NSG 3500 Comprehensive Exam 3 with
correct questions with verified answers
and a rationale updated 2026
Section 1: Cardiovascular Disorders (Hypertension & CAD)
1. A nurse is teaching a client with newly diagnosed hypertension about lifestyle modifications.
Which statement by the client indicates a need for further teaching?
A. "I will limit my sodium intake to 2,300 mg per day."
B. "I plan to walk for 30 minutes most days of the week."
C. "I will continue to drink a glass of wine with dinner every night."
D. "I know that stress management is important for my blood pressure."
Rationale: While moderate alcohol may be permissible for some, daily alcohol consumption can
hinder BP control. The DASH diet and exercise are correct. Limiting sodium is correct. Daily alcohol
suggests a need for clarification on limits.
2. A client is experiencing an acute myocardial infarction (MI). Which medication should the nurse
anticipate administering first to reduce cardiac workload?
A. Furosemide
B. Metoprolol
C. Digoxin
D. Warfarin
Rationale: Beta-blockers (Metoprolol) decrease heart rate and contractility, reducing myocardial
oxygen demand. Diuretics, digoxin, and anticoagulants do not primarily reduce workload in the
acute phase.
3. When assessing a client with stable angina, the nurse expects the chest pain to:
,A. Occur at rest.
B. Be relieved by rest or nitroglycerin.
C. Last longer than 30 minutes.
D. Radiate only to the left arm.
Rationale: Stable angina is predictable and triggered by exertion, relieved by rest/nitro. Unstable
angina occurs at rest. MI pain lasts >30 mins.
4. A client is prescribed sublingual nitroglycerin. Which instruction is priority for the nurse to
provide?
A. Take with a full glass of water.
B. Sit or lie down immediately after taking the medication.
C. Swallow the tablet whole.
D. Store the medication in the bathroom cabinet.
Rationale: Nitroglycerin causes vasodilation and orthostatic hypotension. Sitting prevents falls. It is
sublingual, not swallowed. Heat/moisture degrades the med.
5. Which laboratory value is most specific for cardiac muscle damage?
A. Creatine Kinase (CK)
B. Troponin I
C. Myoglobin
D. C-Reactive Protein (CRP)
Rationale: Troponin I is highly specific to cardiac tissue. CK and Myoglobin can be elevated due to
skeletal muscle damage. CRP indicates inflammation.
6. A client with coronary artery disease (CAD) asks about the purpose of a low-density lipoprotein
(LDL) goal. What is the nurse's best response?
A. "LDL is the 'good' cholesterol that protects your heart."
B. "LDL contributes to plaque buildup in your arteries."
C. "LDL levels do not affect heart disease risk."
,D. "We want your LDL to be above 130 mg/dL."
Rationale: LDL is "bad" cholesterol that deposits in artery walls. HDL is "good." Lower LDL reduces
CAD risk.
7. Post-cardiac catheterization via the femoral artery, the nurse notes a small amount of bleeding at
the site. What is the initial action?
A. Apply manual pressure to the site.
B. Notify the provider immediately.
C. Place a sandbag on the site.
D. Document the finding and continue monitoring.
Rationale: Safety first. Apply pressure to stop bleeding. Notifying comes after stabilizing. Sandbags
are outdated. Documentation is not the priority intervention.
8. Which finding in a client with hypertension requires immediate intervention?
A. Blood pressure 150/90 mmHg
B. Sudden onset of severe headache and blurred vision.
C. Mild ankle edema
D. Heart rate of 88 bpm
Rationale: These are signs of hypertensive crisis/end-organ damage. The BP reading alone is high but
not necessarily a crisis without symptoms.
9. A client is taking Lisinopril. Which side effect should the nurse instruct the client to report
immediately?
A. Dizziness
B. Swelling of the lips or tongue.
C. Dry cough
D. Fatigue
Rationale: Swelling indicates angioedema, a life-threatening allergic reaction. Cough is common but
not emergent. Dizziness is expected.
, 10. What is the primary goal of therapy for a client with Prinzmetal's (variant) angina?
A. Reduce cholesterol.
B. Prevent coronary artery spasms.
C. Dissolve existing clots.
D. Increase heart rate.
Rationale: Variant angina is caused by vasospasm. Calcium channel blockers are used to prevent
spasms.
Section 2: Heart Failure & Dysrhythmias
11. A client with left-sided heart failure is admitted. Which assessment finding is most expected?
A. Peripheral edema
B. Crackles in the lung fields
C. Jugular vein distention
D. Hepatomegaly
Rationale: Left-sided failure causes pulmonary congestion (crackles). Right-sided failure causes
systemic congestion (edema, JVD, liver).
12. The nurse is caring for a client with a potassium level of 2.9 mEq/L. Which dysrhythmia is the
client at highest risk for?
A. Bradycardia
B. Ventricular Tachycardia
C. Atrial Flutter
D. Sinus Arrhythmia
Rationale: Hypokalemia increases excitability of cardiac cells, leading to dangerous ventricular
dysrhythmias.
13. A client is in Atrial Fibrillation. What is the primary nursing concern regarding hemodynamics?
A. Increased cardiac output
correct questions with verified answers
and a rationale updated 2026
Section 1: Cardiovascular Disorders (Hypertension & CAD)
1. A nurse is teaching a client with newly diagnosed hypertension about lifestyle modifications.
Which statement by the client indicates a need for further teaching?
A. "I will limit my sodium intake to 2,300 mg per day."
B. "I plan to walk for 30 minutes most days of the week."
C. "I will continue to drink a glass of wine with dinner every night."
D. "I know that stress management is important for my blood pressure."
Rationale: While moderate alcohol may be permissible for some, daily alcohol consumption can
hinder BP control. The DASH diet and exercise are correct. Limiting sodium is correct. Daily alcohol
suggests a need for clarification on limits.
2. A client is experiencing an acute myocardial infarction (MI). Which medication should the nurse
anticipate administering first to reduce cardiac workload?
A. Furosemide
B. Metoprolol
C. Digoxin
D. Warfarin
Rationale: Beta-blockers (Metoprolol) decrease heart rate and contractility, reducing myocardial
oxygen demand. Diuretics, digoxin, and anticoagulants do not primarily reduce workload in the
acute phase.
3. When assessing a client with stable angina, the nurse expects the chest pain to:
,A. Occur at rest.
B. Be relieved by rest or nitroglycerin.
C. Last longer than 30 minutes.
D. Radiate only to the left arm.
Rationale: Stable angina is predictable and triggered by exertion, relieved by rest/nitro. Unstable
angina occurs at rest. MI pain lasts >30 mins.
4. A client is prescribed sublingual nitroglycerin. Which instruction is priority for the nurse to
provide?
A. Take with a full glass of water.
B. Sit or lie down immediately after taking the medication.
C. Swallow the tablet whole.
D. Store the medication in the bathroom cabinet.
Rationale: Nitroglycerin causes vasodilation and orthostatic hypotension. Sitting prevents falls. It is
sublingual, not swallowed. Heat/moisture degrades the med.
5. Which laboratory value is most specific for cardiac muscle damage?
A. Creatine Kinase (CK)
B. Troponin I
C. Myoglobin
D. C-Reactive Protein (CRP)
Rationale: Troponin I is highly specific to cardiac tissue. CK and Myoglobin can be elevated due to
skeletal muscle damage. CRP indicates inflammation.
6. A client with coronary artery disease (CAD) asks about the purpose of a low-density lipoprotein
(LDL) goal. What is the nurse's best response?
A. "LDL is the 'good' cholesterol that protects your heart."
B. "LDL contributes to plaque buildup in your arteries."
C. "LDL levels do not affect heart disease risk."
,D. "We want your LDL to be above 130 mg/dL."
Rationale: LDL is "bad" cholesterol that deposits in artery walls. HDL is "good." Lower LDL reduces
CAD risk.
7. Post-cardiac catheterization via the femoral artery, the nurse notes a small amount of bleeding at
the site. What is the initial action?
A. Apply manual pressure to the site.
B. Notify the provider immediately.
C. Place a sandbag on the site.
D. Document the finding and continue monitoring.
Rationale: Safety first. Apply pressure to stop bleeding. Notifying comes after stabilizing. Sandbags
are outdated. Documentation is not the priority intervention.
8. Which finding in a client with hypertension requires immediate intervention?
A. Blood pressure 150/90 mmHg
B. Sudden onset of severe headache and blurred vision.
C. Mild ankle edema
D. Heart rate of 88 bpm
Rationale: These are signs of hypertensive crisis/end-organ damage. The BP reading alone is high but
not necessarily a crisis without symptoms.
9. A client is taking Lisinopril. Which side effect should the nurse instruct the client to report
immediately?
A. Dizziness
B. Swelling of the lips or tongue.
C. Dry cough
D. Fatigue
Rationale: Swelling indicates angioedema, a life-threatening allergic reaction. Cough is common but
not emergent. Dizziness is expected.
, 10. What is the primary goal of therapy for a client with Prinzmetal's (variant) angina?
A. Reduce cholesterol.
B. Prevent coronary artery spasms.
C. Dissolve existing clots.
D. Increase heart rate.
Rationale: Variant angina is caused by vasospasm. Calcium channel blockers are used to prevent
spasms.
Section 2: Heart Failure & Dysrhythmias
11. A client with left-sided heart failure is admitted. Which assessment finding is most expected?
A. Peripheral edema
B. Crackles in the lung fields
C. Jugular vein distention
D. Hepatomegaly
Rationale: Left-sided failure causes pulmonary congestion (crackles). Right-sided failure causes
systemic congestion (edema, JVD, liver).
12. The nurse is caring for a client with a potassium level of 2.9 mEq/L. Which dysrhythmia is the
client at highest risk for?
A. Bradycardia
B. Ventricular Tachycardia
C. Atrial Flutter
D. Sinus Arrhythmia
Rationale: Hypokalemia increases excitability of cardiac cells, leading to dangerous ventricular
dysrhythmias.
13. A client is in Atrial Fibrillation. What is the primary nursing concern regarding hemodynamics?
A. Increased cardiac output
