NSG 4100 EXAM 2 (GALEN) NEWEST 2025 ACTUAL
EXAM| NSG4100 NURSING PRACTICE - ADULT
HEALTH III EXAM 2 REVIEW WITH 300 REAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (BRAND NEW!!)
1. A patient with acute decompensated heart failure (ADHF) has
crackles in both lungs, S3 gallop, and oxygen saturation 88% on
4L nasal cannula. Which intervention should the nurse implement
first?
A. Administer furosemide IV push
B. Place the patient in high-Fowler's position
C. Start a nitroglycerin drip
D. Draw BNP and troponin levels
Answer: B – Positioning is immediate and non-invasive. High-
Fowler's reduces preload and improves oxygenation. Diuretics
and nitroglycerin follow.
2. Which hemodynamic parameter is most consistent with
cardiogenic shock?
A. Cardiac index > 4.0 L/min/m², SVR < 600 dynes/sec/cm⁻⁵
1
,B. Cardiac index < 2.2 L/min/m², SVR > 1200 dynes/sec/cm⁻⁵
C. Cardiac index < 1.8 L/min/m², SVR < 800
D. Cardiac index > 3.5, SVR normal
Answer: B – Cardiogenic shock = low cardiac output + high
systemic vascular resistance (compensatory vasoconstriction).
3. A patient with an intra-aortic balloon pump (IABP) has a blood
pressure of 85/50, HR 110, and urine output 20 mL over 2
hours. The nurse notes decreased augmentation on the IABP
waveform. What is the priority action?
A. Increase the IABP trigger sensitivity
B. Assess for proper timing and catheter position
C. Administer a fluid bolus
D. Notify the provider for possible balloon removal
Answer: B – Decreased augmentation suggests timing issues
(early/late inflation/deflation) or migration. Assess waveform
before escalating.
4. A patient post-cardiac arrest has return of spontaneous
circulation (ROSC). Which targeted temperature management
2
,(TTM) protocol is currently recommended?
A. Cool to 33°C for 24 hours
B. Cool to 36°C for 24 hours
C. Maintain normothermia (36–37.5°C) and treat fever
aggressively
D. Cool to 32°C for 48 hours
Answer: C – Current AHA guidelines: maintain normothermia (≤
37.5°C) and actively prevent fever for at least 72 hours. Rigid
cooling to 33°C is no longer mandatory.
5. A patient with atrial fibrillation and rapid ventricular response
(HR 150) has a blood pressure of 100/60 and reports mild chest
tightness. Which medication should the nurse administer first?
A. Digoxin IV push
B. Amiodarone IV bolus
C. Diltiazem IV bolus
D. Metoprolol IV push
Answer: C – Diltiazem (calcium channel blocker) is first-line for
rate control in stable a-fib without heart failure. Amiodarone is
second-line.
3
, 6. A patient with a new diagnosis of heart failure with reduced
ejection fraction (HFrEF) is started on carvedilol. The nurse knows
that this medication should be:
A. Held if heart rate < 70
B. Started at a low dose and titrated slowly
C. Given with a full meal to increase absorption
D. Avoided if patient has diabetes
Answer: B – Beta-blockers in HFrEF require low, slow initiation to
prevent acute decompensation. Heart rate target > 55–60.
7. A patient with a temporary transvenous pacemaker has a
heart rate of 50 and no pacing spikes seen. The nurse should
first:
A. Increase the mA output
B. Change the battery
C. Check connections and threshold
D. Prepare for emergent transcutaneous pacing
Answer: C – Loss of capture is often due to loose connections,
lead dislodgement, or increased threshold. Troubleshoot
connections first.
4
EXAM| NSG4100 NURSING PRACTICE - ADULT
HEALTH III EXAM 2 REVIEW WITH 300 REAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (BRAND NEW!!)
1. A patient with acute decompensated heart failure (ADHF) has
crackles in both lungs, S3 gallop, and oxygen saturation 88% on
4L nasal cannula. Which intervention should the nurse implement
first?
A. Administer furosemide IV push
B. Place the patient in high-Fowler's position
C. Start a nitroglycerin drip
D. Draw BNP and troponin levels
Answer: B – Positioning is immediate and non-invasive. High-
Fowler's reduces preload and improves oxygenation. Diuretics
and nitroglycerin follow.
2. Which hemodynamic parameter is most consistent with
cardiogenic shock?
A. Cardiac index > 4.0 L/min/m², SVR < 600 dynes/sec/cm⁻⁵
1
,B. Cardiac index < 2.2 L/min/m², SVR > 1200 dynes/sec/cm⁻⁵
C. Cardiac index < 1.8 L/min/m², SVR < 800
D. Cardiac index > 3.5, SVR normal
Answer: B – Cardiogenic shock = low cardiac output + high
systemic vascular resistance (compensatory vasoconstriction).
3. A patient with an intra-aortic balloon pump (IABP) has a blood
pressure of 85/50, HR 110, and urine output 20 mL over 2
hours. The nurse notes decreased augmentation on the IABP
waveform. What is the priority action?
A. Increase the IABP trigger sensitivity
B. Assess for proper timing and catheter position
C. Administer a fluid bolus
D. Notify the provider for possible balloon removal
Answer: B – Decreased augmentation suggests timing issues
(early/late inflation/deflation) or migration. Assess waveform
before escalating.
4. A patient post-cardiac arrest has return of spontaneous
circulation (ROSC). Which targeted temperature management
2
,(TTM) protocol is currently recommended?
A. Cool to 33°C for 24 hours
B. Cool to 36°C for 24 hours
C. Maintain normothermia (36–37.5°C) and treat fever
aggressively
D. Cool to 32°C for 48 hours
Answer: C – Current AHA guidelines: maintain normothermia (≤
37.5°C) and actively prevent fever for at least 72 hours. Rigid
cooling to 33°C is no longer mandatory.
5. A patient with atrial fibrillation and rapid ventricular response
(HR 150) has a blood pressure of 100/60 and reports mild chest
tightness. Which medication should the nurse administer first?
A. Digoxin IV push
B. Amiodarone IV bolus
C. Diltiazem IV bolus
D. Metoprolol IV push
Answer: C – Diltiazem (calcium channel blocker) is first-line for
rate control in stable a-fib without heart failure. Amiodarone is
second-line.
3
, 6. A patient with a new diagnosis of heart failure with reduced
ejection fraction (HFrEF) is started on carvedilol. The nurse knows
that this medication should be:
A. Held if heart rate < 70
B. Started at a low dose and titrated slowly
C. Given with a full meal to increase absorption
D. Avoided if patient has diabetes
Answer: B – Beta-blockers in HFrEF require low, slow initiation to
prevent acute decompensation. Heart rate target > 55–60.
7. A patient with a temporary transvenous pacemaker has a
heart rate of 50 and no pacing spikes seen. The nurse should
first:
A. Increase the mA output
B. Change the battery
C. Check connections and threshold
D. Prepare for emergent transcutaneous pacing
Answer: C – Loss of capture is often due to loose connections,
lead dislodgement, or increased threshold. Troubleshoot
connections first.
4
