,NSG 2610 Final Exam Adult Health Nursing II Questions And Answers
2026/2027 South College
Q1. A 64-year-old client with a history of coronary artery disease
develops severe chest discomfort and diaphoresis.
Electrocardiography reveals ST-segment depression in leads V1–V3,
with unusually tall R waves and upright T waves in the same leads.
Which additional diagnostic assessment is most appropriate?
A) Routine exercise stress testing before further evaluation
B) Right-sided abdominal ultrasonography
C) Posterior electrocardiographic leads V7–V9 to evaluate for posterior
myocardial infarction
D) Electroencephalography to evaluate for seizure activity
Correct Answer: C) Posterior electrocardiographic leads V7–V9 to evaluate for
posterior myocardial infarction
Rationale: Posterior myocardial infarction can produce reciprocal ST
depression and prominent R waves in anterior leads V1–V3. Posterior leads
V7–V9 may demonstrate ST elevation and help identify an acute coronary
occlusion requiring urgent reperfusion. A standard 12-lead electrocardiogram
may not directly visualize posterior myocardial injury.
Q2. A 71-year-old client with acute myocardial infarction develops
blood pressure of 82/46 mmHg, cool extremities, and reduced urine
output. A pulmonary artery catheter reveals cardiac index 1.5
L/min/m² and pulmonary capillary wedge pressure 29 mmHg. Which
treatment strategy best addresses the underlying hemodynamic
disturbance?
A) Administer unrestricted crystalloid boluses without reassessment.
B) Initiate appropriate cardiac support while arranging urgent treatment of
the underlying myocardial ischemia.
C) Increase systemic vascular resistance without evaluating cardiac output.
D) Administer a medication that markedly reduces myocardial contractility.
Correct Answer: B) Initiate appropriate cardiac support while arranging
urgent treatment of the underlying myocardial ischemia.
,Rationale: Reduced cardiac index combined with elevated pulmonary
capillary wedge pressure indicates impaired left ventricular pumping with
elevated filling pressures. This pattern supports cardiogenic shock.
Management focuses on restoring coronary perfusion, supporting cardiac
output, maintaining systemic circulation, and preventing further myocardial
injury.
Q3. A 58-year-old client undergoes coronary stenting after an acute
myocardial infarction. Twelve hours later, the client develops
recurrent severe chest pain and new ST-segment elevation in the
same coronary territory. Which complication requires immediate
consideration?
A) Expected discomfort from arterial catheterization
B) Chronic stable angina unrelated to the procedure
C) Normal ventricular remodeling
D) Acute coronary stent thrombosis
Correct Answer: D) Acute coronary stent thrombosis
Rationale: Sudden recurrent ischemic symptoms and ST elevation shortly
after percutaneous coronary intervention raise concern for acute stent
thrombosis. Occlusion can rapidly cause extensive myocardial injury and
fatal dysrhythmias. Emergency coronary angiography and reperfusion
assessment are necessary.
Q4. A 69-year-old client has an inferior myocardial infarction
involving the right ventricle. The client develops hypotension after
receiving intravenous furosemide. Lung sounds remain clear, and
jugular venous distension is present. Which mechanism best
explains the deterioration?
A) Reduced right ventricular preload further decreases left ventricular filling
and cardiac output.
B) Diuresis immediately increases right ventricular stroke volume.
C) The medication causes complete coronary artery reopening.
D) Reduced preload automatically improves circulation during right
ventricular infarction.
, Correct Answer: A) Reduced right ventricular preload further decreases left
ventricular filling and cardiac output.
Rationale: Right ventricular infarction can make cardiac output particularly
dependent on adequate preload. Excessive volume reduction may
compromise right ventricular forward flow, reducing left ventricular filling
and systemic blood pressure. Fluid management requires careful
hemodynamic assessment because excessive volume can also worsen right
ventricular dysfunction.
Q5. A 62-year-old client with a recent myocardial infarction develops
a new systolic murmur, worsening pulmonary edema, and
hypotension. Echocardiography demonstrates severe acute mitral
regurgitation caused by papillary muscle disruption. Which
intervention is most appropriate?
A) Routine outpatient monitoring
B) Oral antibiotics as definitive treatment
C) Emergency hemodynamic stabilization and cardiothoracic surgical
evaluation
D) Increased physical activity to improve ventricular function
Correct Answer: C) Emergency hemodynamic stabilization and cardiothoracic
surgical evaluation
Rationale: Acute papillary muscle rupture can cause catastrophic mitral
regurgitation, rapidly increasing left atrial pressure and producing pulmonary
edema and cardiogenic shock. Emergency support and surgical correction
are generally required. Definitive treatment should not be delayed by routine
outpatient management.
Q6. A 67-year-old client develops acute chest pain and shortness of
breath. Electrocardiography reveals diffuse ST-segment elevation
with PR-segment depression. The pain worsens when lying flat and
improves when leaning forward. Which additional finding supports
the suspected diagnosis?
A) Severe hypoglycemia
B) A pericardial friction rub
C) Absent distal pedal pulses
2026/2027 South College
Q1. A 64-year-old client with a history of coronary artery disease
develops severe chest discomfort and diaphoresis.
Electrocardiography reveals ST-segment depression in leads V1–V3,
with unusually tall R waves and upright T waves in the same leads.
Which additional diagnostic assessment is most appropriate?
A) Routine exercise stress testing before further evaluation
B) Right-sided abdominal ultrasonography
C) Posterior electrocardiographic leads V7–V9 to evaluate for posterior
myocardial infarction
D) Electroencephalography to evaluate for seizure activity
Correct Answer: C) Posterior electrocardiographic leads V7–V9 to evaluate for
posterior myocardial infarction
Rationale: Posterior myocardial infarction can produce reciprocal ST
depression and prominent R waves in anterior leads V1–V3. Posterior leads
V7–V9 may demonstrate ST elevation and help identify an acute coronary
occlusion requiring urgent reperfusion. A standard 12-lead electrocardiogram
may not directly visualize posterior myocardial injury.
Q2. A 71-year-old client with acute myocardial infarction develops
blood pressure of 82/46 mmHg, cool extremities, and reduced urine
output. A pulmonary artery catheter reveals cardiac index 1.5
L/min/m² and pulmonary capillary wedge pressure 29 mmHg. Which
treatment strategy best addresses the underlying hemodynamic
disturbance?
A) Administer unrestricted crystalloid boluses without reassessment.
B) Initiate appropriate cardiac support while arranging urgent treatment of
the underlying myocardial ischemia.
C) Increase systemic vascular resistance without evaluating cardiac output.
D) Administer a medication that markedly reduces myocardial contractility.
Correct Answer: B) Initiate appropriate cardiac support while arranging
urgent treatment of the underlying myocardial ischemia.
,Rationale: Reduced cardiac index combined with elevated pulmonary
capillary wedge pressure indicates impaired left ventricular pumping with
elevated filling pressures. This pattern supports cardiogenic shock.
Management focuses on restoring coronary perfusion, supporting cardiac
output, maintaining systemic circulation, and preventing further myocardial
injury.
Q3. A 58-year-old client undergoes coronary stenting after an acute
myocardial infarction. Twelve hours later, the client develops
recurrent severe chest pain and new ST-segment elevation in the
same coronary territory. Which complication requires immediate
consideration?
A) Expected discomfort from arterial catheterization
B) Chronic stable angina unrelated to the procedure
C) Normal ventricular remodeling
D) Acute coronary stent thrombosis
Correct Answer: D) Acute coronary stent thrombosis
Rationale: Sudden recurrent ischemic symptoms and ST elevation shortly
after percutaneous coronary intervention raise concern for acute stent
thrombosis. Occlusion can rapidly cause extensive myocardial injury and
fatal dysrhythmias. Emergency coronary angiography and reperfusion
assessment are necessary.
Q4. A 69-year-old client has an inferior myocardial infarction
involving the right ventricle. The client develops hypotension after
receiving intravenous furosemide. Lung sounds remain clear, and
jugular venous distension is present. Which mechanism best
explains the deterioration?
A) Reduced right ventricular preload further decreases left ventricular filling
and cardiac output.
B) Diuresis immediately increases right ventricular stroke volume.
C) The medication causes complete coronary artery reopening.
D) Reduced preload automatically improves circulation during right
ventricular infarction.
, Correct Answer: A) Reduced right ventricular preload further decreases left
ventricular filling and cardiac output.
Rationale: Right ventricular infarction can make cardiac output particularly
dependent on adequate preload. Excessive volume reduction may
compromise right ventricular forward flow, reducing left ventricular filling
and systemic blood pressure. Fluid management requires careful
hemodynamic assessment because excessive volume can also worsen right
ventricular dysfunction.
Q5. A 62-year-old client with a recent myocardial infarction develops
a new systolic murmur, worsening pulmonary edema, and
hypotension. Echocardiography demonstrates severe acute mitral
regurgitation caused by papillary muscle disruption. Which
intervention is most appropriate?
A) Routine outpatient monitoring
B) Oral antibiotics as definitive treatment
C) Emergency hemodynamic stabilization and cardiothoracic surgical
evaluation
D) Increased physical activity to improve ventricular function
Correct Answer: C) Emergency hemodynamic stabilization and cardiothoracic
surgical evaluation
Rationale: Acute papillary muscle rupture can cause catastrophic mitral
regurgitation, rapidly increasing left atrial pressure and producing pulmonary
edema and cardiogenic shock. Emergency support and surgical correction
are generally required. Definitive treatment should not be delayed by routine
outpatient management.
Q6. A 67-year-old client develops acute chest pain and shortness of
breath. Electrocardiography reveals diffuse ST-segment elevation
with PR-segment depression. The pain worsens when lying flat and
improves when leaning forward. Which additional finding supports
the suspected diagnosis?
A) Severe hypoglycemia
B) A pericardial friction rub
C) Absent distal pedal pulses
