NUR417 / NUR 417 Final Exam Care of
Adult II Concordia St. Paul ACTUAL
EXAM 2026/2027 | Concordia NUR 417
Adult II | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Cardiovascular & Hematologic Disorders (Questions 1–20)
Q1: A 68-year-old male is admitted with acute decompensated heart failure. Vital signs: BP 92/58
mmHg, HR 118 bpm, RR 28/min, SpO₂ 88% on room air. He has crackles bilaterally, JVD at 8 cm, and 3+
pitting edema. Lab values: BNP 1,850 pg/mL, creatinine 1.9 mg/dL. Based on the ADHERE classification,
the nurse recognizes this patient is at highest risk for:
A. Stable chronic heart failure with preserved ejection fraction
B. [CORRECT] In-hospital mortality due to low systolic blood pressure, elevated BNP, and renal
dysfunction consistent with advanced cardiorenal syndrome
C. Discharge to home within 24 hours
D. Isolated right ventricular failure
Correct Answer: B Rationale: The ADHERE registry identifies BUN ≥ 43 mg/dL, SBP < 115 mmHg, and
creatinine ≥ 2.75 mg/dL as the strongest predictors of in-hospital mortality. This patient presents with
hypotension (SBP 92), markedly elevated BNP, and acute kidney injury, indicating severe cardiorenal
syndrome with high mortality risk requiring aggressive intervention and ICU-level monitoring.
Q2: A 72-year-old female with a history of atrial fibrillation presents with sudden onset of severe
dyspnea, hypotension, and altered mental status. ECG shows irregularly irregular rhythm with no
discernible P waves and a ventricular rate of 160 bpm. The nurse prepares for immediate:
A. Oral metoprolol administration
, B. [CORRECT] Synchronized cardioversion following sedation, as the patient is hemodynamically
unstable with hypotension and altered mental status
C. Observation and telemetry monitoring only
D. Oral anticoagulation initiation
Correct Answer: B Rationale: Unstable atrial fibrillation with hemodynamic compromise (hypotension,
altered mental status, acute heart failure, or ongoing ischemia) requires immediate synchronized
cardioversion (100–200 J biphasic) after appropriate sedation. Rate control and anticoagulation are
appropriate for stable patients but are contraindicated as sole therapy in unstable presentations where
restoration of sinus rhythm is emergently needed.
Q3: A patient with acute ST-elevation myocardial infarction (STEMI) develops a new holosystolic
murmur at the apex, pulmonary edema, and cardiogenic shock 5 days post-infarction. The nurse
recognizes this clinical picture as most consistent with:
A. Acute pericarditis
B. [CORRECT] Papillary muscle rupture causing acute severe mitral regurgitation
C. Stable ventricular septal defect
D. Right ventricular infarction
Correct Answer: B Rationale: Papillary muscle rupture is a catastrophic mechanical complication of
STEMI, typically occurring 2–7 days post-infarction. It produces acute severe mitral regurgitation,
manifesting as a new holosystolic murmur, flash pulmonary edema, and cardiogenic shock. Emergency
surgical repair or mitral valve replacement is required, as medical management alone carries extremely
high mortality.
Q4: A patient with infective endocarditis has blood cultures positive for Staphylococcus aureus and
develops Janeway lesions, Osler nodes, and splinter hemorrhages. The nurse understands that these
peripheral manifestations represent:
A. Allergic reactions to antibiotic therapy
B. [CORRECT] Septic microemboli and immune complex deposition resulting from bacteremia
and valvular vegetations
C. Direct bacterial invasion of skin and nail beds
D. Coagulation disorders unrelated to the infection
,Correct Answer: B Rationale: Janeway lesions (non-tender erythematous macules on palms/soles) result
from septic microemboli. Osler nodes (tender subcutaneous nodules on fingers/toes) and splinter
hemorrhages result from immune complex deposition and vasculitis. These peripheral stigmata, along
with Roth spots and petechiae, are classic peripheral manifestations of infective endocarditis caused by
embolic and immunologic phenomena.
Q5: A patient with acute pericarditis presents with sharp, pleuritic chest pain that improves when
leaning forward. ECG shows diffuse ST-segment elevation and PR-segment depression. The priority
nursing intervention is:
A. Prepare for immediate cardiac catheterization
B. [CORRECT] Administer NSAIDs and colchicine as ordered, monitor for signs of cardiac
tamponade, and position the patient upright and leaning forward for comfort
C. Administer thrombolytic therapy
D. Initiate beta-blocker therapy
Correct Answer: B Rationale: Acute pericarditis is treated with NSAIDs (ibuprofen or aspirin) and
colchicine to reduce inflammation and prevent recurrence. The characteristic positional pain (worsened
supine, improved leaning forward) and ECG findings (diffuse ST elevation without reciprocal changes, PR
depression) distinguish pericarditis from STEMI. The nurse must monitor for cardiac tamponade (Beck's
triad: hypotension, JVD, muffled heart sounds) as a life-threatening complication.
Q6: A patient with a mechanical heart valve on warfarin presents with acute onset of left-sided
weakness and aphasia. INR is 1.2 (therapeutic range 2.5–3.5). CT head shows no hemorrhage. The nurse
anticipates which intervention?
A. Immediate warfarin reversal with vitamin K and fresh frozen plasma
B. [CORRECT] Evaluation for ischemic stroke with consideration of thrombolysis if within
window, and urgent assessment of valve function for thrombosis
C. Observation and serial neurological checks only
D. Immediate surgical valve replacement
Correct Answer: B Rationale: Subtherapeutic INR in a patient with a mechanical valve suggests valve
thrombosis or embolic stroke as the cause of neurological deficits. With a non-hemorrhagic CT and
presentation within the thrombolytic window, the patient may be a candidate for tPA. Urgent
echocardiography is needed to assess valve function and thrombus burden, as valve thrombosis may
require fibrinolysis or emergent surgery.
, Q7: A patient with severe aortic stenosis develops syncope with exertion. The nurse understands that
the pathophysiological mechanism is:
A. Ventricular arrhythmia due to ischemia
B. [CORRECT] Inability to increase cardiac output across the stenotic valve during exertion,
resulting in cerebral hypoperfusion
C. Paroxysmal atrial fibrillation
D. Hypoglycemia
Correct Answer: B Rationale: Severe aortic stenosis creates a fixed obstruction to left ventricular
outflow. During exertion, the heart cannot increase stroke volume sufficiently to meet metabolic
demands because flow across the stenotic valve is limited. This results in cerebral hypoperfusion and
syncope. This symptom, along with angina and dyspnea, constitutes the classic triad indicating severe
disease requiring valve replacement.
Q8: A patient with disseminated intravascular coagulation (DIC) has prolonged PT/PTT, low fibrinogen,
elevated D-dimer, and thrombocytopenia. The patient is actively bleeding from IV sites and has
hematuria. The priority intervention is:
A. Immediate heparin infusion
B. [CORRECT] Replacement of depleted clotting factors with fresh frozen plasma,
cryoprecipitate, and platelets while treating the underlying cause
C. Therapeutic phlebotomy
D. Aspirin administration
Correct Answer: B Rationale: DIC is a consumptive coagulopathy characterized by simultaneous
thrombosis and bleeding due to uncontrolled activation of coagulation and fibrinolysis. In bleeding DIC,
management focuses on replacing depleted factors (FFP for clotting factors, cryoprecipitate for
fibrinogen, platelets for thrombocytopenia) while aggressively treating the underlying trigger (sepsis,
trauma, obstetric catastrophe). Heparin is reserved for thrombotic DIC.
Q9: A patient develops thrombocytopenia (platelet count 45,000/μL) 8 days after initiating
unfractionated heparin. Platelet count was normal on admission. The nurse suspects heparin-induced
thrombocytopenia (HIT) and anticipates:
Adult II Concordia St. Paul ACTUAL
EXAM 2026/2027 | Concordia NUR 417
Adult II | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Cardiovascular & Hematologic Disorders (Questions 1–20)
Q1: A 68-year-old male is admitted with acute decompensated heart failure. Vital signs: BP 92/58
mmHg, HR 118 bpm, RR 28/min, SpO₂ 88% on room air. He has crackles bilaterally, JVD at 8 cm, and 3+
pitting edema. Lab values: BNP 1,850 pg/mL, creatinine 1.9 mg/dL. Based on the ADHERE classification,
the nurse recognizes this patient is at highest risk for:
A. Stable chronic heart failure with preserved ejection fraction
B. [CORRECT] In-hospital mortality due to low systolic blood pressure, elevated BNP, and renal
dysfunction consistent with advanced cardiorenal syndrome
C. Discharge to home within 24 hours
D. Isolated right ventricular failure
Correct Answer: B Rationale: The ADHERE registry identifies BUN ≥ 43 mg/dL, SBP < 115 mmHg, and
creatinine ≥ 2.75 mg/dL as the strongest predictors of in-hospital mortality. This patient presents with
hypotension (SBP 92), markedly elevated BNP, and acute kidney injury, indicating severe cardiorenal
syndrome with high mortality risk requiring aggressive intervention and ICU-level monitoring.
Q2: A 72-year-old female with a history of atrial fibrillation presents with sudden onset of severe
dyspnea, hypotension, and altered mental status. ECG shows irregularly irregular rhythm with no
discernible P waves and a ventricular rate of 160 bpm. The nurse prepares for immediate:
A. Oral metoprolol administration
, B. [CORRECT] Synchronized cardioversion following sedation, as the patient is hemodynamically
unstable with hypotension and altered mental status
C. Observation and telemetry monitoring only
D. Oral anticoagulation initiation
Correct Answer: B Rationale: Unstable atrial fibrillation with hemodynamic compromise (hypotension,
altered mental status, acute heart failure, or ongoing ischemia) requires immediate synchronized
cardioversion (100–200 J biphasic) after appropriate sedation. Rate control and anticoagulation are
appropriate for stable patients but are contraindicated as sole therapy in unstable presentations where
restoration of sinus rhythm is emergently needed.
Q3: A patient with acute ST-elevation myocardial infarction (STEMI) develops a new holosystolic
murmur at the apex, pulmonary edema, and cardiogenic shock 5 days post-infarction. The nurse
recognizes this clinical picture as most consistent with:
A. Acute pericarditis
B. [CORRECT] Papillary muscle rupture causing acute severe mitral regurgitation
C. Stable ventricular septal defect
D. Right ventricular infarction
Correct Answer: B Rationale: Papillary muscle rupture is a catastrophic mechanical complication of
STEMI, typically occurring 2–7 days post-infarction. It produces acute severe mitral regurgitation,
manifesting as a new holosystolic murmur, flash pulmonary edema, and cardiogenic shock. Emergency
surgical repair or mitral valve replacement is required, as medical management alone carries extremely
high mortality.
Q4: A patient with infective endocarditis has blood cultures positive for Staphylococcus aureus and
develops Janeway lesions, Osler nodes, and splinter hemorrhages. The nurse understands that these
peripheral manifestations represent:
A. Allergic reactions to antibiotic therapy
B. [CORRECT] Septic microemboli and immune complex deposition resulting from bacteremia
and valvular vegetations
C. Direct bacterial invasion of skin and nail beds
D. Coagulation disorders unrelated to the infection
,Correct Answer: B Rationale: Janeway lesions (non-tender erythematous macules on palms/soles) result
from septic microemboli. Osler nodes (tender subcutaneous nodules on fingers/toes) and splinter
hemorrhages result from immune complex deposition and vasculitis. These peripheral stigmata, along
with Roth spots and petechiae, are classic peripheral manifestations of infective endocarditis caused by
embolic and immunologic phenomena.
Q5: A patient with acute pericarditis presents with sharp, pleuritic chest pain that improves when
leaning forward. ECG shows diffuse ST-segment elevation and PR-segment depression. The priority
nursing intervention is:
A. Prepare for immediate cardiac catheterization
B. [CORRECT] Administer NSAIDs and colchicine as ordered, monitor for signs of cardiac
tamponade, and position the patient upright and leaning forward for comfort
C. Administer thrombolytic therapy
D. Initiate beta-blocker therapy
Correct Answer: B Rationale: Acute pericarditis is treated with NSAIDs (ibuprofen or aspirin) and
colchicine to reduce inflammation and prevent recurrence. The characteristic positional pain (worsened
supine, improved leaning forward) and ECG findings (diffuse ST elevation without reciprocal changes, PR
depression) distinguish pericarditis from STEMI. The nurse must monitor for cardiac tamponade (Beck's
triad: hypotension, JVD, muffled heart sounds) as a life-threatening complication.
Q6: A patient with a mechanical heart valve on warfarin presents with acute onset of left-sided
weakness and aphasia. INR is 1.2 (therapeutic range 2.5–3.5). CT head shows no hemorrhage. The nurse
anticipates which intervention?
A. Immediate warfarin reversal with vitamin K and fresh frozen plasma
B. [CORRECT] Evaluation for ischemic stroke with consideration of thrombolysis if within
window, and urgent assessment of valve function for thrombosis
C. Observation and serial neurological checks only
D. Immediate surgical valve replacement
Correct Answer: B Rationale: Subtherapeutic INR in a patient with a mechanical valve suggests valve
thrombosis or embolic stroke as the cause of neurological deficits. With a non-hemorrhagic CT and
presentation within the thrombolytic window, the patient may be a candidate for tPA. Urgent
echocardiography is needed to assess valve function and thrombus burden, as valve thrombosis may
require fibrinolysis or emergent surgery.
, Q7: A patient with severe aortic stenosis develops syncope with exertion. The nurse understands that
the pathophysiological mechanism is:
A. Ventricular arrhythmia due to ischemia
B. [CORRECT] Inability to increase cardiac output across the stenotic valve during exertion,
resulting in cerebral hypoperfusion
C. Paroxysmal atrial fibrillation
D. Hypoglycemia
Correct Answer: B Rationale: Severe aortic stenosis creates a fixed obstruction to left ventricular
outflow. During exertion, the heart cannot increase stroke volume sufficiently to meet metabolic
demands because flow across the stenotic valve is limited. This results in cerebral hypoperfusion and
syncope. This symptom, along with angina and dyspnea, constitutes the classic triad indicating severe
disease requiring valve replacement.
Q8: A patient with disseminated intravascular coagulation (DIC) has prolonged PT/PTT, low fibrinogen,
elevated D-dimer, and thrombocytopenia. The patient is actively bleeding from IV sites and has
hematuria. The priority intervention is:
A. Immediate heparin infusion
B. [CORRECT] Replacement of depleted clotting factors with fresh frozen plasma,
cryoprecipitate, and platelets while treating the underlying cause
C. Therapeutic phlebotomy
D. Aspirin administration
Correct Answer: B Rationale: DIC is a consumptive coagulopathy characterized by simultaneous
thrombosis and bleeding due to uncontrolled activation of coagulation and fibrinolysis. In bleeding DIC,
management focuses on replacing depleted factors (FFP for clotting factors, cryoprecipitate for
fibrinogen, platelets for thrombocytopenia) while aggressively treating the underlying trigger (sepsis,
trauma, obstetric catastrophe). Heparin is reserved for thrombotic DIC.
Q9: A patient develops thrombocytopenia (platelet count 45,000/μL) 8 days after initiating
unfractionated heparin. Platelet count was normal on admission. The nurse suspects heparin-induced
thrombocytopenia (HIT) and anticipates:
