NSG430 Adult Health Nursing II Exam 1
Comprehensive Study Guide | Grand Canyon University
| 2026/2027 Mastery Update
Exam Overview
● Questions: 50 | Time: 90 min
● Focus: Advanced Clinical Judgment, High-Acuity Management, NGN-NCLEX
Readiness
● Alignment: GCU Nursing Program Outcomes & 2026 NCLEX-RN
Blueprint | Christian worldview woven throughout
MODULE 1 – Advanced Cardiovascular & Hemodynamic Management (15
Questions)
Case Study 1 – Questions 1-4
Scenario: A 62-year-old male with a history of ischemic cardiomyopathy (EF 25 %) is
admitted with acute decompensated heart failure (ADHF). He is on BiPAP, has a
pulmonary artery catheter in place. PAWP is 28 mmHg, Cardiac Output is 3.8 L/min. He
is receiving dobutamine and furosemide.
Q1 (Cloze/Drop-Down)
The nurse interprets these hemodynamic values as indicative of _____. Based on this,
the primary goal of current therapy is to _____.
● First Drop-Down Options: Cardiogenic Shock | Hypovolemic Shock | Obstructive
Shock | Neurogenic Shock
, ● Second Drop-Down Options: Increase preload | Reduce preload and increase
contractility | Increase afterload | Administer broad-spectrum antibiotics
Verified Answer: Cardiogenic Shock | Reduce preload and increase contractility
Rationale: Elevated PAWP (>18 mmHg) with low cardiac output defines cardiogenic
shock. The goals of therapy are to reduce pulmonary congestion (preload) with diuretics
and improve pump function (contractility) with inotropes like dobutamine.
Q2 (NGN-Extended Multiple Response)
The nurse is preparing to administer intravenous furosemide. Which actions are
essential for safe administration? Select all that apply.
☐ A. Assess for sulfa allergy before administration.
☐ B. Administer as a slow IV push over 1-2 minutes.
☐ C. Obtain a daily weight prior to administration.
☐ D. Monitor serum potassium and creatinine levels.
☐ E. Ensure the patient has a Foley catheter in place.
Verified Answers: A, B, D
Rationale:
● A is essential due to cross-sensitivity.
● B is correct for safe IV push administration of furosemide.
● D is critical for monitoring electrolyte imbalance and renal function.
● C is important, but a daily weight is not required immediately before a single
dose; trend is key.
● E is not essential; urine output can be monitored without an indwelling catheter.
, Q3 (Prioritization)
Four post-MI patients are in the step-down unit at 0800. Who should the nurse assess
FIRST?
A. 58-year-old, sinus rhythm 98 bpm, BP 110/70, denies chest pain
B. 62-year-old, new-onset ST elevation in leads II, III, aVF, BP 90/60, cool/clammy
C. 55-year-old, atrial fibrillation 110 bpm, on amiodarone drip, BP 120/80
D. 60-year-old, mild dyspnea on exertion, O₂ sat 94 % on 2 L NC
Verified Answer: B
Rationale: Inferior ST-elevation + hypotension + cool skin = cardiogenic shock; requires
immediate reperfusion therapy and hemodynamic support. This is a life-threatening
emergency.
Q4 (Calculation)
Dobutamine is ordered at 8 mcg/kg/min. Concentration = 500 mg/250 mL. Patient
weight = 80 kg.
Pump rate = ______ mL/hr (round to nearest whole number).
Answer: 38 mL/hr
Rationale:
● Concentration = 500 mg ÷ 250 mL = 2 mg/mL = 2000 mcg/mL
● Dose: 8 mcg/kg/min × 80 kg = 640 mcg/min
● 640 mcg/min × 60 min = 38,400 mcg/hr
Comprehensive Study Guide | Grand Canyon University
| 2026/2027 Mastery Update
Exam Overview
● Questions: 50 | Time: 90 min
● Focus: Advanced Clinical Judgment, High-Acuity Management, NGN-NCLEX
Readiness
● Alignment: GCU Nursing Program Outcomes & 2026 NCLEX-RN
Blueprint | Christian worldview woven throughout
MODULE 1 – Advanced Cardiovascular & Hemodynamic Management (15
Questions)
Case Study 1 – Questions 1-4
Scenario: A 62-year-old male with a history of ischemic cardiomyopathy (EF 25 %) is
admitted with acute decompensated heart failure (ADHF). He is on BiPAP, has a
pulmonary artery catheter in place. PAWP is 28 mmHg, Cardiac Output is 3.8 L/min. He
is receiving dobutamine and furosemide.
Q1 (Cloze/Drop-Down)
The nurse interprets these hemodynamic values as indicative of _____. Based on this,
the primary goal of current therapy is to _____.
● First Drop-Down Options: Cardiogenic Shock | Hypovolemic Shock | Obstructive
Shock | Neurogenic Shock
, ● Second Drop-Down Options: Increase preload | Reduce preload and increase
contractility | Increase afterload | Administer broad-spectrum antibiotics
Verified Answer: Cardiogenic Shock | Reduce preload and increase contractility
Rationale: Elevated PAWP (>18 mmHg) with low cardiac output defines cardiogenic
shock. The goals of therapy are to reduce pulmonary congestion (preload) with diuretics
and improve pump function (contractility) with inotropes like dobutamine.
Q2 (NGN-Extended Multiple Response)
The nurse is preparing to administer intravenous furosemide. Which actions are
essential for safe administration? Select all that apply.
☐ A. Assess for sulfa allergy before administration.
☐ B. Administer as a slow IV push over 1-2 minutes.
☐ C. Obtain a daily weight prior to administration.
☐ D. Monitor serum potassium and creatinine levels.
☐ E. Ensure the patient has a Foley catheter in place.
Verified Answers: A, B, D
Rationale:
● A is essential due to cross-sensitivity.
● B is correct for safe IV push administration of furosemide.
● D is critical for monitoring electrolyte imbalance and renal function.
● C is important, but a daily weight is not required immediately before a single
dose; trend is key.
● E is not essential; urine output can be monitored without an indwelling catheter.
, Q3 (Prioritization)
Four post-MI patients are in the step-down unit at 0800. Who should the nurse assess
FIRST?
A. 58-year-old, sinus rhythm 98 bpm, BP 110/70, denies chest pain
B. 62-year-old, new-onset ST elevation in leads II, III, aVF, BP 90/60, cool/clammy
C. 55-year-old, atrial fibrillation 110 bpm, on amiodarone drip, BP 120/80
D. 60-year-old, mild dyspnea on exertion, O₂ sat 94 % on 2 L NC
Verified Answer: B
Rationale: Inferior ST-elevation + hypotension + cool skin = cardiogenic shock; requires
immediate reperfusion therapy and hemodynamic support. This is a life-threatening
emergency.
Q4 (Calculation)
Dobutamine is ordered at 8 mcg/kg/min. Concentration = 500 mg/250 mL. Patient
weight = 80 kg.
Pump rate = ______ mL/hr (round to nearest whole number).
Answer: 38 mL/hr
Rationale:
● Concentration = 500 mg ÷ 250 mL = 2 mg/mL = 2000 mcg/mL
● Dose: 8 mcg/kg/min × 80 kg = 640 mcg/min
● 640 mcg/min × 60 min = 38,400 mcg/hr
