NSG 464 Actual Final Exam Pack – Verified
Answers 2026 | Graded & Latest Update
NSG 464 — ACTUAL FINAL EXAM PACK
Verified Answers 2026 | Graded & Latest Update
QUESTION 1
A nurse is assessing a client with heart failure. Which finding requires IMMEDIATE
intervention?
A. Mild ankle edema bilaterally
B. Blood pressure of 130/80 mmHg
C. S3 gallop with crackles in bilateral lung bases
D. Weight gain of 0.5 kg over 2 days
E. Mild fatigue after activity
CORRECT ANSWER: C — S3 gallop with crackles in bilateral lung bases
RATIONALE: An S3 gallop combined with bilateral crackles indicates acute
pulmonary edema — fluid is backing up into the lungs due to left ventricular failure. This
is a sign of decompensated heart failure requiring immediate intervention such as
oxygen therapy, diuretics, and positioning.
QUESTION 2
Which electrolyte imbalance is MOST commonly associated with loop diuretic therapy?
A. Hypernatremia
B. Hyperkalemia
C. Hypercalcemia
D. Hypokalemia
E. Hypermagnesemia
CORRECT ANSWER: D — Hypokalemia
, RATIONALE: Loop diuretics (e.g., furosemide) inhibit sodium and potassium
reabsorption in the loop of Henle, leading to potassium wasting. Hypokalemia increases
the risk of life-threatening cardiac dysrhythmias, especially in clients on digoxin.
QUESTION 3
A client is prescribed digoxin 0.125 mg daily. Before administering the drug, the nurse
checks the apical pulse and finds it to be 54 bpm. What is the CORRECT nursing
action?
A. Administer the medication as prescribed
B. Administer half the dose and document
C. Increase the dose to compensate for the low heart rate
D. Hold the medication and notify the provider
E. Ask the client if they feel dizzy before giving the dose
CORRECT ANSWER: D — Hold the medication and notify the provider
RATIONALE: Digoxin is held and the provider notified when the apical pulse is
below 60 bpm in adults. Digoxin slows the heart rate further and can cause fatal
bradycardia and heart block if administered when the rate is already low.
QUESTION 4
A nurse is caring for a client in cardiogenic shock. Which hemodynamic finding is
EXPECTED?
A. Increased cardiac output
B. Decreased systemic vascular resistance
C. Decreased cardiac output with increased preload
D. Normal pulmonary capillary wedge pressure
E. Elevated blood pressure
CORRECT ANSWER: C — Decreased cardiac output with increased preload
RATIONALE: Cardiogenic shock results from the heart's inability to pump
adequately, causing decreased cardiac output. The failing ventricle cannot eject blood
,effectively, so blood backs up, increasing preload. SVR is elevated as a compensatory
mechanism.
QUESTION 5
Which assessment finding is MOST indicative of right-sided heart failure?
A. Pulmonary crackles
B. Pink frothy sputum
C. Orthopnea
D. Jugular venous distension and peripheral edema
E. Paroxysmal nocturnal dyspnea
CORRECT ANSWER: D — Jugular venous distension and peripheral edema
RATIONALE: Right-sided heart failure causes a backup of blood into the systemic
venous circulation, resulting in jugular venous distension, peripheral pitting edema,
hepatomegaly, and ascites. Left-sided failure manifests with pulmonary signs.
QUESTION 6
A client with chronic kidney disease has a potassium level of 6.8 mEq/L. Which ECG
change should the nurse ANTICIPATE?
A. Prolonged QT interval
B. ST depression
C. U waves
D. Atrial fibrillation
E. Peaked T waves
CORRECT ANSWER: E — Peaked T waves
RATIONALE: Hyperkalemia first manifests on ECG as tall, peaked (tent-shaped) T
waves. As potassium rises further, the PR interval widens, QRS broadens, and
eventually ventricular fibrillation or asystole can occur.
, QUESTION 7
A nurse is providing discharge teaching to a client prescribed warfarin. Which statement
by the client indicates CORRECT understanding?
A. "I can take aspirin whenever I have a headache."
B. "I will eat a lot of spinach to keep my blood thin."
C. "I only need lab work once a year."
D. "I should stop the medication if I miss a dose."
E. "I will report any unusual bruising or bleeding to my doctor."
CORRECT ANSWER: E — "I will report any unusual bruising or bleeding to my
doctor."
RATIONALE: Warfarin is an anticoagulant with a narrow therapeutic index. Clients
must report signs of bleeding promptly. Aspirin increases bleeding risk, vitamin K-rich
foods antagonize warfarin, and INR monitoring must be regular — not annual.
QUESTION 8
A client is admitted with chest pain. Troponin I is elevated. What does this indicate?
A. Pulmonary embolism
B. Pericarditis only
C. Stable angina
D. Myocardial injury or infarction
E. Aortic stenosis
CORRECT ANSWER: D — Myocardial injury or infarction
RATIONALE: Troponin I is a highly specific cardiac biomarker released when
myocardial cells are injured or die. Elevated troponin is the gold standard for diagnosing
acute myocardial infarction and remains elevated for 7–10 days post-infarction.
QUESTION 9
Which nursing intervention is the HIGHEST priority for a client experiencing an acute
asthma attack?
Answers 2026 | Graded & Latest Update
NSG 464 — ACTUAL FINAL EXAM PACK
Verified Answers 2026 | Graded & Latest Update
QUESTION 1
A nurse is assessing a client with heart failure. Which finding requires IMMEDIATE
intervention?
A. Mild ankle edema bilaterally
B. Blood pressure of 130/80 mmHg
C. S3 gallop with crackles in bilateral lung bases
D. Weight gain of 0.5 kg over 2 days
E. Mild fatigue after activity
CORRECT ANSWER: C — S3 gallop with crackles in bilateral lung bases
RATIONALE: An S3 gallop combined with bilateral crackles indicates acute
pulmonary edema — fluid is backing up into the lungs due to left ventricular failure. This
is a sign of decompensated heart failure requiring immediate intervention such as
oxygen therapy, diuretics, and positioning.
QUESTION 2
Which electrolyte imbalance is MOST commonly associated with loop diuretic therapy?
A. Hypernatremia
B. Hyperkalemia
C. Hypercalcemia
D. Hypokalemia
E. Hypermagnesemia
CORRECT ANSWER: D — Hypokalemia
, RATIONALE: Loop diuretics (e.g., furosemide) inhibit sodium and potassium
reabsorption in the loop of Henle, leading to potassium wasting. Hypokalemia increases
the risk of life-threatening cardiac dysrhythmias, especially in clients on digoxin.
QUESTION 3
A client is prescribed digoxin 0.125 mg daily. Before administering the drug, the nurse
checks the apical pulse and finds it to be 54 bpm. What is the CORRECT nursing
action?
A. Administer the medication as prescribed
B. Administer half the dose and document
C. Increase the dose to compensate for the low heart rate
D. Hold the medication and notify the provider
E. Ask the client if they feel dizzy before giving the dose
CORRECT ANSWER: D — Hold the medication and notify the provider
RATIONALE: Digoxin is held and the provider notified when the apical pulse is
below 60 bpm in adults. Digoxin slows the heart rate further and can cause fatal
bradycardia and heart block if administered when the rate is already low.
QUESTION 4
A nurse is caring for a client in cardiogenic shock. Which hemodynamic finding is
EXPECTED?
A. Increased cardiac output
B. Decreased systemic vascular resistance
C. Decreased cardiac output with increased preload
D. Normal pulmonary capillary wedge pressure
E. Elevated blood pressure
CORRECT ANSWER: C — Decreased cardiac output with increased preload
RATIONALE: Cardiogenic shock results from the heart's inability to pump
adequately, causing decreased cardiac output. The failing ventricle cannot eject blood
,effectively, so blood backs up, increasing preload. SVR is elevated as a compensatory
mechanism.
QUESTION 5
Which assessment finding is MOST indicative of right-sided heart failure?
A. Pulmonary crackles
B. Pink frothy sputum
C. Orthopnea
D. Jugular venous distension and peripheral edema
E. Paroxysmal nocturnal dyspnea
CORRECT ANSWER: D — Jugular venous distension and peripheral edema
RATIONALE: Right-sided heart failure causes a backup of blood into the systemic
venous circulation, resulting in jugular venous distension, peripheral pitting edema,
hepatomegaly, and ascites. Left-sided failure manifests with pulmonary signs.
QUESTION 6
A client with chronic kidney disease has a potassium level of 6.8 mEq/L. Which ECG
change should the nurse ANTICIPATE?
A. Prolonged QT interval
B. ST depression
C. U waves
D. Atrial fibrillation
E. Peaked T waves
CORRECT ANSWER: E — Peaked T waves
RATIONALE: Hyperkalemia first manifests on ECG as tall, peaked (tent-shaped) T
waves. As potassium rises further, the PR interval widens, QRS broadens, and
eventually ventricular fibrillation or asystole can occur.
, QUESTION 7
A nurse is providing discharge teaching to a client prescribed warfarin. Which statement
by the client indicates CORRECT understanding?
A. "I can take aspirin whenever I have a headache."
B. "I will eat a lot of spinach to keep my blood thin."
C. "I only need lab work once a year."
D. "I should stop the medication if I miss a dose."
E. "I will report any unusual bruising or bleeding to my doctor."
CORRECT ANSWER: E — "I will report any unusual bruising or bleeding to my
doctor."
RATIONALE: Warfarin is an anticoagulant with a narrow therapeutic index. Clients
must report signs of bleeding promptly. Aspirin increases bleeding risk, vitamin K-rich
foods antagonize warfarin, and INR monitoring must be regular — not annual.
QUESTION 8
A client is admitted with chest pain. Troponin I is elevated. What does this indicate?
A. Pulmonary embolism
B. Pericarditis only
C. Stable angina
D. Myocardial injury or infarction
E. Aortic stenosis
CORRECT ANSWER: D — Myocardial injury or infarction
RATIONALE: Troponin I is a highly specific cardiac biomarker released when
myocardial cells are injured or die. Elevated troponin is the gold standard for diagnosing
acute myocardial infarction and remains elevated for 7–10 days post-infarction.
QUESTION 9
Which nursing intervention is the HIGHEST priority for a client experiencing an acute
asthma attack?
