NR 324 Adult Health I Final Exam Actual Exam 2025/2026: Complete
Exam-Style Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Institution: Chamberlain University
Exam Version: 2026/2027 Update
Total Questions: 55
Time Allowed: 110 minutes
Passing Score: 78%
Question Types: Multiple-Choice (MCQ), Select-All-That-Apply (SATA),
Prioritization/Delegation, and Data Interpretation
Section A: Cardiovascular and Hematologic Health (Questions 1–12)
Question 1
A 68-year-old male is admitted with chest pain and is diagnosed with an acute anterior
wall ST-elevation myocardial infarction (STEMI). The nurse notes the following vital
signs: BP 88/52 mmHg, HR 118 bpm (sinus tachycardia), RR 24/min, SpO₂ 91% on room
air. The 12-lead ECG shows ST elevations in leads V1–V4 with new-onset left bundle
branch block. The primary healthcare provider orders aspirin 325 mg chewable,
,nitroglycerin 0.4 mg sublingual, and morphine 4 mg IV. Which action should the nurse
prioritize?
A. Administer all ordered medications immediately in the sequence listed
B. Administer aspirin, withhold nitroglycerin due to hypotension, and notify the provider
C. Administer morphine first for pain relief, then administer aspirin and nitroglycerin
D. Obtain a stat echocardiogram before administering any medications
Correct Answer: B
Rationale: In acute STEMI, aspirin should be administered promptly for antiplatelet
effect. However, nitroglycerin is contraindicated in patients with systolic BP <90 mmHg
because it causes venodilation, further reducing preload and potentially worsening
hypotension and coronary perfusion. The nurse must withhold nitroglycerin, administer
aspirin, and immediately notify the provider regarding the hemodynamic instability.
Morphine is appropriate for refractory pain but does not take priority over hemodynamic
stabilization.
Question 2 (SATA — Select All That Apply)
A nurse is caring for a patient with newly diagnosed heart failure with reduced ejection
fraction (HFrEF; EF 30%). The provider orders lisinopril 10 mg daily, metoprolol
succinate 25 mg daily, furosemide 40 mg daily, and spironolactone 25 mg daily. Which
laboratory values require immediate nursing intervention before administering these
medications?
A. Serum potassium 5.8 mEq/L
B. Serum creatinine 1.9 mg/dL (baseline 1.1 mg/dL)
,C. Serum sodium 138 mEq/L
D. Blood urea nitrogen (BUN) 42 mg/dL
E. Serum magnesium 1.6 mg/dL
Correct Answers: A, B, D
Rationale: Hyperkalemia (5.8 mEq/L) is critical with ACE inhibitors (lisinopril) and
spironolactone, both of which can cause life-threatening hyperkalemia. Acute kidney
injury (creatinine rise from 1.1 to 1.9 mg/dL) requires holding nephrotoxic or renally
cleared medications and provider notification. Elevated BUN (42 mg/dL) with rising
creatinine indicates prerenal azotemia, likely from overdiuresis or hypoperfusion.
Normal sodium (C) does not require intervention. Low-normal magnesium (E) should be
monitored but does not require immediate medication hold.
Question 3
The following telemetry strip is obtained from a 72-year-old patient admitted for
syncope. The rhythm shows: regular narrow-complex tachycardia at 150 bpm, no
discernible P waves, QRS duration 0.08 seconds. The patient is alert, BP 102/68 mmHg,
complaining of mild dizziness. Which intervention is most appropriate?
A. Immediate synchronized cardioversion at 100 joules
B. Adenosine 6 mg rapid IV push followed by 12 mg if needed
C. Amiodarone 150 mg IV bolus over 10 minutes
D. Vagal maneuvers followed by adenosine if unsuccessful
Correct Answer: D
, Rationale: The rhythm is supraventricular tachycardia (SVT) — regular, narrow-complex,
rate ~150 bpm, absent P waves. The patient is hemodynamically stable (alert, BP >90
systolic), so immediate cardioversion (A) is not indicated per ACLS guidelines. Vagal
maneuvers (Valsalva, carotid massage if no bruit) are first-line for stable SVT, followed
by adenosine if unsuccessful. Amiodarone (C) is not first-line for SVT. Adenosine (B) is
appropriate but should follow vagal maneuvers in stable patients.
Question 4
A 54-year-old female with a history of atrial fibrillation presents to the emergency
department with sudden-onset left-sided weakness, facial droop, and slurred speech.
Her last known well time was 90 minutes ago. She takes apixaban 5 mg twice daily for
stroke prevention. CT scan shows no hemorrhage. Which action should the nurse
anticipate?
A. Prepare for immediate administration of IV alteplase (tPA)
B. Notify the provider that tPA is contraindicated due to apixaban use
C. Obtain a stat coagulation panel and prepare for possible mechanical thrombectomy
D. Administer aspirin 325 mg and obtain MRI for definitive stroke classification
Correct Answer: C
Rationale: Apixaban (a direct oral anticoagulant, DOAC) is a relative contraindication to
IV thrombolysis unless specific coagulation tests (e.g., anti-factor Xa level, PT/INR)
confirm no residual anticoagulant effect. The nurse should obtain coagulation studies
and prepare for mechanical thrombectomy, which is indicated for large vessel occlusion
within 6–24 hours in selected patients. Aspirin (D) is appropriate for ischemic stroke but
not within 24 hours of thrombolysis. tPA (A) is contraindicated without coagulation
Exam-Style Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Institution: Chamberlain University
Exam Version: 2026/2027 Update
Total Questions: 55
Time Allowed: 110 minutes
Passing Score: 78%
Question Types: Multiple-Choice (MCQ), Select-All-That-Apply (SATA),
Prioritization/Delegation, and Data Interpretation
Section A: Cardiovascular and Hematologic Health (Questions 1–12)
Question 1
A 68-year-old male is admitted with chest pain and is diagnosed with an acute anterior
wall ST-elevation myocardial infarction (STEMI). The nurse notes the following vital
signs: BP 88/52 mmHg, HR 118 bpm (sinus tachycardia), RR 24/min, SpO₂ 91% on room
air. The 12-lead ECG shows ST elevations in leads V1–V4 with new-onset left bundle
branch block. The primary healthcare provider orders aspirin 325 mg chewable,
,nitroglycerin 0.4 mg sublingual, and morphine 4 mg IV. Which action should the nurse
prioritize?
A. Administer all ordered medications immediately in the sequence listed
B. Administer aspirin, withhold nitroglycerin due to hypotension, and notify the provider
C. Administer morphine first for pain relief, then administer aspirin and nitroglycerin
D. Obtain a stat echocardiogram before administering any medications
Correct Answer: B
Rationale: In acute STEMI, aspirin should be administered promptly for antiplatelet
effect. However, nitroglycerin is contraindicated in patients with systolic BP <90 mmHg
because it causes venodilation, further reducing preload and potentially worsening
hypotension and coronary perfusion. The nurse must withhold nitroglycerin, administer
aspirin, and immediately notify the provider regarding the hemodynamic instability.
Morphine is appropriate for refractory pain but does not take priority over hemodynamic
stabilization.
Question 2 (SATA — Select All That Apply)
A nurse is caring for a patient with newly diagnosed heart failure with reduced ejection
fraction (HFrEF; EF 30%). The provider orders lisinopril 10 mg daily, metoprolol
succinate 25 mg daily, furosemide 40 mg daily, and spironolactone 25 mg daily. Which
laboratory values require immediate nursing intervention before administering these
medications?
A. Serum potassium 5.8 mEq/L
B. Serum creatinine 1.9 mg/dL (baseline 1.1 mg/dL)
,C. Serum sodium 138 mEq/L
D. Blood urea nitrogen (BUN) 42 mg/dL
E. Serum magnesium 1.6 mg/dL
Correct Answers: A, B, D
Rationale: Hyperkalemia (5.8 mEq/L) is critical with ACE inhibitors (lisinopril) and
spironolactone, both of which can cause life-threatening hyperkalemia. Acute kidney
injury (creatinine rise from 1.1 to 1.9 mg/dL) requires holding nephrotoxic or renally
cleared medications and provider notification. Elevated BUN (42 mg/dL) with rising
creatinine indicates prerenal azotemia, likely from overdiuresis or hypoperfusion.
Normal sodium (C) does not require intervention. Low-normal magnesium (E) should be
monitored but does not require immediate medication hold.
Question 3
The following telemetry strip is obtained from a 72-year-old patient admitted for
syncope. The rhythm shows: regular narrow-complex tachycardia at 150 bpm, no
discernible P waves, QRS duration 0.08 seconds. The patient is alert, BP 102/68 mmHg,
complaining of mild dizziness. Which intervention is most appropriate?
A. Immediate synchronized cardioversion at 100 joules
B. Adenosine 6 mg rapid IV push followed by 12 mg if needed
C. Amiodarone 150 mg IV bolus over 10 minutes
D. Vagal maneuvers followed by adenosine if unsuccessful
Correct Answer: D
, Rationale: The rhythm is supraventricular tachycardia (SVT) — regular, narrow-complex,
rate ~150 bpm, absent P waves. The patient is hemodynamically stable (alert, BP >90
systolic), so immediate cardioversion (A) is not indicated per ACLS guidelines. Vagal
maneuvers (Valsalva, carotid massage if no bruit) are first-line for stable SVT, followed
by adenosine if unsuccessful. Amiodarone (C) is not first-line for SVT. Adenosine (B) is
appropriate but should follow vagal maneuvers in stable patients.
Question 4
A 54-year-old female with a history of atrial fibrillation presents to the emergency
department with sudden-onset left-sided weakness, facial droop, and slurred speech.
Her last known well time was 90 minutes ago. She takes apixaban 5 mg twice daily for
stroke prevention. CT scan shows no hemorrhage. Which action should the nurse
anticipate?
A. Prepare for immediate administration of IV alteplase (tPA)
B. Notify the provider that tPA is contraindicated due to apixaban use
C. Obtain a stat coagulation panel and prepare for possible mechanical thrombectomy
D. Administer aspirin 325 mg and obtain MRI for definitive stroke classification
Correct Answer: C
Rationale: Apixaban (a direct oral anticoagulant, DOAC) is a relative contraindication to
IV thrombolysis unless specific coagulation tests (e.g., anti-factor Xa level, PT/INR)
confirm no residual anticoagulant effect. The nurse should obtain coagulation studies
and prepare for mechanical thrombectomy, which is indicated for large vessel occlusion
within 6–24 hours in selected patients. Aspirin (D) is appropriate for ischemic stroke but
not within 24 hours of thrombolysis. tPA (A) is contraindicated without coagulation
