NSG 430 Exam 3 – GCU Adult Health Nursing II – (2026)
Actual Questions & Answers — 100 Questions
Section 1: Cardiovascular Disorders (Questions 1-10)
1 A patient with chronic heart failure (NYHA class III) on optimal medical therapy presents with worsening
dyspnea, orthopnea, and a 5 kg weight gain over 3 days. Vital signs: BP 98/62, HR 92, RR 24, SpO2 90% on
room air. Laboratory findings: BNP 1200 pg/mL, creatinine 1.8 mg/dL (baseline 1.2), potassium 3.2 mEq/L.
Which combination of interventions is most appropriate initially?
A) Administer furosemide 40 mg IV push and start dopamine at 5 mcg/kg/min
B) Administer metoprolol succinate 50 mg orally and spironolactone 25 mg orally
C) Administer dobutamine infusion at 5 mcg/kg/min and furosemide 80 mg IV push
D) Administer nitroglycerin sublingual 0.4 mg and start nesiritide infusion
Answer: A
Rationale: The patient has decompensated heart failure with hypoperfusion (low BP) and fluid overload. Furosemide
addresses volume overload; low-dose dopamine improves renal perfusion and diuresis. Metoprolol is
contraindicated in acute decompensation due to negative inotropy (B). Dobutamine may be used but without
diuretic is insufficient; furosemide dose is high (C). Nitroglycerin and nesiritide are vasodilators that could worsen
hypotension (D).
2 A patient with ST-elevation myocardial infarction (STEMI) undergoes primary percutaneous coronary
intervention (PCI) with drug-eluting stent placement to the left anterior descending artery. Post-procedure, the
patient develops chest pain and ST elevation in leads V3-V4. What is the most likely cause?
A) Coronary artery vasospasm
B) Stent thrombosis
C) Pericarditis
D) No-reflow phenomenon
Answer: B
Rationale: Stent thrombosis typically presents acutely after PCI with recurrent ST elevation and chest pain due to
thrombotic occlusion. Vasospasm (A) is less common and usually resolves with nitrates. Pericarditis (C) causes
diffuse ST elevation, not localized. No-reflow (D) occurs during PCI and causes persistent ST elevation but without
recurrent pain after initial success.
3 A patient with atrial fibrillation and rapid ventricular response (HR 150 bpm) is hemodynamically unstable (BP
80/40, altered mental status). Which intervention should be performed first?
A) Administer amiodarone 150 mg IV over 10 minutes
B) Perform synchronized cardioversion at 100 J
C) Administer diltiazem 20 mg IV push
D) Start heparin infusion and schedule transesophageal echocardiogram
Answer: B
Rationale: In unstable atrial fibrillation with hypotension and altered mental status, immediate synchronized
cardioversion is indicated to restore cardiac output. Amiodarone (A) or diltiazem (C) are rate/rhythm control
options for stable patients. Anticoagulation (D) is important but not the priority in instability.
,4 A patient with severe aortic stenosis (valve area 0.7 cm²) is scheduled for elective aortic valve replacement.
Preoperative echocardiogram shows left ventricular ejection fraction 35%. Which hemodynamic finding is most
concerning for perioperative risk?
A) Mean aortic valve gradient 50 mmHg
B) Pulmonary artery systolic pressure 60 mmHg
C) Cardiac index 2.2 L/min/m²
D) Left ventricular end-diastolic pressure 25 mmHg
Answer: B
Rationale: Pulmonary hypertension (PASP >55 mmHg) in aortic stenosis indicates advanced disease and increased
perioperative mortality. A mean gradient of 50 mmHg (A) is expected in severe AS. Low cardiac index (C) and
elevated LVEDP (D) are common but less predictive of poor outcomes than pulmonary hypertension.
5 A patient with hypertrophic cardiomyopathy (HOCM) experiences syncope during exercise. Which
pathophysiologic mechanism most likely contributed?
A) Increased preload leading to left ventricular outflow tract obstruction
B) Decreased afterload causing dynamic outflow tract obstruction
C) Tachycardia-induced myocardial ischemia
D) Paradoxical embolus from left atrial thrombus
Answer: B
Rationale: In HOCM, exercise reduces afterload and increases contractility, worsening LVOT obstruction and
decreasing cardiac output. Increased preload (A) typically reduces obstruction. Ischemia (C) can occur but is not
the primary cause of syncope. Embolus (D) is rare and not exercise-related.
6 A patient with acute pericarditis presents with chest pain, fever, and pericardial rub. ECG shows diffuse ST
elevation and PR depression. Which laboratory finding is most specific for the diagnosis?
A) Elevated troponin I
B) Elevated C-reactive protein
C) Positive anti-nuclear antibody
D) Elevated creatine kinase-MB
Answer: B
Rationale: CRP is elevated in acute pericarditis and helps confirm inflammation; it is more specific than troponin
(A) which may be mildly elevated due to epicardial involvement. ANA (C) suggests autoimmune cause but not
specific. CK-MB (D) is rarely elevated in pericarditis.
7 A patient with chronic hypertension (BP 160/100) on lisinopril 40 mg daily and amlodipine 10 mg daily has a
serum potassium of 5.6 mEq/L and creatinine 1.4 mg/dL. Which medication adjustment is most appropriate?
A) Discontinue lisinopril and add chlorthalidone
B) Reduce amlodipine dose and add metoprolol
C) Continue current regimen and start spironolactone
D) Increase lisinopril to 50 mg daily
Answer: A
Rationale: Hyperkalemia (5.6) with ACE inhibitor use warrants discontinuation of lisinopril. Adding chlorthalidone,
a thiazide diuretic, promotes potassium excretion and controls BP. Reducing amlodipine (B) may worsen BP
control. Spironolactone (C) would worsen hyperkalemia. Increasing lisinopril (D) is dangerous.
, 8 A patient with infective endocarditis (IE) of the mitral valve develops sudden onset left-sided weakness and
aphasia. CT head shows no hemorrhage. Which valve vegetation characteristic is most strongly associated with
embolic events?
A) Vegetation size >10 mm
B) Vegetation location on the atrial side
C) Presence of Streptococcus viridans
D) Mobility of the vegetation
Answer: A
Rationale: Vegetation size >10 mm is a strong predictor of embolic events in IE. Location (B) and organism (C) are
less predictive. Mobility (D) is also a factor but size is the most studied and consistent predictor.
9 A patient with acute decompensated heart failure and severe mitral regurgitation has a pulmonary artery catheter
placed. Which hemodynamic profile is most consistent with this condition?
A) PCWP 12 mmHg, CO 5.0 L/min, SVR 800 dynes·sec/cm u
B) PCWP 28 mmHg, CO 3.2 L/min, SVR 1400 dynes·sec/cm u
C) PCWP 8 mmHg, CO 6.5 L/min, SVR 600 dynes·sec/cm u
D) PCWP 22 mmHg, CO 4.8 L/min, SVR 900 dynes·sec/cm u
Answer: B
Rationale: Acute MR with HF leads to elevated PCWP (volume overload), low CO (decreased forward flow), and
high SVR (compensatory vasoconstriction). Profile B shows these features. Profile A is normal. Profile C suggests
distributive shock. Profile D indicates mild elevation but not severe MR.
10 A patient with peripheral artery disease (PAD) undergoes right femoral-popliteal bypass grafting. On
postoperative day 1, the right foot is cool, pale, and pulseless. Doppler signals are absent. What is the priority
nursing action?
A) Elevate the right leg above heart level
B) Apply warm packs to the right foot
C) Notify the surgeon immediately and prepare for possible thrombectomy
D) Administer heparin 5000 units IV bolus as prescribed
Answer: C
Rationale: Acute graft occlusion presents with acute limb ischemia (cool, pale, pulseless). Immediate surgical
evaluation is needed for thrombectomy or revision. Elevation (A) worsens ischemia. Warm packs (B) may increase
metabolic demand. Heparin (D) may be given after notification but surgery is urgent.
Section 2: Respiratory Disorders (Questions 11-20)
11 A patient with a history of moderate persistent asthma is admitted with acute dyspnea, wheezing, and a PaO2 of
60 mmHg on room air. After initial treatment with albuterol and ipratropium, the patient's peak expiratory flow
(PEF) is 40% of predicted. Which intervention should the nurse anticipate next?
A) Initiate noninvasive positive pressure ventilation (NIPPV) with bi-level positive airway pressure (BiPAP).
B) Administer intravenous magnesium sulfate over 20 minutes.
C) Start systemic corticosteroids and consider intubation if no improvement in 2 hours.
D) Repeat albuterol nebulization every 20 minutes for three doses and reassess.
Answer: B
Rationale: In acute severe asthma exacerbation with PEF <50% predicted and poor response to initial
bronchodilators, intravenous magnesium sulfate is recommended as adjunct therapy. NIPPV is not first-line in
Actual Questions & Answers — 100 Questions
Section 1: Cardiovascular Disorders (Questions 1-10)
1 A patient with chronic heart failure (NYHA class III) on optimal medical therapy presents with worsening
dyspnea, orthopnea, and a 5 kg weight gain over 3 days. Vital signs: BP 98/62, HR 92, RR 24, SpO2 90% on
room air. Laboratory findings: BNP 1200 pg/mL, creatinine 1.8 mg/dL (baseline 1.2), potassium 3.2 mEq/L.
Which combination of interventions is most appropriate initially?
A) Administer furosemide 40 mg IV push and start dopamine at 5 mcg/kg/min
B) Administer metoprolol succinate 50 mg orally and spironolactone 25 mg orally
C) Administer dobutamine infusion at 5 mcg/kg/min and furosemide 80 mg IV push
D) Administer nitroglycerin sublingual 0.4 mg and start nesiritide infusion
Answer: A
Rationale: The patient has decompensated heart failure with hypoperfusion (low BP) and fluid overload. Furosemide
addresses volume overload; low-dose dopamine improves renal perfusion and diuresis. Metoprolol is
contraindicated in acute decompensation due to negative inotropy (B). Dobutamine may be used but without
diuretic is insufficient; furosemide dose is high (C). Nitroglycerin and nesiritide are vasodilators that could worsen
hypotension (D).
2 A patient with ST-elevation myocardial infarction (STEMI) undergoes primary percutaneous coronary
intervention (PCI) with drug-eluting stent placement to the left anterior descending artery. Post-procedure, the
patient develops chest pain and ST elevation in leads V3-V4. What is the most likely cause?
A) Coronary artery vasospasm
B) Stent thrombosis
C) Pericarditis
D) No-reflow phenomenon
Answer: B
Rationale: Stent thrombosis typically presents acutely after PCI with recurrent ST elevation and chest pain due to
thrombotic occlusion. Vasospasm (A) is less common and usually resolves with nitrates. Pericarditis (C) causes
diffuse ST elevation, not localized. No-reflow (D) occurs during PCI and causes persistent ST elevation but without
recurrent pain after initial success.
3 A patient with atrial fibrillation and rapid ventricular response (HR 150 bpm) is hemodynamically unstable (BP
80/40, altered mental status). Which intervention should be performed first?
A) Administer amiodarone 150 mg IV over 10 minutes
B) Perform synchronized cardioversion at 100 J
C) Administer diltiazem 20 mg IV push
D) Start heparin infusion and schedule transesophageal echocardiogram
Answer: B
Rationale: In unstable atrial fibrillation with hypotension and altered mental status, immediate synchronized
cardioversion is indicated to restore cardiac output. Amiodarone (A) or diltiazem (C) are rate/rhythm control
options for stable patients. Anticoagulation (D) is important but not the priority in instability.
,4 A patient with severe aortic stenosis (valve area 0.7 cm²) is scheduled for elective aortic valve replacement.
Preoperative echocardiogram shows left ventricular ejection fraction 35%. Which hemodynamic finding is most
concerning for perioperative risk?
A) Mean aortic valve gradient 50 mmHg
B) Pulmonary artery systolic pressure 60 mmHg
C) Cardiac index 2.2 L/min/m²
D) Left ventricular end-diastolic pressure 25 mmHg
Answer: B
Rationale: Pulmonary hypertension (PASP >55 mmHg) in aortic stenosis indicates advanced disease and increased
perioperative mortality. A mean gradient of 50 mmHg (A) is expected in severe AS. Low cardiac index (C) and
elevated LVEDP (D) are common but less predictive of poor outcomes than pulmonary hypertension.
5 A patient with hypertrophic cardiomyopathy (HOCM) experiences syncope during exercise. Which
pathophysiologic mechanism most likely contributed?
A) Increased preload leading to left ventricular outflow tract obstruction
B) Decreased afterload causing dynamic outflow tract obstruction
C) Tachycardia-induced myocardial ischemia
D) Paradoxical embolus from left atrial thrombus
Answer: B
Rationale: In HOCM, exercise reduces afterload and increases contractility, worsening LVOT obstruction and
decreasing cardiac output. Increased preload (A) typically reduces obstruction. Ischemia (C) can occur but is not
the primary cause of syncope. Embolus (D) is rare and not exercise-related.
6 A patient with acute pericarditis presents with chest pain, fever, and pericardial rub. ECG shows diffuse ST
elevation and PR depression. Which laboratory finding is most specific for the diagnosis?
A) Elevated troponin I
B) Elevated C-reactive protein
C) Positive anti-nuclear antibody
D) Elevated creatine kinase-MB
Answer: B
Rationale: CRP is elevated in acute pericarditis and helps confirm inflammation; it is more specific than troponin
(A) which may be mildly elevated due to epicardial involvement. ANA (C) suggests autoimmune cause but not
specific. CK-MB (D) is rarely elevated in pericarditis.
7 A patient with chronic hypertension (BP 160/100) on lisinopril 40 mg daily and amlodipine 10 mg daily has a
serum potassium of 5.6 mEq/L and creatinine 1.4 mg/dL. Which medication adjustment is most appropriate?
A) Discontinue lisinopril and add chlorthalidone
B) Reduce amlodipine dose and add metoprolol
C) Continue current regimen and start spironolactone
D) Increase lisinopril to 50 mg daily
Answer: A
Rationale: Hyperkalemia (5.6) with ACE inhibitor use warrants discontinuation of lisinopril. Adding chlorthalidone,
a thiazide diuretic, promotes potassium excretion and controls BP. Reducing amlodipine (B) may worsen BP
control. Spironolactone (C) would worsen hyperkalemia. Increasing lisinopril (D) is dangerous.
, 8 A patient with infective endocarditis (IE) of the mitral valve develops sudden onset left-sided weakness and
aphasia. CT head shows no hemorrhage. Which valve vegetation characteristic is most strongly associated with
embolic events?
A) Vegetation size >10 mm
B) Vegetation location on the atrial side
C) Presence of Streptococcus viridans
D) Mobility of the vegetation
Answer: A
Rationale: Vegetation size >10 mm is a strong predictor of embolic events in IE. Location (B) and organism (C) are
less predictive. Mobility (D) is also a factor but size is the most studied and consistent predictor.
9 A patient with acute decompensated heart failure and severe mitral regurgitation has a pulmonary artery catheter
placed. Which hemodynamic profile is most consistent with this condition?
A) PCWP 12 mmHg, CO 5.0 L/min, SVR 800 dynes·sec/cm u
B) PCWP 28 mmHg, CO 3.2 L/min, SVR 1400 dynes·sec/cm u
C) PCWP 8 mmHg, CO 6.5 L/min, SVR 600 dynes·sec/cm u
D) PCWP 22 mmHg, CO 4.8 L/min, SVR 900 dynes·sec/cm u
Answer: B
Rationale: Acute MR with HF leads to elevated PCWP (volume overload), low CO (decreased forward flow), and
high SVR (compensatory vasoconstriction). Profile B shows these features. Profile A is normal. Profile C suggests
distributive shock. Profile D indicates mild elevation but not severe MR.
10 A patient with peripheral artery disease (PAD) undergoes right femoral-popliteal bypass grafting. On
postoperative day 1, the right foot is cool, pale, and pulseless. Doppler signals are absent. What is the priority
nursing action?
A) Elevate the right leg above heart level
B) Apply warm packs to the right foot
C) Notify the surgeon immediately and prepare for possible thrombectomy
D) Administer heparin 5000 units IV bolus as prescribed
Answer: C
Rationale: Acute graft occlusion presents with acute limb ischemia (cool, pale, pulseless). Immediate surgical
evaluation is needed for thrombectomy or revision. Elevation (A) worsens ischemia. Warm packs (B) may increase
metabolic demand. Heparin (D) may be given after notification but surgery is urgent.
Section 2: Respiratory Disorders (Questions 11-20)
11 A patient with a history of moderate persistent asthma is admitted with acute dyspnea, wheezing, and a PaO2 of
60 mmHg on room air. After initial treatment with albuterol and ipratropium, the patient's peak expiratory flow
(PEF) is 40% of predicted. Which intervention should the nurse anticipate next?
A) Initiate noninvasive positive pressure ventilation (NIPPV) with bi-level positive airway pressure (BiPAP).
B) Administer intravenous magnesium sulfate over 20 minutes.
C) Start systemic corticosteroids and consider intubation if no improvement in 2 hours.
D) Repeat albuterol nebulization every 20 minutes for three doses and reassess.
Answer: B
Rationale: In acute severe asthma exacerbation with PEF <50% predicted and poor response to initial
bronchodilators, intravenous magnesium sulfate is recommended as adjunct therapy. NIPPV is not first-line in
