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NSG430 EXAM 4 Actual Exam 2026/2027 Complete
Questions and Verified Answers with Detailed
Rationales Adult Health Nursing II Complex Adult
Health GCU Pass Guaranteed - A+ Graded
Q1: A 68-year-old male with ST-elevation myocardial infarction (STEMI) receives thrombolytic
therapy. Which finding indicates a positive response to treatment?
• A. Decreased level of consciousness
• B. Resolution of ST-segment elevation and relief of chest pain [CORRECT]
• C. Increased frequency of premature ventricular contractions
• D. Development of pathological Q waves on ECG
Correct Answer: B
Rationale: Successful reperfusion following thrombolytic therapy is evidenced by resolution of
ST-segment elevation by at least 50% within 60-90 minutes, relief of chest pain, and
establishment of normal blood flow indicated by TIMI grade 3 flow when angiography is
available.
Q2: A 72-year-old female with decompensated heart failure (EF 25%) receives furosemide 80mg
IV. Which assessment finding indicates the medication is achieving the desired therapeutic
effect?
• A. Weight gain of 2 kg over 24 hours
• B. Decreased jugular venous pressure and reduced peripheral edema [CORRECT]
• C. Increased heart rate from 88 to 110 bpm
• D. Serum sodium decrease from 138 to 128 mEq/L
Correct Answer: B
Rationale: Furosemide produces diuresis reducing preload and afterload in heart failure;
therapeutic effectiveness is demonstrated by decreased jugular venous distension (reduced right
atrial pressure), decreased peripheral edema, and weight loss indicating fluid removal, with target
urine output of 0.5-1 mL/kg/hr.
,2
Q3: A 55-year-old male with atrial fibrillation (HR 150, BP 90/60) presents with acute altered
mental status. Which intervention is the priority?
• A. Anticoagulation with heparin
• B. Immediate synchronized cardioversion [CORRECT]
• C. Rate control with oral metoprolol
• D. Transesophageal echocardiography
Correct Answer: B
Rationale: Unstable atrial fibrillation with hemodynamic compromise (hypotension, altered
mental status, signs of shock) requires immediate synchronized cardioversion (100-200 J
biphasic) to restore perfusion and prevent cardiovascular collapse; anticoagulation and rate
control are contraindicated in unstable patients requiring immediate rhythm restoration.
Q4: A 62-year-old male with COPD presents with acute exacerbation, RR 32, O2 sat 84% on
room air, and use of accessory muscles. Which arterial blood gas finding indicates need for
mechanical ventilation?
• A. pH 7.32, PaCO2 55, PaO2 60
• B. pH 7.25, PaCO2 70, PaO2 50 [CORRECT]
• C. pH 7.38, PaCO2 48, PaO2 55
• D. pH 7.35, PaCO2 50, PaO2 65
Correct Answer: B
Rationale: Severe COPD exacerbation with acute-on-chronic respiratory acidosis (pH <7.30,
PaCO2 >60 mmHg) refractory to supplemental oxygen and non-invasive positive pressure
ventilation indicates need for invasive mechanical ventilation to prevent respiratory arrest and
severe acidemia causing arrhythmias and hemodynamic instability.
Q5: A 45-year-old female with pulmonary embolism receiving heparin infusion develops new-
onset right leg swelling and pain. Which laboratory finding requires immediate intervention?
• A. aPTT 60 seconds (therapeutic range 60-80)
• B. Platelet count decreased from 250,000 to 80,000 [CORRECT]
• C. INR 1.2
, 3
• D. Fibrinogen 400 mg/dL
Correct Answer: B
Rationale: Heparin-induced thrombocytopenia (HIT) is an immune-mediated prothrombotic
disorder occurring 5-10 days after heparin exposure, characterized by platelet count decrease
>50% from baseline or absolute count <150,000 with new thrombosis; immediate
discontinuation of all heparin and initiation of non-heparin anticoagulant (argatroban,
fondaparinux) is required to prevent life-threatening arterial and venous thrombosis.
Q6: A 58-year-old male with acute kidney injury (creatinine 4.5, baseline 1.0) following cardiac
catheterization receives orders for metformin. Which action by the nurse is appropriate?
• A. Administer metformin as ordered
• B. Hold metformin and notify prescriber of contraindication [CORRECT]
• C. Administer half the ordered dose
• D. Give metformin with food to reduce renal toxicity
Correct Answer: B
Rationale: Metformin is contraindicated in patients with eGFR <30 mL/min/1.73m² or serum
creatinine ≥1.5 (males) or ≥1.4 (females) due to risk of lactic acidosis; the nurse must hold the
medication and notify the prescriber to obtain alternative glycemic management and ensure
metformin is discontinued until renal function recovers to acceptable levels.
Q7: A 70-year-old female with end-stage renal disease on hemodialysis develops muscle cramps,
twitching, and prolonged QT interval during treatment. Which electrolyte imbalance is most
likely?
• A. Hypernatremia
• B. Hypocalcemia [CORRECT]
• C. Hypermagnesemia
• D. Hyperphosphatemia
Correct Answer: B
Rationale: Hemodialysis patients frequently develop hypocalcemia due to calcium removal
during dialysis, low calcium dialysate, and pre-existing calcium-phosphate abnormalities;
manifestations include neuromuscular irritability (cramps, tetany, Chvostek's and Trousseau's
NSG430 EXAM 4 Actual Exam 2026/2027 Complete
Questions and Verified Answers with Detailed
Rationales Adult Health Nursing II Complex Adult
Health GCU Pass Guaranteed - A+ Graded
Q1: A 68-year-old male with ST-elevation myocardial infarction (STEMI) receives thrombolytic
therapy. Which finding indicates a positive response to treatment?
• A. Decreased level of consciousness
• B. Resolution of ST-segment elevation and relief of chest pain [CORRECT]
• C. Increased frequency of premature ventricular contractions
• D. Development of pathological Q waves on ECG
Correct Answer: B
Rationale: Successful reperfusion following thrombolytic therapy is evidenced by resolution of
ST-segment elevation by at least 50% within 60-90 minutes, relief of chest pain, and
establishment of normal blood flow indicated by TIMI grade 3 flow when angiography is
available.
Q2: A 72-year-old female with decompensated heart failure (EF 25%) receives furosemide 80mg
IV. Which assessment finding indicates the medication is achieving the desired therapeutic
effect?
• A. Weight gain of 2 kg over 24 hours
• B. Decreased jugular venous pressure and reduced peripheral edema [CORRECT]
• C. Increased heart rate from 88 to 110 bpm
• D. Serum sodium decrease from 138 to 128 mEq/L
Correct Answer: B
Rationale: Furosemide produces diuresis reducing preload and afterload in heart failure;
therapeutic effectiveness is demonstrated by decreased jugular venous distension (reduced right
atrial pressure), decreased peripheral edema, and weight loss indicating fluid removal, with target
urine output of 0.5-1 mL/kg/hr.
,2
Q3: A 55-year-old male with atrial fibrillation (HR 150, BP 90/60) presents with acute altered
mental status. Which intervention is the priority?
• A. Anticoagulation with heparin
• B. Immediate synchronized cardioversion [CORRECT]
• C. Rate control with oral metoprolol
• D. Transesophageal echocardiography
Correct Answer: B
Rationale: Unstable atrial fibrillation with hemodynamic compromise (hypotension, altered
mental status, signs of shock) requires immediate synchronized cardioversion (100-200 J
biphasic) to restore perfusion and prevent cardiovascular collapse; anticoagulation and rate
control are contraindicated in unstable patients requiring immediate rhythm restoration.
Q4: A 62-year-old male with COPD presents with acute exacerbation, RR 32, O2 sat 84% on
room air, and use of accessory muscles. Which arterial blood gas finding indicates need for
mechanical ventilation?
• A. pH 7.32, PaCO2 55, PaO2 60
• B. pH 7.25, PaCO2 70, PaO2 50 [CORRECT]
• C. pH 7.38, PaCO2 48, PaO2 55
• D. pH 7.35, PaCO2 50, PaO2 65
Correct Answer: B
Rationale: Severe COPD exacerbation with acute-on-chronic respiratory acidosis (pH <7.30,
PaCO2 >60 mmHg) refractory to supplemental oxygen and non-invasive positive pressure
ventilation indicates need for invasive mechanical ventilation to prevent respiratory arrest and
severe acidemia causing arrhythmias and hemodynamic instability.
Q5: A 45-year-old female with pulmonary embolism receiving heparin infusion develops new-
onset right leg swelling and pain. Which laboratory finding requires immediate intervention?
• A. aPTT 60 seconds (therapeutic range 60-80)
• B. Platelet count decreased from 250,000 to 80,000 [CORRECT]
• C. INR 1.2
, 3
• D. Fibrinogen 400 mg/dL
Correct Answer: B
Rationale: Heparin-induced thrombocytopenia (HIT) is an immune-mediated prothrombotic
disorder occurring 5-10 days after heparin exposure, characterized by platelet count decrease
>50% from baseline or absolute count <150,000 with new thrombosis; immediate
discontinuation of all heparin and initiation of non-heparin anticoagulant (argatroban,
fondaparinux) is required to prevent life-threatening arterial and venous thrombosis.
Q6: A 58-year-old male with acute kidney injury (creatinine 4.5, baseline 1.0) following cardiac
catheterization receives orders for metformin. Which action by the nurse is appropriate?
• A. Administer metformin as ordered
• B. Hold metformin and notify prescriber of contraindication [CORRECT]
• C. Administer half the ordered dose
• D. Give metformin with food to reduce renal toxicity
Correct Answer: B
Rationale: Metformin is contraindicated in patients with eGFR <30 mL/min/1.73m² or serum
creatinine ≥1.5 (males) or ≥1.4 (females) due to risk of lactic acidosis; the nurse must hold the
medication and notify the prescriber to obtain alternative glycemic management and ensure
metformin is discontinued until renal function recovers to acceptable levels.
Q7: A 70-year-old female with end-stage renal disease on hemodialysis develops muscle cramps,
twitching, and prolonged QT interval during treatment. Which electrolyte imbalance is most
likely?
• A. Hypernatremia
• B. Hypocalcemia [CORRECT]
• C. Hypermagnesemia
• D. Hyperphosphatemia
Correct Answer: B
Rationale: Hemodialysis patients frequently develop hypocalcemia due to calcium removal
during dialysis, low calcium dialysate, and pre-existing calcium-phosphate abnormalities;
manifestations include neuromuscular irritability (cramps, tetany, Chvostek's and Trousseau's
