1
NURS 5433 Final ACTUAL EXAM 2026/2027 |
All Questions and Correct Verified Answers |
Latest Update This Year NEW!! | Pass
Guaranteed - A+ Graded
Question 1
A 68-year-old patient with metastatic melanoma, type 2 diabetes, and recent
COVID-19 infection presents with progressive dyspnea, hypoxemia requiring 15L
high-flow nasal cannula, and diffuse ground-glass opacities on CT. The oncology
team is considering pembrolizumab restart. Which pathophysiological mechanism
best explains the likely cause of respiratory failure, and what is the most critical
diagnostic test to guide immediate therapy?
A. Checkpoint inhibitor-induced pneumonitis; serum IL-6 level and corticosteroid
trial
B. COVID-19-related pulmonary fibrosis; bronchoalveolar lavage for viral cultures
C. Drug-induced organizing pneumonia; transbronchial biopsy for definitive
diagnosis
D. Immune-related adverse event (irAE) vs. viral pneumonia; CRP, procalcitonin,
and BAL with viral PCR panel
Correct Answer: D
Detailed Rationale: This complex presentation demonstrates the critical differential
between immune-related adverse events (irAEs) and persistent viral pathology in
the immunocompromised host. The 2026 ASCO guidelines emphasize that
checkpoint inhibitor-related pneumonitis occurs in 3-5% of patients, typically 2-24
months after initiation, but can be precipitated by viral triggers. The concurrent
temporal relationship with recent COVID-19, which can cause persistent viral
shedding and immune dysregulation, necessitates a multimodal diagnostic
approach. While corticosteroids are first-line for irAEs, premature administration
,2
without excluding active viral replication risks worsening infection. The serum IL-
6 elevation (Option A) is non-specific and appears in both conditions.
Transbronchial biopsy (Option C) carries prohibitive risk in a hypoxemic patient.
The evidence-based approach requires both inflammatory markers (CRP,
procalcitonin) and BAL with multiplex PCR to differentiate viral persistence from
irAEs before initiating immunosuppression. This reflects the 2026 shift toward
precision diagnostics in onco-immunology.
Question 2
A rural critical access hospital's leadership team is implementing an AI-driven
predictive analytics platform for sepsis detection. Which ethical framework best
addresses the tension between improved outcomes and algorithmic bias against
underrepresented populations in the training data, and what concurrent quality
measure should be prioritized?
A. Utilitarianism; implement algorithm immediately, measuring aggregate
mortality reduction
B. Justice and health equity; conduct algorithmic fairness auditing with
demographic stratification of sensitivity/specificity before deployment, addressing
model drift
C. Deontology; reject AI implementation as it violates individual physician
autonomy in diagnosis
D. Virtue ethics; deploy system while training staff on compassionate care to offset
bias
Correct Answer: B
Detailed Rationale: The 2026 WHO guidance on AI in healthcare explicitly
requires algorithmic fairness assessment as a quality imperative, not an
afterthought. Historical sepsis algorithms have demonstrated 15-20% lower
sensitivity in Black and Hispanic populations due to biased vital sign baselines and
lab thresholds. A justice-based framework demands proactive demographic
stratification of performance metrics, continuous monitoring for model drift, and
transparent reporting to CMS quality programs. Option A's utilitarian approach
ignores distributive justice and violates the Joint Commission's 2026 health equity
,3
standards. Option C's categorical rejection ignores AI's proven mortality benefits
(NNT ≈ 50 for sepsis bundle activation). Option D's virtue-based approach is
insufficient without structural bias mitigation.
Question 3
A 72-year-old patient with heart failure with preserved ejection fraction (HFpEF),
CKD stage 3b (eGFR 32 mL/min), and atrial fibrillation on apixaban presents with
acute decompensated HF. The admitting team must balance diuresis with renal
perfusion while managing anticoagulation. Based on 2026 ACC/AHA/HFSA HF
guidelines, which medication adjustment represents the most evidence-based
approach?
A. Initiate high-dose loop diuretic bolus, continue apixaban at standard dose, add
empagliflozin 10 mg daily
B. Start continuous loop diuretic infusion, reduce apixaban dose by 50% due to
CKD, hold SGLT2 inhibitor until eGFR >45
C. Use loop diuretic with metolazone synergy, continue apixaban with anti-Xa
monitoring, empagliflozin 10 mg regardless of eGFR down to 20
D. Replace apixaban with warfarin for better renal clearance monitoring, avoid
diuretics in HFpEF
Correct Answer: C
Detailed Rationale: The 2026 HF guideline update fundamentally changed SGLT2
inhibitor recommendations, now endorsing empagliflozin for HFpEF down to
eGFR 20 mL/min based on EMPEROR-Preserved extended follow-up showing
preserved cardiovascular benefit. For diuretic resistance in CKD, the metolazone-
loop synergy achieves effective natriuresis. While apixaban dose reduction is
recommended for severe CKD (eGFR 15-29) or end-stage disease, in stage 3b with
AF, the standard DOAC dose maintains stroke prevention with lower bleeding risk
than warfarin. Anti-Xa monitoring (though not required by FDA) provides
pharmacokinetic precision in this high-risk scenario. Option A's standard-dose
diuretic is insufficient for high loop threshold in CKD. Option B's SGLT2 hold
contradicts current evidence. Option D's warfarin substitution increases bleeding
and monitoring burden without benefit.
, 4
Question 4
A hospital system is transitioning to a value-based care model for total joint
arthroplasty. The leadership must redesign care pathways, incentive structures, and
quality metrics. Which organizational change theory best predicts resistance from
orthopedic surgeons, and which countermeasure is most effective?
A. Lewin's Unfreeze-Change-Refreeze; mandating participation with financial
penalties for non-compliance
B. Kotter's 8-Step Model; building urgency through data on cost variation while
creating a guiding coalition that includes respected surgeon champions
C. Roger's Diffusion of Innovations; focusing on early adopters and ignoring late
majority/laggards
D. Complexity Science; allowing self-organization without structured intervention
Correct Answer: B
Detailed Rationale: Kotter's framework systematically addresses physician
resistance by targeting both rational and emotional drivers. The 2026 CMS
Bundled Payments for Care Improvement Advanced (BPCI-A) program requires
surgeon engagement in episode-based cost accountability. Step 1 (Create Urgency)
leverages surgeons' competitive nature through peer-comparison dashboards of
cost and outcomes. Step 2 (Guiding Coalition) is critical—surgeon champions
provide peer credibility that administrative mandates lack. Lewin's model (Option
A) is too simplistic for complex professional culture change and mandates generate
covert resistance. Roger's model (Option C) insufficiently addresses the power
dynamics in physician-led departments. Complexity science (Option D)
underestimates the need for deliberate structure in high-stakes reimbursement
models.
Question 5
A patient with BRCA1-positive triple-negative breast cancer is considering
neoadjuvant immunotherapy (pembrolizumab + chemotherapy). Pharmacogenomic
testing reveals a CYP2D6 poor metabolizer phenotype. The oncology nurse
navigator must coordinate care with pharmacy, genetics, and psychosocial services.
NURS 5433 Final ACTUAL EXAM 2026/2027 |
All Questions and Correct Verified Answers |
Latest Update This Year NEW!! | Pass
Guaranteed - A+ Graded
Question 1
A 68-year-old patient with metastatic melanoma, type 2 diabetes, and recent
COVID-19 infection presents with progressive dyspnea, hypoxemia requiring 15L
high-flow nasal cannula, and diffuse ground-glass opacities on CT. The oncology
team is considering pembrolizumab restart. Which pathophysiological mechanism
best explains the likely cause of respiratory failure, and what is the most critical
diagnostic test to guide immediate therapy?
A. Checkpoint inhibitor-induced pneumonitis; serum IL-6 level and corticosteroid
trial
B. COVID-19-related pulmonary fibrosis; bronchoalveolar lavage for viral cultures
C. Drug-induced organizing pneumonia; transbronchial biopsy for definitive
diagnosis
D. Immune-related adverse event (irAE) vs. viral pneumonia; CRP, procalcitonin,
and BAL with viral PCR panel
Correct Answer: D
Detailed Rationale: This complex presentation demonstrates the critical differential
between immune-related adverse events (irAEs) and persistent viral pathology in
the immunocompromised host. The 2026 ASCO guidelines emphasize that
checkpoint inhibitor-related pneumonitis occurs in 3-5% of patients, typically 2-24
months after initiation, but can be precipitated by viral triggers. The concurrent
temporal relationship with recent COVID-19, which can cause persistent viral
shedding and immune dysregulation, necessitates a multimodal diagnostic
approach. While corticosteroids are first-line for irAEs, premature administration
,2
without excluding active viral replication risks worsening infection. The serum IL-
6 elevation (Option A) is non-specific and appears in both conditions.
Transbronchial biopsy (Option C) carries prohibitive risk in a hypoxemic patient.
The evidence-based approach requires both inflammatory markers (CRP,
procalcitonin) and BAL with multiplex PCR to differentiate viral persistence from
irAEs before initiating immunosuppression. This reflects the 2026 shift toward
precision diagnostics in onco-immunology.
Question 2
A rural critical access hospital's leadership team is implementing an AI-driven
predictive analytics platform for sepsis detection. Which ethical framework best
addresses the tension between improved outcomes and algorithmic bias against
underrepresented populations in the training data, and what concurrent quality
measure should be prioritized?
A. Utilitarianism; implement algorithm immediately, measuring aggregate
mortality reduction
B. Justice and health equity; conduct algorithmic fairness auditing with
demographic stratification of sensitivity/specificity before deployment, addressing
model drift
C. Deontology; reject AI implementation as it violates individual physician
autonomy in diagnosis
D. Virtue ethics; deploy system while training staff on compassionate care to offset
bias
Correct Answer: B
Detailed Rationale: The 2026 WHO guidance on AI in healthcare explicitly
requires algorithmic fairness assessment as a quality imperative, not an
afterthought. Historical sepsis algorithms have demonstrated 15-20% lower
sensitivity in Black and Hispanic populations due to biased vital sign baselines and
lab thresholds. A justice-based framework demands proactive demographic
stratification of performance metrics, continuous monitoring for model drift, and
transparent reporting to CMS quality programs. Option A's utilitarian approach
ignores distributive justice and violates the Joint Commission's 2026 health equity
,3
standards. Option C's categorical rejection ignores AI's proven mortality benefits
(NNT ≈ 50 for sepsis bundle activation). Option D's virtue-based approach is
insufficient without structural bias mitigation.
Question 3
A 72-year-old patient with heart failure with preserved ejection fraction (HFpEF),
CKD stage 3b (eGFR 32 mL/min), and atrial fibrillation on apixaban presents with
acute decompensated HF. The admitting team must balance diuresis with renal
perfusion while managing anticoagulation. Based on 2026 ACC/AHA/HFSA HF
guidelines, which medication adjustment represents the most evidence-based
approach?
A. Initiate high-dose loop diuretic bolus, continue apixaban at standard dose, add
empagliflozin 10 mg daily
B. Start continuous loop diuretic infusion, reduce apixaban dose by 50% due to
CKD, hold SGLT2 inhibitor until eGFR >45
C. Use loop diuretic with metolazone synergy, continue apixaban with anti-Xa
monitoring, empagliflozin 10 mg regardless of eGFR down to 20
D. Replace apixaban with warfarin for better renal clearance monitoring, avoid
diuretics in HFpEF
Correct Answer: C
Detailed Rationale: The 2026 HF guideline update fundamentally changed SGLT2
inhibitor recommendations, now endorsing empagliflozin for HFpEF down to
eGFR 20 mL/min based on EMPEROR-Preserved extended follow-up showing
preserved cardiovascular benefit. For diuretic resistance in CKD, the metolazone-
loop synergy achieves effective natriuresis. While apixaban dose reduction is
recommended for severe CKD (eGFR 15-29) or end-stage disease, in stage 3b with
AF, the standard DOAC dose maintains stroke prevention with lower bleeding risk
than warfarin. Anti-Xa monitoring (though not required by FDA) provides
pharmacokinetic precision in this high-risk scenario. Option A's standard-dose
diuretic is insufficient for high loop threshold in CKD. Option B's SGLT2 hold
contradicts current evidence. Option D's warfarin substitution increases bleeding
and monitoring burden without benefit.
, 4
Question 4
A hospital system is transitioning to a value-based care model for total joint
arthroplasty. The leadership must redesign care pathways, incentive structures, and
quality metrics. Which organizational change theory best predicts resistance from
orthopedic surgeons, and which countermeasure is most effective?
A. Lewin's Unfreeze-Change-Refreeze; mandating participation with financial
penalties for non-compliance
B. Kotter's 8-Step Model; building urgency through data on cost variation while
creating a guiding coalition that includes respected surgeon champions
C. Roger's Diffusion of Innovations; focusing on early adopters and ignoring late
majority/laggards
D. Complexity Science; allowing self-organization without structured intervention
Correct Answer: B
Detailed Rationale: Kotter's framework systematically addresses physician
resistance by targeting both rational and emotional drivers. The 2026 CMS
Bundled Payments for Care Improvement Advanced (BPCI-A) program requires
surgeon engagement in episode-based cost accountability. Step 1 (Create Urgency)
leverages surgeons' competitive nature through peer-comparison dashboards of
cost and outcomes. Step 2 (Guiding Coalition) is critical—surgeon champions
provide peer credibility that administrative mandates lack. Lewin's model (Option
A) is too simplistic for complex professional culture change and mandates generate
covert resistance. Roger's model (Option C) insufficiently addresses the power
dynamics in physician-led departments. Complexity science (Option D)
underestimates the need for deliberate structure in high-stakes reimbursement
models.
Question 5
A patient with BRCA1-positive triple-negative breast cancer is considering
neoadjuvant immunotherapy (pembrolizumab + chemotherapy). Pharmacogenomic
testing reveals a CYP2D6 poor metabolizer phenotype. The oncology nurse
navigator must coordinate care with pharmacy, genetics, and psychosocial services.
