Page 1 of 78
RNSG 2539 (HEALTH CARE CONCEPTS IV)
PREP EXAMINATION 2026 COMPLETE (180)
CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED
RATIONALES.
RNSG
Prepare for the RNSG 2539 (Health Care Concepts IV) Prep Examination
with practice questions covering advanced nursing concepts typical of a
fourth-level RN course: complex care, leadership/management,
community health, critical care, disaster nursing, ethics, delegation,
quality improvement, and NCLEX-RN style prioritization. Designed to
improve critical thinking skills and boost confidence in caring for patients
with diverse healthcare needs. Suitable for ADN, RN, and nursing
students preparing for advanced nursing coursework and exams.
MULTIPLE CHOICE.
Concepts: Perfusion, Gas Exchange, Hemodynamics
1. A patient with septic shock has a mean arterial pressure (MAP) of
55 mm Hg. Which intervention does the nurse anticipate first?
A. Administer broad-spectrum antibiotics
B. Start a norepinephrine drip
C. Give a 500 mL bolus of isotonic crystalloid
D. Obtain a serum lactate level
Answer: C
Rationale: The Surviving Sepsis Campaign recommends rapid
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administration of 30 mL/kg of crystalloid for hypotension or
lactate ≥4 mmol/L. Fluids are first-line before vasopressors.
Antibiotics and lactate draw can occur simultaneously, but
volume resuscitation takes priority to improve MAP.
2. A patient with acute decompensated heart failure has crackles in
all lung fields, oxygen saturation 88% on 4 L nasal cannula, and
jugular venous distension. Which prescribed order should the nurse
implement first?
A. Furosemide 40 mg IV push
B. Morphine 2 mg IV
C. Non-invasive positive pressure ventilation (NIPPV)
D. Dopamine 5 mcg/kg/min
Answer: C
Rationale: NIPPV (BiPAP/CPAP) rapidly improves oxygenation
and reduces work of breathing in pulmonary edema. While
furosemide is critical, NIPPV addresses immediate hypoxemia.
Morphine is no longer first-line, and dopamine is for cardiogenic
shock with hypotension.
3. After a cardiac catheterization through the right femoral artery,
the patient reports severe pain and coolness in the right foot. The
nurse assesses a pale, pulseless foot. What is the priority action?
A. Reassure the patient that this is expected
B. Elevate the right leg on pillows
C. Notify the provider immediately
D. Apply warm compresses to the foot
Answer: C
Rationale: The findings suggest acute arterial occlusion or
thromboembolism. Immediate provider notification is critical to
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restore blood flow. Elevation worsens ischemia; warm
compresses are not appropriate for possible occlusion.
4. A patient on a dobutamine drip for cardiogenic shock has a heart
rate of 124 bpm and blood pressure 86/50 mm Hg. Which
assessment finding indicates a desired effect of the medication?
A. Urine output 20 mL/hr
B. Pulmonary artery wedge pressure (PAWP) 24 mm Hg
C. Cardiac index 2.8 L/min/m²
D. Central venous pressure (CVP) 18 mm Hg
Answer: C
Rationale: Dobutamine increases cardiac contractility and
cardiac output. Normal cardiac index is 2.5–4.0 L/min/m²; a
value of 2.8 indicates improved perfusion. Low urine output (A)
and elevated PAWP/CVP suggest ongoing failure.
5. The nurse is caring for a patient with a pulmonary artery catheter.
The waveform shows a sudden loss of the diastolic waveform and
an arterial-like tracing. What does this indicate?
A. The catheter is wedged correctly
B. The catheter has migrated to the right ventricle
C. The balloon is overinflated
D. The catheter tip is in the pulmonary artery wedge position
Answer: B
Rationale: A pulmonary artery waveform that suddenly becomes
arterialized (with a dicrotic notch) indicates the catheter tip has
advanced into the pulmonary artery wedge position or, more
commonly, the balloon is deflated and the catheter is in the right
ventricle. The most likely cause is migration requiring
repositioning.
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6. A patient with a history of deep vein thrombosis (DVT) suddenly
develops dyspnea, pleuritic chest pain, and hemoptysis. Vital signs:
HR 118, RR 32, SpO2 88% on room air. Which medication does the
nurse prepare to administer first?
A. Alteplase (tPA)
B. Unfractionated heparin bolus
C. Enoxaparin subcutaneously
D. Warfarin 10 mg orally
Answer: B
Rationale: Acute massive pulmonary embolism with
hemodynamic compromise requires immediate anticoagulation.
Unfractionated heparin IV bolus is given first while considering
thrombolytics. Warfarin is long-term; enoxaparin is not first-line
in unstable patients.
7. A patient is admitted with an acute exacerbation of chronic
systolic heart failure, ejection fraction 25%. The nurse hears an S3
gallop and sees pitting edema of the lower extremities. Which
laboratory finding is most consistent with this presentation?
A. BNP 45 pg/mL
B. BNP 850 pg/mL
C. Troponin I 0.02 ng/mL
D. Hemoglobin 16 g/dL
Answer: B
Rationale: B-type natriuretic peptide (BNP) is elevated in heart
failure (>100 pg/mL). A level of 850 pg/mL supports acute
decompensation. Low BNP (A) rules out HF. Troponin might be
normal unless ischemia is present.
RNSG 2539 (HEALTH CARE CONCEPTS IV)
PREP EXAMINATION 2026 COMPLETE (180)
CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED
RATIONALES.
RNSG
Prepare for the RNSG 2539 (Health Care Concepts IV) Prep Examination
with practice questions covering advanced nursing concepts typical of a
fourth-level RN course: complex care, leadership/management,
community health, critical care, disaster nursing, ethics, delegation,
quality improvement, and NCLEX-RN style prioritization. Designed to
improve critical thinking skills and boost confidence in caring for patients
with diverse healthcare needs. Suitable for ADN, RN, and nursing
students preparing for advanced nursing coursework and exams.
MULTIPLE CHOICE.
Concepts: Perfusion, Gas Exchange, Hemodynamics
1. A patient with septic shock has a mean arterial pressure (MAP) of
55 mm Hg. Which intervention does the nurse anticipate first?
A. Administer broad-spectrum antibiotics
B. Start a norepinephrine drip
C. Give a 500 mL bolus of isotonic crystalloid
D. Obtain a serum lactate level
Answer: C
Rationale: The Surviving Sepsis Campaign recommends rapid
, Page 2 of 78
administration of 30 mL/kg of crystalloid for hypotension or
lactate ≥4 mmol/L. Fluids are first-line before vasopressors.
Antibiotics and lactate draw can occur simultaneously, but
volume resuscitation takes priority to improve MAP.
2. A patient with acute decompensated heart failure has crackles in
all lung fields, oxygen saturation 88% on 4 L nasal cannula, and
jugular venous distension. Which prescribed order should the nurse
implement first?
A. Furosemide 40 mg IV push
B. Morphine 2 mg IV
C. Non-invasive positive pressure ventilation (NIPPV)
D. Dopamine 5 mcg/kg/min
Answer: C
Rationale: NIPPV (BiPAP/CPAP) rapidly improves oxygenation
and reduces work of breathing in pulmonary edema. While
furosemide is critical, NIPPV addresses immediate hypoxemia.
Morphine is no longer first-line, and dopamine is for cardiogenic
shock with hypotension.
3. After a cardiac catheterization through the right femoral artery,
the patient reports severe pain and coolness in the right foot. The
nurse assesses a pale, pulseless foot. What is the priority action?
A. Reassure the patient that this is expected
B. Elevate the right leg on pillows
C. Notify the provider immediately
D. Apply warm compresses to the foot
Answer: C
Rationale: The findings suggest acute arterial occlusion or
thromboembolism. Immediate provider notification is critical to
, Page 3 of 78
restore blood flow. Elevation worsens ischemia; warm
compresses are not appropriate for possible occlusion.
4. A patient on a dobutamine drip for cardiogenic shock has a heart
rate of 124 bpm and blood pressure 86/50 mm Hg. Which
assessment finding indicates a desired effect of the medication?
A. Urine output 20 mL/hr
B. Pulmonary artery wedge pressure (PAWP) 24 mm Hg
C. Cardiac index 2.8 L/min/m²
D. Central venous pressure (CVP) 18 mm Hg
Answer: C
Rationale: Dobutamine increases cardiac contractility and
cardiac output. Normal cardiac index is 2.5–4.0 L/min/m²; a
value of 2.8 indicates improved perfusion. Low urine output (A)
and elevated PAWP/CVP suggest ongoing failure.
5. The nurse is caring for a patient with a pulmonary artery catheter.
The waveform shows a sudden loss of the diastolic waveform and
an arterial-like tracing. What does this indicate?
A. The catheter is wedged correctly
B. The catheter has migrated to the right ventricle
C. The balloon is overinflated
D. The catheter tip is in the pulmonary artery wedge position
Answer: B
Rationale: A pulmonary artery waveform that suddenly becomes
arterialized (with a dicrotic notch) indicates the catheter tip has
advanced into the pulmonary artery wedge position or, more
commonly, the balloon is deflated and the catheter is in the right
ventricle. The most likely cause is migration requiring
repositioning.
, Page 4 of 78
6. A patient with a history of deep vein thrombosis (DVT) suddenly
develops dyspnea, pleuritic chest pain, and hemoptysis. Vital signs:
HR 118, RR 32, SpO2 88% on room air. Which medication does the
nurse prepare to administer first?
A. Alteplase (tPA)
B. Unfractionated heparin bolus
C. Enoxaparin subcutaneously
D. Warfarin 10 mg orally
Answer: B
Rationale: Acute massive pulmonary embolism with
hemodynamic compromise requires immediate anticoagulation.
Unfractionated heparin IV bolus is given first while considering
thrombolytics. Warfarin is long-term; enoxaparin is not first-line
in unstable patients.
7. A patient is admitted with an acute exacerbation of chronic
systolic heart failure, ejection fraction 25%. The nurse hears an S3
gallop and sees pitting edema of the lower extremities. Which
laboratory finding is most consistent with this presentation?
A. BNP 45 pg/mL
B. BNP 850 pg/mL
C. Troponin I 0.02 ng/mL
D. Hemoglobin 16 g/dL
Answer: B
Rationale: B-type natriuretic peptide (BNP) is elevated in heart
failure (>100 pg/mL). A level of 850 pg/mL supports acute
decompensation. Low BNP (A) rules out HF. Troponin might be
normal unless ischemia is present.
