NR547 Final Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2027 Latest Update| Instant
Download PDF
1. A patient with chronic heart failure reports increasing fatigue,
orthopnea, and a 2.5-kg weight gain over 3 days. Which finding
most strongly suggests worsening fluid retention?
A. Heart rate of 76/min
B. Increased appetite
C. Rapid increase in daily weight
D. Decreased respiratory rate
Rationale: A rapid increase in weight over several days is a sensitive
indicator of fluid accumulation in patients with heart failure. Daily
weights help identify worsening congestion before severe symptoms
develop.
2. A nurse is assessing a patient taking an angiotensin-converting
enzyme (ACE) inhibitor. Which adverse effect requires immediate
attention?
A. Mild fatigue
B. Dry skin
C. Swelling of the lips and tongue
D. Increased urination
Rationale: Lip and tongue swelling can indicate angioedema, a
potentially life-threatening reaction to ACE inhibitors. The medication
should be stopped and urgent medical evaluation obtained.
1|Page
, 3. A patient prescribed warfarin asks why regular laboratory
monitoring is necessary. Which response is most appropriate?
A. "It measures your platelet count."
B. "It determines whether your kidneys are functioning normally."
C. "It measures the effect of the medication on your blood clotting."
D. "It determines whether you are developing an infection."
Rationale: Warfarin therapy is monitored primarily with the
prothrombin time expressed as the international normalized ratio
(INR). Monitoring helps maintain therapeutic anticoagulation while
reducing bleeding risk.
4. A patient receiving a loop diuretic reports muscle weakness and
palpitations. Which laboratory abnormality should the nurse
suspect?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Rationale: Loop diuretics can increase urinary potassium losses.
Hypokalemia may cause muscle weakness, cramps, and potentially
dangerous cardiac dysrhythmias.
5. Which assessment finding is most characteristic of left-sided heart
failure?
A. Peripheral edema only
B. Ascites
C. Enlarged liver
D. Pulmonary crackles and dyspnea
2|Page
,Rationale: Left-sided heart failure causes pulmonary venous
congestion, which commonly produces dyspnea, orthopnea, and
crackles. Right-sided failure more commonly produces systemic
venous congestion such as peripheral edema and ascites.
6. A patient with atrial fibrillation is prescribed an anticoagulant.
What is the primary purpose of this therapy?
A. Increase ventricular contractility
B. Lower serum cholesterol
C. Reduce the risk of thromboembolic stroke
D. Restore normal sinus rhythm
Rationale: Atrial fibrillation promotes blood stasis, particularly in the
left atrial appendage. Anticoagulation reduces formation of thrombi
and therefore decreases the risk of embolic stroke.
7. A patient taking digoxin reports nausea, loss of appetite, and
seeing yellow-green halos around lights. What should the nurse
suspect?
A. Dehydration
B. Hypoglycemia
C. Digoxin toxicity
D. Hyperthyroidism
Rationale: Gastrointestinal symptoms and visual disturbances are
classic manifestations of digoxin toxicity. Bradycardia and various
dysrhythmias may also occur.
8. Which electrolyte imbalance increases the risk of digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
3|Page
, C. Hyperchloremia
D. Hyperphosphatemia
Rationale: Low potassium levels increase the binding of digoxin to
cardiac tissue, increasing the risk of toxicity. Patients receiving digoxin
and diuretics require careful potassium monitoring.
9. A patient presents with crushing substernal chest pain,
diaphoresis, and nausea. Which action should occur first?
A. Encourage ambulation
B. Obtain a dietary history
C. Assess vital signs and initiate immediate cardiac evaluation
D. Schedule an outpatient follow-up
Rationale: The symptoms are concerning for acute coronary
syndrome. Immediate assessment and cardiac evaluation are
priorities because myocardial ischemia can rapidly become life-
threatening.
10. Which biomarker is commonly used to assess myocardial
injury?
A. Hemoglobin A1c
B. BNP
C. Cardiac troponin
D. Albumin
Rationale: Cardiac troponins are highly sensitive and specific
biomarkers of myocardial injury and are central to the evaluation of
suspected acute coronary syndrome.
11. A patient with chronic kidney disease has a markedly
elevated serum creatinine. What does this finding generally
indicate?
4|Page
[Verified Answers], Plus Explained
Rationales|2027 Latest Update| Instant
Download PDF
1. A patient with chronic heart failure reports increasing fatigue,
orthopnea, and a 2.5-kg weight gain over 3 days. Which finding
most strongly suggests worsening fluid retention?
A. Heart rate of 76/min
B. Increased appetite
C. Rapid increase in daily weight
D. Decreased respiratory rate
Rationale: A rapid increase in weight over several days is a sensitive
indicator of fluid accumulation in patients with heart failure. Daily
weights help identify worsening congestion before severe symptoms
develop.
2. A nurse is assessing a patient taking an angiotensin-converting
enzyme (ACE) inhibitor. Which adverse effect requires immediate
attention?
A. Mild fatigue
B. Dry skin
C. Swelling of the lips and tongue
D. Increased urination
Rationale: Lip and tongue swelling can indicate angioedema, a
potentially life-threatening reaction to ACE inhibitors. The medication
should be stopped and urgent medical evaluation obtained.
1|Page
, 3. A patient prescribed warfarin asks why regular laboratory
monitoring is necessary. Which response is most appropriate?
A. "It measures your platelet count."
B. "It determines whether your kidneys are functioning normally."
C. "It measures the effect of the medication on your blood clotting."
D. "It determines whether you are developing an infection."
Rationale: Warfarin therapy is monitored primarily with the
prothrombin time expressed as the international normalized ratio
(INR). Monitoring helps maintain therapeutic anticoagulation while
reducing bleeding risk.
4. A patient receiving a loop diuretic reports muscle weakness and
palpitations. Which laboratory abnormality should the nurse
suspect?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Rationale: Loop diuretics can increase urinary potassium losses.
Hypokalemia may cause muscle weakness, cramps, and potentially
dangerous cardiac dysrhythmias.
5. Which assessment finding is most characteristic of left-sided heart
failure?
A. Peripheral edema only
B. Ascites
C. Enlarged liver
D. Pulmonary crackles and dyspnea
2|Page
,Rationale: Left-sided heart failure causes pulmonary venous
congestion, which commonly produces dyspnea, orthopnea, and
crackles. Right-sided failure more commonly produces systemic
venous congestion such as peripheral edema and ascites.
6. A patient with atrial fibrillation is prescribed an anticoagulant.
What is the primary purpose of this therapy?
A. Increase ventricular contractility
B. Lower serum cholesterol
C. Reduce the risk of thromboembolic stroke
D. Restore normal sinus rhythm
Rationale: Atrial fibrillation promotes blood stasis, particularly in the
left atrial appendage. Anticoagulation reduces formation of thrombi
and therefore decreases the risk of embolic stroke.
7. A patient taking digoxin reports nausea, loss of appetite, and
seeing yellow-green halos around lights. What should the nurse
suspect?
A. Dehydration
B. Hypoglycemia
C. Digoxin toxicity
D. Hyperthyroidism
Rationale: Gastrointestinal symptoms and visual disturbances are
classic manifestations of digoxin toxicity. Bradycardia and various
dysrhythmias may also occur.
8. Which electrolyte imbalance increases the risk of digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
3|Page
, C. Hyperchloremia
D. Hyperphosphatemia
Rationale: Low potassium levels increase the binding of digoxin to
cardiac tissue, increasing the risk of toxicity. Patients receiving digoxin
and diuretics require careful potassium monitoring.
9. A patient presents with crushing substernal chest pain,
diaphoresis, and nausea. Which action should occur first?
A. Encourage ambulation
B. Obtain a dietary history
C. Assess vital signs and initiate immediate cardiac evaluation
D. Schedule an outpatient follow-up
Rationale: The symptoms are concerning for acute coronary
syndrome. Immediate assessment and cardiac evaluation are
priorities because myocardial ischemia can rapidly become life-
threatening.
10. Which biomarker is commonly used to assess myocardial
injury?
A. Hemoglobin A1c
B. BNP
C. Cardiac troponin
D. Albumin
Rationale: Cardiac troponins are highly sensitive and specific
biomarkers of myocardial injury and are central to the evaluation of
suspected acute coronary syndrome.
11. A patient with chronic kidney disease has a markedly
elevated serum creatinine. What does this finding generally
indicate?
4|Page
