NSG 430 Exam 1 – GCU Adult Health Nursing II – (2026)
Actual Questions & Answers — 99 Questions
Section 1: Cardiovascular Disorders (Questions 1-10)
1 A patient with chronic heart failure (HFrEF, LVEF 30%) on optimal medical therapy (sacubitril/valsartan,
carvedilol, spironolactone) presents with worsening dyspnea, jugular venous distention, and 3+ pitting edema.
Vital signs: BP 88/56, HR 110, RR 24, SpO2 89% on room air. Which intervention should the nurse question if
prescribed?
A) Intravenous furosemide 40 mg now
B) Intravenous dopamine 5 mcg/kg/min
C) Intravenous nitroglycerin infusion at 10 mcg/min
D) Noninvasive positive pressure ventilation (BiPAP)
Answer: C
Rationale: Intravenous nitroglycerin is contraindicated in hypotension (systolic BP <90 mm Hg) due to risk of
further reducing coronary perfusion and worsening shock. Furosemide addresses volume overload, dopamine
provides inotropic support, and BiPAP reduces preload and work of breathing—all appropriate in this
decompensated HF with hypotension.
2 A patient with acute ST-segment elevation myocardial infarction (STEMI) undergoes primary percutaneous
coronary intervention (PCI) with a drug-eluting stent to the left anterior descending artery. Twenty-four hours
later, the patient develops chest pain, ST elevation in leads V2-V4, and elevated cardiac troponin. Which
complication is most likely?
A) Acute stent thrombosis
B) Pericarditis
C) Ventricular free wall rupture
D) Coronary vasospasm
Answer: A
Rationale: Acute stent thrombosis typically presents within 24-48 hours post-PCI with recurrent chest pain, ST
elevation, and biomarker rise. Pericarditis usually causes diffuse ST elevation and pain positional, not localized.
Free wall rupture is catastrophic with electromechanical dissociation. Vasospasm is less common and often
responds to nitrates.
3 A patient with severe aortic stenosis (valve area 0.7 cm², mean gradient 50 mm Hg) is admitted for elective
valve replacement. The patient develops sudden onset of chest pain and syncope while walking. Which
hemodynamic change most likely precipitated this event?
A) Increased left ventricular end-diastolic pressure causing pulmonary congestion
B) Fixed left ventricular outflow tract obstruction limiting cardiac output during exertion
C) Paradoxical splitting of S2 due to delayed aortic valve closure
D) Development of atrial fibrillation with rapid ventricular response
Answer: B
Rationale: In severe aortic stenosis, the fixed obstruction limits the ability to increase stroke volume during exertion,
leading to decreased cerebral perfusion (syncope) and myocardial oxygen demand-supply mismatch (angina).
Increased LVEDP causes dyspnea but not syncope directly. Atrial fibrillation worsens symptoms but is not the
primary mechanism here.
,4 A patient with hypertrophic cardiomyopathy (HCM) and a resting left ventricular outflow tract gradient of 60
mm Hg is admitted for management of dyspnea and presyncope. The nurse reviews the medication list. Which
medication should the nurse question?
A) Metoprolol succinate 100 mg daily
B) Verapamil 240 mg daily
C) Nitroglycerin sublingual 0.4 mg as needed for chest pain
D) Disopyramide 150 mg three times daily
Answer: C
Rationale: Nitroglycerin reduces preload and afterload, which can worsen the outflow tract obstruction and cause
hypotension in HCM. Beta-blockers and verapamil reduce heart rate and contractility, decreasing gradient.
Disopyramide is a negative inotrope used to reduce obstruction. Nitrates are contraindicated in obstructive HCM.
5 A patient with atrial fibrillation (AF) and a CHA2DS2-VASc score of 4 is started on warfarin for stroke
prophylaxis. Three months later, the patient develops an INR of 5.8 without bleeding. The nurse should
anticipate which order?
A) Administer vitamin K 10 mg intravenously
B) Hold warfarin and administer fresh frozen plasma
C) Hold warfarin, monitor INR daily, and resume at lower dose when INR < 3.0
D) Administer prothrombin complex concentrate 25 units/kg
Answer: C
Rationale: For asymptomatic INR >5.0 but <9.0, guidelines recommend holding warfarin and monitoring INR.
Vitamin K is given if INR >9.0 or if there is major bleeding. Fresh frozen plasma and prothrombin complex
concentrate are reserved for life-threatening bleeding. Resuming at a lower dose after INR is therapeutic avoids
overcorrection.
6 A patient in the intensive care unit with septic shock develops new-onset atrial fibrillation with rapid ventricular
response (HR 150). The patient's BP is 78/45 despite norepinephrine 0.5 mcg/kg/min. Which intervention
should the nurse prioritize?
A) Administer amiodarone 150 mg IV bolus
B) Administer diltiazem 20 mg IV bolus
C) Initiate synchronized cardioversion at 100 J
D) Administer metoprolol 5 mg IV
Answer: A
Rationale: In hemodynamically unstable patients (hypotension despite vasopressors), synchronized cardioversion is
first-line for rate control. However, amiodarone may be preferred in septic shock due to its minimal negative
inotropic effect. Diltiazem and beta-blockers can worsen hypotension. Cardioversion is appropriate but amiodarone
is often chosen to avoid sedation risks.
7 A patient with acute decompensated heart failure (ADHF) has a pulmonary artery catheter in place.
Hemodynamic values: PCWP 28 mm Hg, cardiac index 1.8 L/min/m², systemic vascular resistance 1600
dynes·sec·cm { u. Which combination of medications is most appropriate?
A) Dobutamine and intravenous furosemide
B) Nitroprusside and intravenous furosemide
C) Norepinephrine and intravenous furosemide
D) Milrinone and intravenous furosemide
Answer: B
, Rationale: This patient has a low cardiac output state with high filling pressures and high SVR (vasoconstricted).
Nitroprusside reduces afterload and preload, improving cardiac output and reducing PCWP. Furosemide addresses
volume overload. Dobutamine or milrinone could be considered if afterload reduction alone insufficient, but the
high SVR makes vasodilation primary.
8 A patient with infective endocarditis (IE) of the mitral valve develops sudden onset of severe dyspnea, pink
frothy sputum, and a new holosystolic murmur at the apex. Which complication is most likely?
A) Mitral valve perforation causing acute mitral regurgitation
B) Embolic stroke with neurogenic pulmonary edema
C) Myocardial abscess causing ventricular septal defect
D) Fistula from the left ventricle to the right atrium
Answer: A
Rationale: Acute mitral regurgitation from valve perforation or chordal rupture presents with sudden pulmonary
edema and a new holosystolic murmur at the apex. Embolic stroke does not cause pink sputum. Myocardial abscess
may cause conduction abnormalities. A fistula would produce a continuous murmur.
9 A patient with chronic hypertension presents with BP 210/140 mm Hg, headache, and blurred vision. Serum
creatinine 3.2 mg/dL, urinalysis shows proteinuria and red cell casts. Which medication should be avoided if the
patient has bilateral renal artery stenosis?
A) Labetalol
B) Nitroprusside
C) Enalaprilat
D) Hydralazine
Answer: C
Rationale: Angiotensin-converting enzyme inhibitors (e.g., enalaprilat) are contraindicated in bilateral renal artery
stenosis because they can precipitate acute kidney injury by reducing efferent arteriolar tone and glomerular
filtration pressure. Labetalol, nitroprusside, and hydralazine are safer options for hypertensive emergency in this
setting.
10 A patient with dilated cardiomyopathy (LVEF 20%) and a QRS duration of 160 ms on ECG is being evaluated
for device therapy. Which device has the strongest evidence for reducing mortality in this population?
A) Single-chamber implantable cardioverter-defibrillator (ICD)
B) Dual-chamber ICD
C) Cardiac resynchronization therapy with defibrillator (CRT-D)
D) Left ventricular assist device (LVAD)
Answer: C
Rationale: For patients with HFrEF, LVEF "d35%, and QRS "e150 ms with left bundle branch block, CRT-D reduces
mortality and hospitalizations by improving ventricular synchrony. An ICD alone treats arrhythmias but does not
improve hemodynamics. LVAD is reserved for advanced NYHA class IV patients.
Section 2: Respiratory Disorders (Questions 11-20)
11 A patient with severe COPD presents with acute-on-chronic hypercapnic respiratory failure. Despite
noninvasive positive pressure ventilation, arterial blood gas (ABG) shows pH 7.25, PaCO2 75 mm Hg, PaO2
55 mm Hg on 40% FiO2. Which intervention should the nurse anticipate as most appropriate?
A) Increase FiO2 to 100% via non-rebreather mask
B) Initiate high-frequency chest wall oscillation
Actual Questions & Answers — 99 Questions
Section 1: Cardiovascular Disorders (Questions 1-10)
1 A patient with chronic heart failure (HFrEF, LVEF 30%) on optimal medical therapy (sacubitril/valsartan,
carvedilol, spironolactone) presents with worsening dyspnea, jugular venous distention, and 3+ pitting edema.
Vital signs: BP 88/56, HR 110, RR 24, SpO2 89% on room air. Which intervention should the nurse question if
prescribed?
A) Intravenous furosemide 40 mg now
B) Intravenous dopamine 5 mcg/kg/min
C) Intravenous nitroglycerin infusion at 10 mcg/min
D) Noninvasive positive pressure ventilation (BiPAP)
Answer: C
Rationale: Intravenous nitroglycerin is contraindicated in hypotension (systolic BP <90 mm Hg) due to risk of
further reducing coronary perfusion and worsening shock. Furosemide addresses volume overload, dopamine
provides inotropic support, and BiPAP reduces preload and work of breathing—all appropriate in this
decompensated HF with hypotension.
2 A patient with acute ST-segment elevation myocardial infarction (STEMI) undergoes primary percutaneous
coronary intervention (PCI) with a drug-eluting stent to the left anterior descending artery. Twenty-four hours
later, the patient develops chest pain, ST elevation in leads V2-V4, and elevated cardiac troponin. Which
complication is most likely?
A) Acute stent thrombosis
B) Pericarditis
C) Ventricular free wall rupture
D) Coronary vasospasm
Answer: A
Rationale: Acute stent thrombosis typically presents within 24-48 hours post-PCI with recurrent chest pain, ST
elevation, and biomarker rise. Pericarditis usually causes diffuse ST elevation and pain positional, not localized.
Free wall rupture is catastrophic with electromechanical dissociation. Vasospasm is less common and often
responds to nitrates.
3 A patient with severe aortic stenosis (valve area 0.7 cm², mean gradient 50 mm Hg) is admitted for elective
valve replacement. The patient develops sudden onset of chest pain and syncope while walking. Which
hemodynamic change most likely precipitated this event?
A) Increased left ventricular end-diastolic pressure causing pulmonary congestion
B) Fixed left ventricular outflow tract obstruction limiting cardiac output during exertion
C) Paradoxical splitting of S2 due to delayed aortic valve closure
D) Development of atrial fibrillation with rapid ventricular response
Answer: B
Rationale: In severe aortic stenosis, the fixed obstruction limits the ability to increase stroke volume during exertion,
leading to decreased cerebral perfusion (syncope) and myocardial oxygen demand-supply mismatch (angina).
Increased LVEDP causes dyspnea but not syncope directly. Atrial fibrillation worsens symptoms but is not the
primary mechanism here.
,4 A patient with hypertrophic cardiomyopathy (HCM) and a resting left ventricular outflow tract gradient of 60
mm Hg is admitted for management of dyspnea and presyncope. The nurse reviews the medication list. Which
medication should the nurse question?
A) Metoprolol succinate 100 mg daily
B) Verapamil 240 mg daily
C) Nitroglycerin sublingual 0.4 mg as needed for chest pain
D) Disopyramide 150 mg three times daily
Answer: C
Rationale: Nitroglycerin reduces preload and afterload, which can worsen the outflow tract obstruction and cause
hypotension in HCM. Beta-blockers and verapamil reduce heart rate and contractility, decreasing gradient.
Disopyramide is a negative inotrope used to reduce obstruction. Nitrates are contraindicated in obstructive HCM.
5 A patient with atrial fibrillation (AF) and a CHA2DS2-VASc score of 4 is started on warfarin for stroke
prophylaxis. Three months later, the patient develops an INR of 5.8 without bleeding. The nurse should
anticipate which order?
A) Administer vitamin K 10 mg intravenously
B) Hold warfarin and administer fresh frozen plasma
C) Hold warfarin, monitor INR daily, and resume at lower dose when INR < 3.0
D) Administer prothrombin complex concentrate 25 units/kg
Answer: C
Rationale: For asymptomatic INR >5.0 but <9.0, guidelines recommend holding warfarin and monitoring INR.
Vitamin K is given if INR >9.0 or if there is major bleeding. Fresh frozen plasma and prothrombin complex
concentrate are reserved for life-threatening bleeding. Resuming at a lower dose after INR is therapeutic avoids
overcorrection.
6 A patient in the intensive care unit with septic shock develops new-onset atrial fibrillation with rapid ventricular
response (HR 150). The patient's BP is 78/45 despite norepinephrine 0.5 mcg/kg/min. Which intervention
should the nurse prioritize?
A) Administer amiodarone 150 mg IV bolus
B) Administer diltiazem 20 mg IV bolus
C) Initiate synchronized cardioversion at 100 J
D) Administer metoprolol 5 mg IV
Answer: A
Rationale: In hemodynamically unstable patients (hypotension despite vasopressors), synchronized cardioversion is
first-line for rate control. However, amiodarone may be preferred in septic shock due to its minimal negative
inotropic effect. Diltiazem and beta-blockers can worsen hypotension. Cardioversion is appropriate but amiodarone
is often chosen to avoid sedation risks.
7 A patient with acute decompensated heart failure (ADHF) has a pulmonary artery catheter in place.
Hemodynamic values: PCWP 28 mm Hg, cardiac index 1.8 L/min/m², systemic vascular resistance 1600
dynes·sec·cm { u. Which combination of medications is most appropriate?
A) Dobutamine and intravenous furosemide
B) Nitroprusside and intravenous furosemide
C) Norepinephrine and intravenous furosemide
D) Milrinone and intravenous furosemide
Answer: B
, Rationale: This patient has a low cardiac output state with high filling pressures and high SVR (vasoconstricted).
Nitroprusside reduces afterload and preload, improving cardiac output and reducing PCWP. Furosemide addresses
volume overload. Dobutamine or milrinone could be considered if afterload reduction alone insufficient, but the
high SVR makes vasodilation primary.
8 A patient with infective endocarditis (IE) of the mitral valve develops sudden onset of severe dyspnea, pink
frothy sputum, and a new holosystolic murmur at the apex. Which complication is most likely?
A) Mitral valve perforation causing acute mitral regurgitation
B) Embolic stroke with neurogenic pulmonary edema
C) Myocardial abscess causing ventricular septal defect
D) Fistula from the left ventricle to the right atrium
Answer: A
Rationale: Acute mitral regurgitation from valve perforation or chordal rupture presents with sudden pulmonary
edema and a new holosystolic murmur at the apex. Embolic stroke does not cause pink sputum. Myocardial abscess
may cause conduction abnormalities. A fistula would produce a continuous murmur.
9 A patient with chronic hypertension presents with BP 210/140 mm Hg, headache, and blurred vision. Serum
creatinine 3.2 mg/dL, urinalysis shows proteinuria and red cell casts. Which medication should be avoided if the
patient has bilateral renal artery stenosis?
A) Labetalol
B) Nitroprusside
C) Enalaprilat
D) Hydralazine
Answer: C
Rationale: Angiotensin-converting enzyme inhibitors (e.g., enalaprilat) are contraindicated in bilateral renal artery
stenosis because they can precipitate acute kidney injury by reducing efferent arteriolar tone and glomerular
filtration pressure. Labetalol, nitroprusside, and hydralazine are safer options for hypertensive emergency in this
setting.
10 A patient with dilated cardiomyopathy (LVEF 20%) and a QRS duration of 160 ms on ECG is being evaluated
for device therapy. Which device has the strongest evidence for reducing mortality in this population?
A) Single-chamber implantable cardioverter-defibrillator (ICD)
B) Dual-chamber ICD
C) Cardiac resynchronization therapy with defibrillator (CRT-D)
D) Left ventricular assist device (LVAD)
Answer: C
Rationale: For patients with HFrEF, LVEF "d35%, and QRS "e150 ms with left bundle branch block, CRT-D reduces
mortality and hospitalizations by improving ventricular synchrony. An ICD alone treats arrhythmias but does not
improve hemodynamics. LVAD is reserved for advanced NYHA class IV patients.
Section 2: Respiratory Disorders (Questions 11-20)
11 A patient with severe COPD presents with acute-on-chronic hypercapnic respiratory failure. Despite
noninvasive positive pressure ventilation, arterial blood gas (ABG) shows pH 7.25, PaCO2 75 mm Hg, PaO2
55 mm Hg on 40% FiO2. Which intervention should the nurse anticipate as most appropriate?
A) Increase FiO2 to 100% via non-rebreather mask
B) Initiate high-frequency chest wall oscillation
