Adult Health Nursing Examination
2026/2027 Academic Year
75 Questions with Correct Answers and Rationales
Instructions: Select the best answer for each question. Correct answers appear in
bold cyan with accompanying rationales.
Domain Questions Items Score
Cardiac Disorders 1–8 8
Respiratory Disorders 9–16 8
Gastrointestinal 17–23 7
Disorders
Endocrine Disorders 24–30 7
Renal Disorders 31–36 6
Neurological Disorders 37–44 8
Musculoskeletal 45–49 5
Disorders
Pharmacology & 50–55 6
Medication Safety
Perioperative & Wound 56–60 5
Care
Infection Control & 61–64 4
Isolation
Fluid/Electrolyte & 65–68 4
Acid-Base
Patient Education & 69–71 3
Health Promotion
Cultural Competence & 72–73 2
Health Equity
Legal/Ethical & Scope 74–75 2
of Practice
Total 1–75 75
1
,Section 1: Cardiac Disorders
1. A client with heart failure reports waking up breathless at night. Which intervention should the nurse
implement first?
A. Restrict fluid intake to 500 mL/day
B. Elevate the head of the bed 30-45 degrees
C. Administer prescribed diuretic
D. Obtain a pulse oximetry reading
Rationale: Elevating the head of the bed reduces venous return to the heart, relieving pulmonary congestion immediately.
This is a non-invasive, safety-first intervention aligned with the ABC (Airway, Breathing, Circulation) framework. While
diuretics address fluid overload pharmacologically, positioning is the priority nursing action before medications can take
effect. Fluid restriction requires a provider order, and pulse oximetry is an assessment action that does not relieve the
symptom directly.
2. A client is receiving digoxin (Lanoxin) 0.25 mg PO daily. Which finding requires the nurse to withhold the
dose and notify the provider?
A. Heart rate 78 bpm B. Potassium level 4.2 mEq/L
C. Heart rate 56 bpm D. Blood pressure 118/76 mmHg
Rationale: Digoxin slows AV node conduction, and the primary toxicity indicator is a heart rate below 60 bpm. The nurse
must withhold the dose and notify the provider immediately per pharmacological safety protocols. Hypokalemia (not the
normal K+ of 4.2) increases digoxin toxicity risk, but bradycardia is the immediate contraindication. Heart rate of 78 bpm
and normal blood pressure are within acceptable parameters for safe administration.
3. A client admitted with acute myocardial infarction (AMI) reports severe substernal chest pain radiating to the
left arm. Which is the priority nursing action?
A. Administer prescribed sublingual nitroglycerin
B. Obtain a 12-lead electrocardiogram (ECG)
C. Assess vital signs and oxygen saturation
D. Prepare the client for emergency percutaneous coronary intervention (PCI)
Rationale: Chest pain management in AMI follows the MONA protocol (Morphine, Oxygen, Nitroglycerin, Aspirin).
Nitroglycerin is the first-line pharmacologic intervention to relieve ischemic pain by coronary vasodilation and reducing
myocardial oxygen demand. While ECG is critical for diagnosis, pain relief takes precedence to limit myocardial damage.
Vitals are assessed concurrently but do not replace immediate pain intervention. PCI preparation follows after initial
stabilization.
2
, 4. A client with atrial fibrillation is prescribed warfarin (Coumadin). Which INR range indicates therapeutic
anticoagulation?
A. 1.0-2.0 B. 2.0-3.0
C. 3.0-4.0 D. 4.0-5.0
Rationale: For atrial fibrillation, the target INR is 2.0-3.0 per AHA/ACC and CHEST guidelines. This range balances
thromboembolism prevention against bleeding risk. An INR below 2.0 provides insufficient protection against stroke; above
3.0 significantly increases hemorrhage risk without additional therapeutic benefit. Range 3.0-4.0 is reserved for
mechanical heart valve patients, and 4.0-5.0 is dangerously high for any indication.
5. A nurse is assessing a client with left-sided heart failure. Which assessment finding is most consistent with this
condition?
A. Jugular venous distention B. Crackles in bilateral lung bases
C. Dependent peripheral edema D. Hepatomegaly and ascites
Rationale: Left-sided heart failure causes pulmonary congestion due to backup of blood into the pulmonary vasculature,
resulting in crackles (rales) in the lung bases from fluid accumulation in the alveoli. Jugular venous distention, peripheral
edema, and hepatomegaly are manifestations of right-sided heart failure resulting from systemic venous congestion.
Differentiating left from right heart failure is fundamental to targeted nursing assessment and intervention planning.
6. A client with a history of hypertension is prescribed lisinopril (an ACE inhibitor). Which instruction is most
important for the nurse to include in discharge teaching?
A. Increase potassium-rich foods in the diet
B. Rise slowly from sitting or lying positions
C. Expect a persistent dry cough and do not report it
D. Take the medication at bedtime only
Rationale: ACE inhibitors cause vasodilation, which can lead to orthostatic hypotension and fall risk. Instructing the client
to change positions slowly is a critical safety intervention. ACE inhibitors actually cause potassium retention
(hyperkalemia risk), so increasing potassium-rich foods is contraindicated. A persistent dry cough is a known side effect
that should be reported to the provider for potential medication change, not ignored. Lisinopril can be taken at any time of
day.
7. A client who had a permanent pacemaker inserted reports dizziness and lightheadedness. The nurse observes a
heart rate of 42 bpm on the monitor. What is the priority action?
A. Reassure the client this is expected after insertion
B. Apply a magnet over the pacemaker generator
C. Assess the pacemaker incision site for infection
D. Notify the provider immediately
3
2026/2027 Academic Year
75 Questions with Correct Answers and Rationales
Instructions: Select the best answer for each question. Correct answers appear in
bold cyan with accompanying rationales.
Domain Questions Items Score
Cardiac Disorders 1–8 8
Respiratory Disorders 9–16 8
Gastrointestinal 17–23 7
Disorders
Endocrine Disorders 24–30 7
Renal Disorders 31–36 6
Neurological Disorders 37–44 8
Musculoskeletal 45–49 5
Disorders
Pharmacology & 50–55 6
Medication Safety
Perioperative & Wound 56–60 5
Care
Infection Control & 61–64 4
Isolation
Fluid/Electrolyte & 65–68 4
Acid-Base
Patient Education & 69–71 3
Health Promotion
Cultural Competence & 72–73 2
Health Equity
Legal/Ethical & Scope 74–75 2
of Practice
Total 1–75 75
1
,Section 1: Cardiac Disorders
1. A client with heart failure reports waking up breathless at night. Which intervention should the nurse
implement first?
A. Restrict fluid intake to 500 mL/day
B. Elevate the head of the bed 30-45 degrees
C. Administer prescribed diuretic
D. Obtain a pulse oximetry reading
Rationale: Elevating the head of the bed reduces venous return to the heart, relieving pulmonary congestion immediately.
This is a non-invasive, safety-first intervention aligned with the ABC (Airway, Breathing, Circulation) framework. While
diuretics address fluid overload pharmacologically, positioning is the priority nursing action before medications can take
effect. Fluid restriction requires a provider order, and pulse oximetry is an assessment action that does not relieve the
symptom directly.
2. A client is receiving digoxin (Lanoxin) 0.25 mg PO daily. Which finding requires the nurse to withhold the
dose and notify the provider?
A. Heart rate 78 bpm B. Potassium level 4.2 mEq/L
C. Heart rate 56 bpm D. Blood pressure 118/76 mmHg
Rationale: Digoxin slows AV node conduction, and the primary toxicity indicator is a heart rate below 60 bpm. The nurse
must withhold the dose and notify the provider immediately per pharmacological safety protocols. Hypokalemia (not the
normal K+ of 4.2) increases digoxin toxicity risk, but bradycardia is the immediate contraindication. Heart rate of 78 bpm
and normal blood pressure are within acceptable parameters for safe administration.
3. A client admitted with acute myocardial infarction (AMI) reports severe substernal chest pain radiating to the
left arm. Which is the priority nursing action?
A. Administer prescribed sublingual nitroglycerin
B. Obtain a 12-lead electrocardiogram (ECG)
C. Assess vital signs and oxygen saturation
D. Prepare the client for emergency percutaneous coronary intervention (PCI)
Rationale: Chest pain management in AMI follows the MONA protocol (Morphine, Oxygen, Nitroglycerin, Aspirin).
Nitroglycerin is the first-line pharmacologic intervention to relieve ischemic pain by coronary vasodilation and reducing
myocardial oxygen demand. While ECG is critical for diagnosis, pain relief takes precedence to limit myocardial damage.
Vitals are assessed concurrently but do not replace immediate pain intervention. PCI preparation follows after initial
stabilization.
2
, 4. A client with atrial fibrillation is prescribed warfarin (Coumadin). Which INR range indicates therapeutic
anticoagulation?
A. 1.0-2.0 B. 2.0-3.0
C. 3.0-4.0 D. 4.0-5.0
Rationale: For atrial fibrillation, the target INR is 2.0-3.0 per AHA/ACC and CHEST guidelines. This range balances
thromboembolism prevention against bleeding risk. An INR below 2.0 provides insufficient protection against stroke; above
3.0 significantly increases hemorrhage risk without additional therapeutic benefit. Range 3.0-4.0 is reserved for
mechanical heart valve patients, and 4.0-5.0 is dangerously high for any indication.
5. A nurse is assessing a client with left-sided heart failure. Which assessment finding is most consistent with this
condition?
A. Jugular venous distention B. Crackles in bilateral lung bases
C. Dependent peripheral edema D. Hepatomegaly and ascites
Rationale: Left-sided heart failure causes pulmonary congestion due to backup of blood into the pulmonary vasculature,
resulting in crackles (rales) in the lung bases from fluid accumulation in the alveoli. Jugular venous distention, peripheral
edema, and hepatomegaly are manifestations of right-sided heart failure resulting from systemic venous congestion.
Differentiating left from right heart failure is fundamental to targeted nursing assessment and intervention planning.
6. A client with a history of hypertension is prescribed lisinopril (an ACE inhibitor). Which instruction is most
important for the nurse to include in discharge teaching?
A. Increase potassium-rich foods in the diet
B. Rise slowly from sitting or lying positions
C. Expect a persistent dry cough and do not report it
D. Take the medication at bedtime only
Rationale: ACE inhibitors cause vasodilation, which can lead to orthostatic hypotension and fall risk. Instructing the client
to change positions slowly is a critical safety intervention. ACE inhibitors actually cause potassium retention
(hyperkalemia risk), so increasing potassium-rich foods is contraindicated. A persistent dry cough is a known side effect
that should be reported to the provider for potential medication change, not ignored. Lisinopril can be taken at any time of
day.
7. A client who had a permanent pacemaker inserted reports dizziness and lightheadedness. The nurse observes a
heart rate of 42 bpm on the monitor. What is the priority action?
A. Reassure the client this is expected after insertion
B. Apply a magnet over the pacemaker generator
C. Assess the pacemaker incision site for infection
D. Notify the provider immediately
3
