NSG-430 Exam 2 Practice Questions: (Latest 2026/2027 Update) Cardiac
& Renal Emergencies | Q&A | Grade A | 100% Correct (Verified Answers)
– Nursing Program
Subject: NSG-430 – Advanced Medical-Surgical / Critical Care
Source: NSG-430 Exam 2 Practice Questions 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which
assessment finding indicates the presence of this complication?
Correct Answer: Muffled or distant heart sounds
1. Cardiac tamponade findings: Beck's triad (hypotension, JVD, muffled heart sounds) plus pulsus paradoxus
(>10 mmHg drop with inspiration).
2. Other signs: tachycardia, clear lung sounds (differentiating from tension pneumothorax), falling BP.
3. Immediate intervention: pericardiocentesis or pericardial window.
2. The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor.
The nurse notes that the client has developed atrial fibrillation with a rapid ventricular rate of 150
beats/minute. The nurse would NEXT assess the client for which finding?
Correct Answer: Hypotension
1. Uncontrolled AF with rapid ventricular response (RVR) reduces cardiac output due to loss of atrial kick and
decreased filling time.
2. Assess for hypotension, dizziness, dyspnea, angina, and signs of heart failure.
3. Rate control with diltiazem or metoprolol; anticoagulation per CHA₂DS₂-VASc score.
3. The nurse has completed an educational course about first degree heart block. Which statement
by the nurse indicates that the teaching has been effective?
Correct Answer: Prolonged, equal PR intervals indicate first degree heart block
1. First-degree AV block: PR interval >0.20 seconds, constant, no dropped beats.
2. Usually benign; monitor for progression to higher-degree block.
3. No treatment needed unless symptomatic bradycardia.
4. Postoperative care of a patient undergoing CABG surgery includes monitoring for which common
complication?
Correct Answer: Atrial dysrhythmias (common first 3 days after)
1. Atrial fibrillation occurs in 30-50% of patients post-CABG, peaking days 2-3.
2. Causes: pericardial inflammation, electrolyte shifts, catecholamine surge.
3. Treat with rate control (beta-blockers, amiodarone) and anticoagulation if persistent.
, 5. A patient has received a bolus dose and an infusion of alteplase (tPA) for an ST segment elevation
myocardial infarction (STEMI). Which patient assessment would determine the effectiveness of this
medication?
Correct Answer: Presence of chest pain
1. Resolution of chest pain indicates reperfusion; other signs: ST segment resolution, reperfusion arrhythmias
(accelerated idioventricular rhythm).
2. Monitor for bleeding complications (intracranial hemorrhage, GI bleed).
3. Goal: door-to-needle time <30 minutes if PCI not available.
6. The nurse would assess a patient with reports of chest pain for which clinical manifestations
associated with a myocardial infarction?
Correct Answer: Ashen skin, diaphoresis, nausea and vomiting, S3 or S4 heart sounds (S3 and S4
are due to ventricular dysfunction)
1. MI symptoms: chest pressure/pain radiating to jaw/arm, dyspnea, nausea, vomiting, diaphoresis, ashen/gray
skin.
2. S3 gallop indicates heart failure from myocardial dysfunction; S4 suggests decreased ventricular compliance.
3. Women and diabetics may present atypically (fatigue, indigestion, epigastric pain).
7. A 74-year-old man with a history of prostate cancer and hypertension is admitted to the ER with
substernal chest pain. Which priority action will the nurse complete before administering sublingual
nitroglycerin?
Correct Answer: Obtain a 12-lead EKG
1. Protocol: 1) O2 (if SpO2 <90%), 2) Vital signs, 3) 12-lead ECG within 10 minutes of arrival, 4) Nitroglycerin if
no contraindications.
2. ECG identifies STEMI vs non-STEMI, guides reperfusion strategy.
3. Avoid nitroglycerin if SBP <90 mmHg or recent phosphodiesterase inhibitor use.
8. The nurse in the recovery room assesses the right femoral artery puncture site after the patient
had a stent inserted into a coronary artery. The insertion site is not bleeding or discolored. What
should the nurse do next to ensure the femoral artery is intact?
Correct Answer: Inspect the patient's right side and back (log roll to inspect for retroperitoneal
bleeding)
1. Retroperitoneal bleeding is a life-threatening complication of femoral artery access that may not be visible
anteriorly.
2. Signs: back/flank pain, hypotension, tachycardia, drop in hemoglobin.
3. Log-rolling allows inspection of back and flank for swelling or ecchymosis.
9. The patient is being discharged from the hospital after acute coronary syndrome and will be
attending rehabilitation. What information would be taught in the early recovery phase of
rehabilitation?
Correct Answer: Activity level is gradually increased under cardiac rehabilitation team supervision
and monitoring
1. Early phase (phase 1 in hospital, phase 2 outpatient): supervised gradual increase in activity (walking,
stationary bike) with ECG monitoring.
2. Later phases: therapeutic lifestyle changes (diet, smoking cessation, stress management), medication
adherence.
3. Exercise prescription: 30-45 minutes most days of week at moderate intensity.
& Renal Emergencies | Q&A | Grade A | 100% Correct (Verified Answers)
– Nursing Program
Subject: NSG-430 – Advanced Medical-Surgical / Critical Care
Source: NSG-430 Exam 2 Practice Questions 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which
assessment finding indicates the presence of this complication?
Correct Answer: Muffled or distant heart sounds
1. Cardiac tamponade findings: Beck's triad (hypotension, JVD, muffled heart sounds) plus pulsus paradoxus
(>10 mmHg drop with inspiration).
2. Other signs: tachycardia, clear lung sounds (differentiating from tension pneumothorax), falling BP.
3. Immediate intervention: pericardiocentesis or pericardial window.
2. The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor.
The nurse notes that the client has developed atrial fibrillation with a rapid ventricular rate of 150
beats/minute. The nurse would NEXT assess the client for which finding?
Correct Answer: Hypotension
1. Uncontrolled AF with rapid ventricular response (RVR) reduces cardiac output due to loss of atrial kick and
decreased filling time.
2. Assess for hypotension, dizziness, dyspnea, angina, and signs of heart failure.
3. Rate control with diltiazem or metoprolol; anticoagulation per CHA₂DS₂-VASc score.
3. The nurse has completed an educational course about first degree heart block. Which statement
by the nurse indicates that the teaching has been effective?
Correct Answer: Prolonged, equal PR intervals indicate first degree heart block
1. First-degree AV block: PR interval >0.20 seconds, constant, no dropped beats.
2. Usually benign; monitor for progression to higher-degree block.
3. No treatment needed unless symptomatic bradycardia.
4. Postoperative care of a patient undergoing CABG surgery includes monitoring for which common
complication?
Correct Answer: Atrial dysrhythmias (common first 3 days after)
1. Atrial fibrillation occurs in 30-50% of patients post-CABG, peaking days 2-3.
2. Causes: pericardial inflammation, electrolyte shifts, catecholamine surge.
3. Treat with rate control (beta-blockers, amiodarone) and anticoagulation if persistent.
, 5. A patient has received a bolus dose and an infusion of alteplase (tPA) for an ST segment elevation
myocardial infarction (STEMI). Which patient assessment would determine the effectiveness of this
medication?
Correct Answer: Presence of chest pain
1. Resolution of chest pain indicates reperfusion; other signs: ST segment resolution, reperfusion arrhythmias
(accelerated idioventricular rhythm).
2. Monitor for bleeding complications (intracranial hemorrhage, GI bleed).
3. Goal: door-to-needle time <30 minutes if PCI not available.
6. The nurse would assess a patient with reports of chest pain for which clinical manifestations
associated with a myocardial infarction?
Correct Answer: Ashen skin, diaphoresis, nausea and vomiting, S3 or S4 heart sounds (S3 and S4
are due to ventricular dysfunction)
1. MI symptoms: chest pressure/pain radiating to jaw/arm, dyspnea, nausea, vomiting, diaphoresis, ashen/gray
skin.
2. S3 gallop indicates heart failure from myocardial dysfunction; S4 suggests decreased ventricular compliance.
3. Women and diabetics may present atypically (fatigue, indigestion, epigastric pain).
7. A 74-year-old man with a history of prostate cancer and hypertension is admitted to the ER with
substernal chest pain. Which priority action will the nurse complete before administering sublingual
nitroglycerin?
Correct Answer: Obtain a 12-lead EKG
1. Protocol: 1) O2 (if SpO2 <90%), 2) Vital signs, 3) 12-lead ECG within 10 minutes of arrival, 4) Nitroglycerin if
no contraindications.
2. ECG identifies STEMI vs non-STEMI, guides reperfusion strategy.
3. Avoid nitroglycerin if SBP <90 mmHg or recent phosphodiesterase inhibitor use.
8. The nurse in the recovery room assesses the right femoral artery puncture site after the patient
had a stent inserted into a coronary artery. The insertion site is not bleeding or discolored. What
should the nurse do next to ensure the femoral artery is intact?
Correct Answer: Inspect the patient's right side and back (log roll to inspect for retroperitoneal
bleeding)
1. Retroperitoneal bleeding is a life-threatening complication of femoral artery access that may not be visible
anteriorly.
2. Signs: back/flank pain, hypotension, tachycardia, drop in hemoglobin.
3. Log-rolling allows inspection of back and flank for swelling or ecchymosis.
9. The patient is being discharged from the hospital after acute coronary syndrome and will be
attending rehabilitation. What information would be taught in the early recovery phase of
rehabilitation?
Correct Answer: Activity level is gradually increased under cardiac rehabilitation team supervision
and monitoring
1. Early phase (phase 1 in hospital, phase 2 outpatient): supervised gradual increase in activity (walking,
stationary bike) with ECG monitoring.
2. Later phases: therapeutic lifestyle changes (diet, smoking cessation, stress management), medication
adherence.
3. Exercise prescription: 30-45 minutes most days of week at moderate intensity.
