NUR 600 Module 5 Exam – Questions and Answers | 2026
Update | 100% Correct - St. Thomas University.
Total Questions: 150
Format: Multiple Choice
Time Limit: 3 hours
Passing Score: 80%
Section 1: Advanced Health Assessment (Questions 1–25)
1. A 45-year-old patient presents with chest pain that is substernal, radiating
to the left arm, and associated with diaphoresis and nausea. The pain began
30 minutes ago while the patient was at rest. What is the most appropriate
initial action?
A) Order a stress test
B) Administer aspirin and obtain a STAT ECG
C) Prescribe nitroglycerin and send the patient home
D) Schedule an echocardiogram for tomorrow
Answer: B
*Rationale: This presentation is concerning for acute coronary syndrome
(ACS). The initial management includes administering aspirin (325 mg
chewed) to reduce platelet aggregation and obtaining a STAT ECG to
evaluate for ST-segment elevation or other ischemic changes.*
2. A 68-year-old patient reports progressive shortness of breath with
exertion, orthopnea, and paroxysmal nocturnal dyspnea. On examination,
the nurse practitioner notes jugular venous distention, crackles in both lung
bases, and 2+ pitting edema in the lower extremities. What is the most likely
diagnosis?
,A) Chronic obstructive pulmonary disease (COPD)
B) Heart failure with reduced ejection fraction (HFrEF)
C) Pulmonary embolism
D) Pneumonia
Answer: B
Rationale: The symptoms of dyspnea on exertion, orthopnea, and PND,
along with findings of JVD, crackles (pulmonary congestion), and peripheral
edema (systemic congestion), are classic for heart failure. Both HFrEF and
HFpEF can present this way.
3. A 55-year-old patient with a 30-pack-year smoking history presents with a
chronic cough producing small amounts of mucoid sputum. The patient
reports progressive dyspnea on exertion and wheezing. Pulmonary function
tests show FEV1/FVC ratio of 0.65. What is the most likely diagnosis?
A) Asthma
B) Chronic obstructive pulmonary disease (COPD)
C) Interstitial lung disease
D) Bronchiectasis
Answer: B
*Rationale: An FEV1/FVC ratio <0.70 confirms airflow obstruction. In a
patient with significant smoking history and chronic cough, COPD is the
most likely diagnosis. Asthma typically shows reversibility with
bronchodilators.*
4. A 32-year-old patient presents with episodic wheezing, chest tightness,
and shortness of breath that occurs after exposure to cold air and exercise.
Symptoms improve with albuterol. What is the most likely diagnosis?
A) COPD
B) Exercise-induced bronchoconstriction (asthma)
,C) Pulmonary embolism
D) Gastroesophageal reflux disease
Answer: B
Rationale: Exercise-induced bronchoconstriction is a common asthma
phenotype. Symptoms occur after (not during) exercise and respond well to
bronchodilators. Pretreatment with albuterol or ICS-formoterol before
exercise can prevent symptoms.
5. A 72-year-old patient presents with acute onset of right-sided weakness,
facial droop, and aphasia. Symptoms began 1 hour ago. CT head shows no
hemorrhage. What is the most appropriate management?
A) Aspirin 325 mg and discharge home
B) IV alteplase (tPA) if no contraindications
C) Clopidogrel 75 mg daily
D) Transfer for mechanical thrombectomy without tPA
Answer: B
*Rationale: The patient is within the 3-hour window for IV tPA (alteplase).
tPA improves outcomes in acute ischemic stroke when given within 3 hours
(or 4.5 hours with criteria). Thrombectomy may be considered for large
vessel occlusion but does not replace tPA when eligible.*
6. A 28-year-old female presents with fatigue, weight gain, cold intolerance,
and constipation. On examination, the thyroid is non-palpable. TSH is 12.5
mIU/L (normal 0.4-4.0). What is the most likely diagnosis?
A) Hyperthyroidism
B) Primary hypothyroidism
C) Subclinical hyperthyroidism
D) Thyroiditis
, Answer: B
*Rationale: Elevated TSH with low or normal free T4 indicates primary
hypothyroidism. Common causes include Hashimoto's thyroiditis
(autoimmune). Treatment is levothyroxine, starting at 1.6 mcg/kg/day.*
7. A 50-year-old patient presents with a painful, red, swollen right knee. The
patient has a history of gout. Joint aspiration reveals urate crystals. What is
the first-line treatment for an acute gout flare?
A) Allopurinol
B) Colchicine or NSAIDs (e.g., indomethacin, naproxen)
C) Febuxostat
D) Prednisone (if contraindications to NSAIDs/colchicine)
Answer: B
*Rationale: First-line treatment for acute gout flare includes NSAIDs or
colchicine (if started within 24 hours). Allopurinol and febuxostat are used
for long-term urate-lowering, not acute flares. Corticosteroids are second-
line.*
8. A 65-year-old patient with a history of diabetes and hypertension has a
blood pressure of 145/90 mmHg. According to the 2017 ACC/AHA guideline,
this is classified as:
A) Normal
B) Elevated
C) Stage 1 hypertension
D) Stage 2 hypertension
Answer: C
Update | 100% Correct - St. Thomas University.
Total Questions: 150
Format: Multiple Choice
Time Limit: 3 hours
Passing Score: 80%
Section 1: Advanced Health Assessment (Questions 1–25)
1. A 45-year-old patient presents with chest pain that is substernal, radiating
to the left arm, and associated with diaphoresis and nausea. The pain began
30 minutes ago while the patient was at rest. What is the most appropriate
initial action?
A) Order a stress test
B) Administer aspirin and obtain a STAT ECG
C) Prescribe nitroglycerin and send the patient home
D) Schedule an echocardiogram for tomorrow
Answer: B
*Rationale: This presentation is concerning for acute coronary syndrome
(ACS). The initial management includes administering aspirin (325 mg
chewed) to reduce platelet aggregation and obtaining a STAT ECG to
evaluate for ST-segment elevation or other ischemic changes.*
2. A 68-year-old patient reports progressive shortness of breath with
exertion, orthopnea, and paroxysmal nocturnal dyspnea. On examination,
the nurse practitioner notes jugular venous distention, crackles in both lung
bases, and 2+ pitting edema in the lower extremities. What is the most likely
diagnosis?
,A) Chronic obstructive pulmonary disease (COPD)
B) Heart failure with reduced ejection fraction (HFrEF)
C) Pulmonary embolism
D) Pneumonia
Answer: B
Rationale: The symptoms of dyspnea on exertion, orthopnea, and PND,
along with findings of JVD, crackles (pulmonary congestion), and peripheral
edema (systemic congestion), are classic for heart failure. Both HFrEF and
HFpEF can present this way.
3. A 55-year-old patient with a 30-pack-year smoking history presents with a
chronic cough producing small amounts of mucoid sputum. The patient
reports progressive dyspnea on exertion and wheezing. Pulmonary function
tests show FEV1/FVC ratio of 0.65. What is the most likely diagnosis?
A) Asthma
B) Chronic obstructive pulmonary disease (COPD)
C) Interstitial lung disease
D) Bronchiectasis
Answer: B
*Rationale: An FEV1/FVC ratio <0.70 confirms airflow obstruction. In a
patient with significant smoking history and chronic cough, COPD is the
most likely diagnosis. Asthma typically shows reversibility with
bronchodilators.*
4. A 32-year-old patient presents with episodic wheezing, chest tightness,
and shortness of breath that occurs after exposure to cold air and exercise.
Symptoms improve with albuterol. What is the most likely diagnosis?
A) COPD
B) Exercise-induced bronchoconstriction (asthma)
,C) Pulmonary embolism
D) Gastroesophageal reflux disease
Answer: B
Rationale: Exercise-induced bronchoconstriction is a common asthma
phenotype. Symptoms occur after (not during) exercise and respond well to
bronchodilators. Pretreatment with albuterol or ICS-formoterol before
exercise can prevent symptoms.
5. A 72-year-old patient presents with acute onset of right-sided weakness,
facial droop, and aphasia. Symptoms began 1 hour ago. CT head shows no
hemorrhage. What is the most appropriate management?
A) Aspirin 325 mg and discharge home
B) IV alteplase (tPA) if no contraindications
C) Clopidogrel 75 mg daily
D) Transfer for mechanical thrombectomy without tPA
Answer: B
*Rationale: The patient is within the 3-hour window for IV tPA (alteplase).
tPA improves outcomes in acute ischemic stroke when given within 3 hours
(or 4.5 hours with criteria). Thrombectomy may be considered for large
vessel occlusion but does not replace tPA when eligible.*
6. A 28-year-old female presents with fatigue, weight gain, cold intolerance,
and constipation. On examination, the thyroid is non-palpable. TSH is 12.5
mIU/L (normal 0.4-4.0). What is the most likely diagnosis?
A) Hyperthyroidism
B) Primary hypothyroidism
C) Subclinical hyperthyroidism
D) Thyroiditis
, Answer: B
*Rationale: Elevated TSH with low or normal free T4 indicates primary
hypothyroidism. Common causes include Hashimoto's thyroiditis
(autoimmune). Treatment is levothyroxine, starting at 1.6 mcg/kg/day.*
7. A 50-year-old patient presents with a painful, red, swollen right knee. The
patient has a history of gout. Joint aspiration reveals urate crystals. What is
the first-line treatment for an acute gout flare?
A) Allopurinol
B) Colchicine or NSAIDs (e.g., indomethacin, naproxen)
C) Febuxostat
D) Prednisone (if contraindications to NSAIDs/colchicine)
Answer: B
*Rationale: First-line treatment for acute gout flare includes NSAIDs or
colchicine (if started within 24 hours). Allopurinol and febuxostat are used
for long-term urate-lowering, not acute flares. Corticosteroids are second-
line.*
8. A 65-year-old patient with a history of diabetes and hypertension has a
blood pressure of 145/90 mmHg. According to the 2017 ACC/AHA guideline,
this is classified as:
A) Normal
B) Elevated
C) Stage 1 hypertension
D) Stage 2 hypertension
Answer: C
