NR-325 – Adult Health II Builds advanced
competencies in managing complex adult health
conditions, interdisciplinary care, evidence-based
practice, and patient outcomes.
1. A 68-year-old male with acute decompensated heart failure (ADHF)
presents with dyspnea, crackles in both lungs, and an S3 gallop. His BP is
160/95, HR 110, oxygen saturation 88% on room air. Which intervention
should the nurse implement first?
A. Administer IV furosemide
B. Apply high-flow oxygen (non-rebreather)
C. Start a nitroglycerin drip
D. Place the patient in a high-Fowler’s position and reassess airway/breathing
Correct Answer: B
Rationale: The priority is oxygenation. Severe hypoxemia (SpO2 88%) requires
immediate high-flow oxygen. High-Fowler’s position helps, but oxygen is the first
specific intervention. Furosemide and nitroglycerin are important but not before
stabilizing oxygenation.
2. A patient with ST-elevation myocardial infarction (STEMI) is receiving
thrombolytic therapy. The nurse notes new-onset, severe headache, nausea,
and altered mental status. What is the priority action?
A. Administer acetaminophen for headache
B. Stop the thrombolytic infusion and prepare for emergency CT scan
C. Increase the infusion rate
D. Reassure the patient and monitor vital signs
Correct Answer: B
Rationale: New severe headache, vomiting, and mental status change during
thrombolysis are signs of intracranial hemorrhage (ICH). Thrombolytics must be
stopped immediately, and an emergency CT scan is needed.
3. A 72-year-old with chronic heart failure (HFrEF, EF 25%) is on carvedilol,
lisinopril, and furosemide. Which assessment finding requires the most
immediate action?
A. BP 100/70, HR 68
,B. Weight gain of 3 kg in 3 days with increasing dyspnea
C. Serum potassium 4.2 mEq/L
D. Mild fatigue after walking one block
Correct Answer: B
Rationale: Rapid weight gain (2-3 lb/day or 1-2 kg/day) indicates worsening fluid
overload and decompensated heart failure. Requires diuretic adjustment. Mild
hypotension is expected with therapy; potassium normal; some fatigue is expected.
4. A patient with aortic stenosis is scheduled for valve replacement. Which
symptom is most concerning for disease progression and imminent risk?
A. Syncope with exertion
B. Mild peripheral edema
C. Occasional palpitations
D. Systolic murmur grade II/VI
Correct Answer: A
Rationale: Exertional syncope in aortic stenosis indicates severe obstruction and
risk of sudden death. It is a class I indication for valve replacement. Edema
suggests right heart failure but less urgent.
5. A nurse is caring for a patient with a newly inserted transvenous
pacemaker. Which ECG finding indicates proper capture?
A. Pacing spikes followed by a wide QRS and T wave opposite the QRS
B. Pacing spikes with no QRS
C. Irregular pacing spikes with variable QRS
D. Pacing spikes at 100 bpm with narrow QRS
Correct Answer: A
Rationale: Ventricular capture is confirmed by a pacing spike followed by a wide
QRS and T wave opposite in polarity. No QRS indicates loss of capture. Narrow
QRS suggests atrial capture or misplacement.
6. A patient with unstable angina has a heart rate of 130 bpm from atrial
fibrillation. The provider orders IV metoprolol. The nurse should hold the
medication and notify the provider if the patient has which finding?
A. BP 110/70
B. Oxygen saturation 95%
C. Acute heart failure with crackles in all fields
D. Chest pain resolved
Correct Answer: C
,Rationale: Metoprolol is contraindicated in acute decompensated heart failure
(pulmonary edema) as it can worsen contractility. The patient with unstable angina
and rapid AF may have underlying HF; assess for crackles.
7. A patient post-cardiac arrest has return of spontaneous circulation (ROSC)
but remains unconscious. Targeted temperature management (TTM) is
initiated. Which complication requires immediate intervention?
A. Shivering
B. Serum potassium 4.0 mEq/L
C. HR 55 bpm
D. Blood glucose 140 mg/dL
Correct Answer: A
Rationale: Shivering during TTM increases metabolic demand, counteracting the
neuroprotective effect. It must be treated (sedation, neuromuscular blockade). Mild
bradycardia and glucose 140 are expected.
8. The nurse assesses a patient with a left ventricular assist device (LVAD).
Which finding indicates a possible inflow obstruction or pump thrombus?
A. Low power consumption and high flow
B. High pump power with low flow and alarms
C. Continuous audible hum
D. BP 120/80
Correct Answer: B
Rationale: High power with low flow suggests increased resistance to flow
(thrombus, obstruction). Low power with high flow might indicate incorrect
settings. Auscultation should show a continuous hum.
9. A patient with pericarditis has a pericardial friction rub. Which medication
order should the nurse question?
A. Ibuprofen
B. Colchicine
C. Aspirin
D. Warfarin
Correct Answer: D
Rationale: Anticoagulation (warfarin) is avoided in acute pericarditis unless there
is a separate indication (e.g., mechanical valve) because of the risk of hemorrhagic
pericardial effusion/tamponade. NSAIDs and colchicine are first-line.
, 10. A 55-year-old with acute right ventricular (RV) infarction has hypotension
and jugular venous distension. The nurse prepares to administer which
intervention first?
A. IV furosemide
B. IV nitroglycerin
C. IV normal saline bolus
D. Morphine
Correct Answer: C
Rationale: RV infarction causes low cardiac output due to inadequate RV preload.
Fluid bolus (500-1000 mL NS) is first-line to increase RV filling pressure and
output. Diuretics and nitroglycerin would worsen hypotension.
11. A patient with an acute aortic dissection (Type A) has a BP of 180/100 and
HR 110. Which medication order is highest priority?
A. Sodium nitroprusside
B. IV esmolol (beta-blocker) BEFORE vasodilator
C. IV hydralazine
D. IV furosemide
Correct Answer: B
Rationale: In aortic dissection, beta-blockers (esmolol) are given first to reduce
shearing force (dP/dt), followed by vasodilators (nitroprusside). Unopposed
vasodilation can increase reflex sympathetic tone.
12. A patient with chronic heart failure is started on sacubitril/valsartan
(Entresto). Which instruction is essential?
A. Take with a high-potassium supplement
B. Discontinue any ACE inhibitor 36 hours before starting Entresto
C. Double the dose if dizzy
D. Take immediately after a high-fat meal
Correct Answer: B
Rationale: Sacubitril/valsartan is contraindicated within 36 hours of last ACE
inhibitor dose due to risk of angioedema. Monitor potassium, not supplement.
Dizziness is common; do not double dose.
13. A patient with hypertrophic cardiomyopathy (HCM) is admitted with
dyspnea. Which medication should the nurse question?
A. Metoprolol
B. Verapamil
competencies in managing complex adult health
conditions, interdisciplinary care, evidence-based
practice, and patient outcomes.
1. A 68-year-old male with acute decompensated heart failure (ADHF)
presents with dyspnea, crackles in both lungs, and an S3 gallop. His BP is
160/95, HR 110, oxygen saturation 88% on room air. Which intervention
should the nurse implement first?
A. Administer IV furosemide
B. Apply high-flow oxygen (non-rebreather)
C. Start a nitroglycerin drip
D. Place the patient in a high-Fowler’s position and reassess airway/breathing
Correct Answer: B
Rationale: The priority is oxygenation. Severe hypoxemia (SpO2 88%) requires
immediate high-flow oxygen. High-Fowler’s position helps, but oxygen is the first
specific intervention. Furosemide and nitroglycerin are important but not before
stabilizing oxygenation.
2. A patient with ST-elevation myocardial infarction (STEMI) is receiving
thrombolytic therapy. The nurse notes new-onset, severe headache, nausea,
and altered mental status. What is the priority action?
A. Administer acetaminophen for headache
B. Stop the thrombolytic infusion and prepare for emergency CT scan
C. Increase the infusion rate
D. Reassure the patient and monitor vital signs
Correct Answer: B
Rationale: New severe headache, vomiting, and mental status change during
thrombolysis are signs of intracranial hemorrhage (ICH). Thrombolytics must be
stopped immediately, and an emergency CT scan is needed.
3. A 72-year-old with chronic heart failure (HFrEF, EF 25%) is on carvedilol,
lisinopril, and furosemide. Which assessment finding requires the most
immediate action?
A. BP 100/70, HR 68
,B. Weight gain of 3 kg in 3 days with increasing dyspnea
C. Serum potassium 4.2 mEq/L
D. Mild fatigue after walking one block
Correct Answer: B
Rationale: Rapid weight gain (2-3 lb/day or 1-2 kg/day) indicates worsening fluid
overload and decompensated heart failure. Requires diuretic adjustment. Mild
hypotension is expected with therapy; potassium normal; some fatigue is expected.
4. A patient with aortic stenosis is scheduled for valve replacement. Which
symptom is most concerning for disease progression and imminent risk?
A. Syncope with exertion
B. Mild peripheral edema
C. Occasional palpitations
D. Systolic murmur grade II/VI
Correct Answer: A
Rationale: Exertional syncope in aortic stenosis indicates severe obstruction and
risk of sudden death. It is a class I indication for valve replacement. Edema
suggests right heart failure but less urgent.
5. A nurse is caring for a patient with a newly inserted transvenous
pacemaker. Which ECG finding indicates proper capture?
A. Pacing spikes followed by a wide QRS and T wave opposite the QRS
B. Pacing spikes with no QRS
C. Irregular pacing spikes with variable QRS
D. Pacing spikes at 100 bpm with narrow QRS
Correct Answer: A
Rationale: Ventricular capture is confirmed by a pacing spike followed by a wide
QRS and T wave opposite in polarity. No QRS indicates loss of capture. Narrow
QRS suggests atrial capture or misplacement.
6. A patient with unstable angina has a heart rate of 130 bpm from atrial
fibrillation. The provider orders IV metoprolol. The nurse should hold the
medication and notify the provider if the patient has which finding?
A. BP 110/70
B. Oxygen saturation 95%
C. Acute heart failure with crackles in all fields
D. Chest pain resolved
Correct Answer: C
,Rationale: Metoprolol is contraindicated in acute decompensated heart failure
(pulmonary edema) as it can worsen contractility. The patient with unstable angina
and rapid AF may have underlying HF; assess for crackles.
7. A patient post-cardiac arrest has return of spontaneous circulation (ROSC)
but remains unconscious. Targeted temperature management (TTM) is
initiated. Which complication requires immediate intervention?
A. Shivering
B. Serum potassium 4.0 mEq/L
C. HR 55 bpm
D. Blood glucose 140 mg/dL
Correct Answer: A
Rationale: Shivering during TTM increases metabolic demand, counteracting the
neuroprotective effect. It must be treated (sedation, neuromuscular blockade). Mild
bradycardia and glucose 140 are expected.
8. The nurse assesses a patient with a left ventricular assist device (LVAD).
Which finding indicates a possible inflow obstruction or pump thrombus?
A. Low power consumption and high flow
B. High pump power with low flow and alarms
C. Continuous audible hum
D. BP 120/80
Correct Answer: B
Rationale: High power with low flow suggests increased resistance to flow
(thrombus, obstruction). Low power with high flow might indicate incorrect
settings. Auscultation should show a continuous hum.
9. A patient with pericarditis has a pericardial friction rub. Which medication
order should the nurse question?
A. Ibuprofen
B. Colchicine
C. Aspirin
D. Warfarin
Correct Answer: D
Rationale: Anticoagulation (warfarin) is avoided in acute pericarditis unless there
is a separate indication (e.g., mechanical valve) because of the risk of hemorrhagic
pericardial effusion/tamponade. NSAIDs and colchicine are first-line.
, 10. A 55-year-old with acute right ventricular (RV) infarction has hypotension
and jugular venous distension. The nurse prepares to administer which
intervention first?
A. IV furosemide
B. IV nitroglycerin
C. IV normal saline bolus
D. Morphine
Correct Answer: C
Rationale: RV infarction causes low cardiac output due to inadequate RV preload.
Fluid bolus (500-1000 mL NS) is first-line to increase RV filling pressure and
output. Diuretics and nitroglycerin would worsen hypotension.
11. A patient with an acute aortic dissection (Type A) has a BP of 180/100 and
HR 110. Which medication order is highest priority?
A. Sodium nitroprusside
B. IV esmolol (beta-blocker) BEFORE vasodilator
C. IV hydralazine
D. IV furosemide
Correct Answer: B
Rationale: In aortic dissection, beta-blockers (esmolol) are given first to reduce
shearing force (dP/dt), followed by vasodilators (nitroprusside). Unopposed
vasodilation can increase reflex sympathetic tone.
12. A patient with chronic heart failure is started on sacubitril/valsartan
(Entresto). Which instruction is essential?
A. Take with a high-potassium supplement
B. Discontinue any ACE inhibitor 36 hours before starting Entresto
C. Double the dose if dizzy
D. Take immediately after a high-fat meal
Correct Answer: B
Rationale: Sacubitril/valsartan is contraindicated within 36 hours of last ACE
inhibitor dose due to risk of angioedema. Monitor potassium, not supplement.
Dizziness is common; do not double dose.
13. A patient with hypertrophic cardiomyopathy (HCM) is admitted with
dyspnea. Which medication should the nurse question?
A. Metoprolol
B. Verapamil
