NR341 ADULT HEALTH II EXAM 1
COMPLETE PRACTICE BANK 2026
2027 UPDATE 200 QUESTIONS
AND ANSWERS WITH DETAILED
RATIONALES AND CLINICAL
JUDGMENT FOCUS
NR341 Adult Health II – Exam 1 Practice Bank (2026/2027
Update)
Cardiovascular & Hemodynamics
1. A patient arrives in the Emergency Department with
complaints of severe substernal chest pain radiating to the left
jaw. The ECG shows ST-segment elevation in leads II, III, and
aVF. The nurse anticipates preparing the patient for which
immediate intervention? A. Administration of sublingual
nitroglycerin every 5 minutes for three doses B. Immediate
preparation for percutaneous coronary intervention (PCI) C.
Administration of intravenous furosemide D. Placement of the patient in
a high-Fowler’s position
Rationale: ST-elevation in leads II, III, and aVF indicates an inferior
wall myocardial infarction. The gold standard treatment for STEMI is
reperfusion therapy, preferably PCI within 90 minutes of first medical
contact. Nitroglycerin is used with caution in inferior MIs due to the
risk of right ventricular involvement and subsequent hypotension.
2. A patient with heart failure is receiving milrinone
(Primacor) via continuous IV infusion. Which assessment
finding requires the nurse to immediately notify the
healthcare provider? A. Heart rate increases from 82 to 88 beats/min
B. Blood pressure decreases from 110/70 to 105/68 mmHg C. Blood
pressure decreases from 110/70 to 88/50 mmHg D. Urine output
increases from 30 to 45 mL/hr
Rationale: Milrinone is a phosphodiesterase inhibitor that acts as an
inotrope and vasodilator. A significant drop in blood pressure
,(hypotension) is a major adverse effect and may require dose
adjustment or discontinuation. Mild increases in heart rate and modest
BP changes are expected; increased urine output is a desired
therapeutic effect.
3. The nurse is caring for a patient 24 hours post-coronary
artery bypass graft (CABG). The patient’s mediastinal chest
tube drainage was 150 mL/hr for the last two hours. What is
the priority nursing action? A. Document the findings as normal
post-operative drainage B. Strip the chest tubes to maintain patency C.
Notify the surgeon immediately D. Increase the suction pressure on
the drainage system
Rationale: Chest tube drainage exceeding 100–150 mL/hr for
consecutive hours in the immediate post-operative period suggests
active hemorrhage and requires immediate surgical evaluation.
Stripping tubes is generally contraindicated as it creates high negative
pressure that can damage tissue. Increasing suction is not the primary
intervention for hemorrhage.
4. A patient with atrial fibrillation is prescribed apixaban
(Eliquis). Which statement by the patient indicates a need for
further teaching? A. "I will use a soft-bristled toothbrush to prevent
gum bleeding." B. "I will report any black, tarry stools to my doctor." C.
"I will take ibuprofen for my arthritis pain if my knee hurts."
D. "I will wear a medical alert bracelet stating I am on a blood thinner."
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) like
ibuprofen increase the risk of bleeding when taken with anticoagulants.
Patients should use acetaminophen for pain unless otherwise directed.
The other statements reflect appropriate safety measures for
anticoagulation therapy.
5. A patient presents with signs of cardiogenic shock. Which
hemodynamic parameter would the nurse expect to see? A.
High cardiac output, low systemic vascular resistance B. Low cardiac
output, high systemic vascular resistance C. High cardiac output,
high systemic vascular resistance D. Low cardiac output, low systemic
vascular resistance
Rationale: Cardiogenic shock is characterized by pump failure, leading
to low cardiac output. The body compensates via sympathetic
stimulation, causing vasoconstriction and increased systemic vascular
,resistance (SVR). Distributive shock (e.g., septic) typically presents with
low SVR.
6. The nurse is assessing a patient with suspected right-sided
heart failure. Which clinical manifestation is most specific to
this condition? A. Pulmonary crackles and dyspnea B. Jugular
venous distention (JVD) and peripheral edema C. Orthopnea and
paroxysmal nocturnal dyspnea D. Cough producing pink, frothy sputum
Rationale: Right-sided heart failure results in backup of blood into the
systemic circulation, causing JVD, hepatomegaly, and peripheral
edema. Options A, C, and D are classic signs of left-sided heart failure
(pulmonary congestion).
7. A patient with hypertension is prescribed lisinopril. The
nurse monitors for which common side effect that may lead to
non-adherence? A. Hypokalemia B. Dry, persistent cough C.
Tachycardia D. Hyperglycemia
Rationale: ACE inhibitors (like lisinopril) block the breakdown of
bradykinin, which can accumulate in the lungs and cause a dry, non-
productive cough in up to 20% of patients. This is a common reason for
discontinuation. ACE inhibitors cause hyperkalemia, not hypokalemia.
8. A patient is admitted with unstable angina. Which
biomarker result would distinguish unstable angina from a
Non-ST-Elevation Myocardial Infarction (NSTEMI)? A. Elevated
CK-MB B. Normal troponin levels C. Elevated troponin levels D.
Elevated myoglobin
Rationale: Unstable angina involves ischemia without myocardial
necrosis, so cardiac biomarkers (troponins) remain normal. NSTEMI
involves necrosis, resulting in elevated troponins. Both may present
with similar ECG changes (ST depression or T-wave inversion).
9. The nurse is caring for a patient with a temporary
transvenous pacemaker. The monitor shows pacing spikes not
followed by QRS complexes. How does the nurse interpret this
finding? A. Failure to capture B. Failure to sense C. Oversensing D.
Normal function
Correction/Refinement: Wait, let's re-evaluate. Pacing spikes NOT
followed by QRS means the electrical impulse did not depolarize the
ventricle. This is Failure to Capture. If the pacemaker fired when it
, shouldn't have (during intrinsic beat), that is oversensing. If it didn't
fire when it should have, that is failure to sense. The prompt says
"spikes not followed by QRS," which is failure to capture.
Revised Question 9: The nurse is caring for a patient with a
temporary transvenous pacemaker. The monitor shows pacing
spikes not followed by QRS complexes. How does the nurse
interpret this finding? A. Failure to capture B. Failure to sense C.
Oversensing D. Normal function
Rationale: Failure to capture occurs when the pacemaker fires (spike
visible) but the myocardium does not respond (no QRS complex). This
may be due to lead displacement, electrolyte imbalances, or battery
issues. Failure to sense would result in pacing spikes occurring on top
of intrinsic beats.
10. A patient with deep vein thrombosis (DVT) is receiving
heparin infusion. The aPTT is 90 seconds (control 30
seconds). What is the nurse’s priority action? A. Continue the
infusion at the current rate B. Increase the infusion rate C. Stop the
infusion and notify the provider D. Administer vitamin K
Rationale: The therapeutic range for aPTT is typically 1.5–2.5 times the
control value (45–75 seconds). An aPTT of 90 seconds indicates
supratherapeutic anticoagulation and a high risk for bleeding. The
infusion should be paused per protocol, and the provider notified.
Vitamin K is the antidote for warfarin, not heparin (protamine sulfate
is the antidote for heparin).
Respiratory & Critical Care
11. A patient with COPD is admitted with an exacerbation. The
arterial blood gas (ABG) results are: pH 7.32, PaCO2 58
mmHg, HCO3 26 mEq/L, PaO2 60 mmHg. How does the nurse
interpret these results? A. Metabolic acidosis B. Respiratory
acidosis, partially compensated C. Respiratory alkalosis D.
Metabolic alkalosis
Rationale: The pH is acidic (<7.35), and PaCO2 is elevated (>45),
indicating respiratory acidosis. The HCO3 is slightly elevated (normal
22-26), suggesting the kidneys are beginning to compensate, but the pH
has not returned to normal, so it is partially compensated.
COMPLETE PRACTICE BANK 2026
2027 UPDATE 200 QUESTIONS
AND ANSWERS WITH DETAILED
RATIONALES AND CLINICAL
JUDGMENT FOCUS
NR341 Adult Health II – Exam 1 Practice Bank (2026/2027
Update)
Cardiovascular & Hemodynamics
1. A patient arrives in the Emergency Department with
complaints of severe substernal chest pain radiating to the left
jaw. The ECG shows ST-segment elevation in leads II, III, and
aVF. The nurse anticipates preparing the patient for which
immediate intervention? A. Administration of sublingual
nitroglycerin every 5 minutes for three doses B. Immediate
preparation for percutaneous coronary intervention (PCI) C.
Administration of intravenous furosemide D. Placement of the patient in
a high-Fowler’s position
Rationale: ST-elevation in leads II, III, and aVF indicates an inferior
wall myocardial infarction. The gold standard treatment for STEMI is
reperfusion therapy, preferably PCI within 90 minutes of first medical
contact. Nitroglycerin is used with caution in inferior MIs due to the
risk of right ventricular involvement and subsequent hypotension.
2. A patient with heart failure is receiving milrinone
(Primacor) via continuous IV infusion. Which assessment
finding requires the nurse to immediately notify the
healthcare provider? A. Heart rate increases from 82 to 88 beats/min
B. Blood pressure decreases from 110/70 to 105/68 mmHg C. Blood
pressure decreases from 110/70 to 88/50 mmHg D. Urine output
increases from 30 to 45 mL/hr
Rationale: Milrinone is a phosphodiesterase inhibitor that acts as an
inotrope and vasodilator. A significant drop in blood pressure
,(hypotension) is a major adverse effect and may require dose
adjustment or discontinuation. Mild increases in heart rate and modest
BP changes are expected; increased urine output is a desired
therapeutic effect.
3. The nurse is caring for a patient 24 hours post-coronary
artery bypass graft (CABG). The patient’s mediastinal chest
tube drainage was 150 mL/hr for the last two hours. What is
the priority nursing action? A. Document the findings as normal
post-operative drainage B. Strip the chest tubes to maintain patency C.
Notify the surgeon immediately D. Increase the suction pressure on
the drainage system
Rationale: Chest tube drainage exceeding 100–150 mL/hr for
consecutive hours in the immediate post-operative period suggests
active hemorrhage and requires immediate surgical evaluation.
Stripping tubes is generally contraindicated as it creates high negative
pressure that can damage tissue. Increasing suction is not the primary
intervention for hemorrhage.
4. A patient with atrial fibrillation is prescribed apixaban
(Eliquis). Which statement by the patient indicates a need for
further teaching? A. "I will use a soft-bristled toothbrush to prevent
gum bleeding." B. "I will report any black, tarry stools to my doctor." C.
"I will take ibuprofen for my arthritis pain if my knee hurts."
D. "I will wear a medical alert bracelet stating I am on a blood thinner."
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) like
ibuprofen increase the risk of bleeding when taken with anticoagulants.
Patients should use acetaminophen for pain unless otherwise directed.
The other statements reflect appropriate safety measures for
anticoagulation therapy.
5. A patient presents with signs of cardiogenic shock. Which
hemodynamic parameter would the nurse expect to see? A.
High cardiac output, low systemic vascular resistance B. Low cardiac
output, high systemic vascular resistance C. High cardiac output,
high systemic vascular resistance D. Low cardiac output, low systemic
vascular resistance
Rationale: Cardiogenic shock is characterized by pump failure, leading
to low cardiac output. The body compensates via sympathetic
stimulation, causing vasoconstriction and increased systemic vascular
,resistance (SVR). Distributive shock (e.g., septic) typically presents with
low SVR.
6. The nurse is assessing a patient with suspected right-sided
heart failure. Which clinical manifestation is most specific to
this condition? A. Pulmonary crackles and dyspnea B. Jugular
venous distention (JVD) and peripheral edema C. Orthopnea and
paroxysmal nocturnal dyspnea D. Cough producing pink, frothy sputum
Rationale: Right-sided heart failure results in backup of blood into the
systemic circulation, causing JVD, hepatomegaly, and peripheral
edema. Options A, C, and D are classic signs of left-sided heart failure
(pulmonary congestion).
7. A patient with hypertension is prescribed lisinopril. The
nurse monitors for which common side effect that may lead to
non-adherence? A. Hypokalemia B. Dry, persistent cough C.
Tachycardia D. Hyperglycemia
Rationale: ACE inhibitors (like lisinopril) block the breakdown of
bradykinin, which can accumulate in the lungs and cause a dry, non-
productive cough in up to 20% of patients. This is a common reason for
discontinuation. ACE inhibitors cause hyperkalemia, not hypokalemia.
8. A patient is admitted with unstable angina. Which
biomarker result would distinguish unstable angina from a
Non-ST-Elevation Myocardial Infarction (NSTEMI)? A. Elevated
CK-MB B. Normal troponin levels C. Elevated troponin levels D.
Elevated myoglobin
Rationale: Unstable angina involves ischemia without myocardial
necrosis, so cardiac biomarkers (troponins) remain normal. NSTEMI
involves necrosis, resulting in elevated troponins. Both may present
with similar ECG changes (ST depression or T-wave inversion).
9. The nurse is caring for a patient with a temporary
transvenous pacemaker. The monitor shows pacing spikes not
followed by QRS complexes. How does the nurse interpret this
finding? A. Failure to capture B. Failure to sense C. Oversensing D.
Normal function
Correction/Refinement: Wait, let's re-evaluate. Pacing spikes NOT
followed by QRS means the electrical impulse did not depolarize the
ventricle. This is Failure to Capture. If the pacemaker fired when it
, shouldn't have (during intrinsic beat), that is oversensing. If it didn't
fire when it should have, that is failure to sense. The prompt says
"spikes not followed by QRS," which is failure to capture.
Revised Question 9: The nurse is caring for a patient with a
temporary transvenous pacemaker. The monitor shows pacing
spikes not followed by QRS complexes. How does the nurse
interpret this finding? A. Failure to capture B. Failure to sense C.
Oversensing D. Normal function
Rationale: Failure to capture occurs when the pacemaker fires (spike
visible) but the myocardium does not respond (no QRS complex). This
may be due to lead displacement, electrolyte imbalances, or battery
issues. Failure to sense would result in pacing spikes occurring on top
of intrinsic beats.
10. A patient with deep vein thrombosis (DVT) is receiving
heparin infusion. The aPTT is 90 seconds (control 30
seconds). What is the nurse’s priority action? A. Continue the
infusion at the current rate B. Increase the infusion rate C. Stop the
infusion and notify the provider D. Administer vitamin K
Rationale: The therapeutic range for aPTT is typically 1.5–2.5 times the
control value (45–75 seconds). An aPTT of 90 seconds indicates
supratherapeutic anticoagulation and a high risk for bleeding. The
infusion should be paused per protocol, and the provider notified.
Vitamin K is the antidote for warfarin, not heparin (protamine sulfate
is the antidote for heparin).
Respiratory & Critical Care
11. A patient with COPD is admitted with an exacerbation. The
arterial blood gas (ABG) results are: pH 7.32, PaCO2 58
mmHg, HCO3 26 mEq/L, PaO2 60 mmHg. How does the nurse
interpret these results? A. Metabolic acidosis B. Respiratory
acidosis, partially compensated C. Respiratory alkalosis D.
Metabolic alkalosis
Rationale: The pH is acidic (<7.35), and PaCO2 is elevated (>45),
indicating respiratory acidosis. The HCO3 is slightly elevated (normal
22-26), suggesting the kidneys are beginning to compensate, but the pH
has not returned to normal, so it is partially compensated.
