 5 lb (2.3 kg) in 1 week.
Rationale: Rapid weight gain reflects fluid retention and worsening heart failure.
13. Which adverse effects of ACE inhibitors must the nurse teach the client to report?
Correct Answer: Persistent dry cough, angioedema, and hyperkalemia.
Rationale: Bradykinin accumulation causes cough and angioedema. Angioedema is an
emergency. Reduced aldosterone raises potassium.
NR 325 Adult Health II Final Exam Study Guide | Page 2
, 14. Why should a client never stop a beta-blocker abruptly?
Correct Answer: Abrupt withdrawal can cause rebound tachycardia, hypertension, angina,
or MI.
Rationale: Receptors become upregulated during therapy, so sudden cessation causes an
exaggerated sympathetic response. Taper the dose.
15. An ECG shows an irregularly irregular rhythm with no discernible P waves. What is
the rhythm and the major complication?
Correct Answer: Atrial fibrillation; stroke from atrial thrombus formation.
Rationale: Quivering atria allow blood to pool and clot. Clots can embolize to the brain.
16. What is the target INR for a client taking warfarin for atrial fibrillation?
Correct Answer: 2.0 to 3.0.
Rationale: This range prevents clotting without excessive bleeding risk.
17. What are the antidotes for warfarin and heparin?
Correct Answer: Warfarin: vitamin K. Heparin: protamine sulfate.
Rationale: Vitamin K restores clotting factor synthesis. Protamine binds and neutralizes
heparin.
18. What is the therapeutic aPTT range for a client on a heparin infusion?
Correct Answer: 1.5 to 2.5 times the control value (about 60 to 80 seconds).
Rationale: Values below range increase clot risk. Values above range increase bleeding risk.
19. A client in the cardiac unit suddenly becomes unresponsive and the monitor shows
ventricular fibrillation. What is the priority action?
Correct Answer: Begin CPR and defibrillate as soon as the defibrillator is available.
Rationale: VF is a lethal, unorganized rhythm and electrical defibrillation is the only
effective treatment.
20. What is the first intervention for a stable client with supraventricular tachycardia?
Correct Answer: Vagal maneuvers (bearing down, carotid massage by provider); then
adenosine 6 mg rapid IV push if unsuccessful.
Rationale: Vagal stimulation slows AV node conduction. Adenosine briefly blocks the AV
node and must be pushed rapidly followed by a saline flush.
21. Which drug is first-line for symptomatic bradycardia?
Correct Answer: Atropine.
Rationale: Atropine blocks vagal tone, increasing heart rate and AV conduction.
22. Which medication is given for pulseless arrest from asystole or PEA?
Correct Answer: Epinephrine 1 mg IV every 3 to 5 minutes.
Rationale: Epinephrine causes vasoconstriction, raising coronary and cerebral perfusion
pressure during CPR.
NR 325 Adult Health II Final Exam Study Guide | Page 3
