Test 1 Materials NURS 5432 Exam 2024
Update ACTUAL EXAM 2026/2027 |
NURS 5432 Test 1 | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: ADVANCED HEALTH ASSESSMENT & DIAGNOSTIC REASONING (30 Questions)
Q1: A 58-year-old male presents with progressive dyspnea on exertion and orthopnea. On exam, you
note a displaced apical impulse, an S3 gallop, and bilateral basilar crackles. Which finding on chest X-ray
would most support your suspected diagnosis?
A. Hyperinflation with flattened diaphragms
B. Bilateral pleural effusions with cephalization of pulmonary vessels [CORRECT]
C. Unilateral hilar mass with mediastinal shift
D. Pneumothorax with absent lung markings
Correct Answer: B
Rationale: Cephalization of vessels and effusions indicate elevated pulmonary capillary pressure from
left ventricular failure; these are classic radiographic findings in decompensated heart failure with
pulmonary venous hypertension.
Q2: A 42-year-old female reports episodes of palpitations, heat intolerance, and 15-pound weight loss
over 3 months. Physical exam reveals lid lag, fine tremor, and brisk reflexes. Which laboratory test is the
most appropriate initial diagnostic step?
A. Serum cortisol level
B. Thyroid-stimulating hormone (TSH) with free T4 [CORRECT]
C. Hemoglobin A1c
D. Antinuclear antibody (ANA)
Correct Answer: B
,Rationale: Hyperthyroidism is the leading differential for this presentation; TSH with free T4 is the
standard initial screening test that reliably identifies primary thyroid dysfunction.
Q3: A 65-year-old African American male with hypertension presents for routine follow-up. His BP today
is 158/92 mmHg (averaged over three readings). According to the 2017 ACC/AHA guidelines, what is his
BP classification?
A. Stage 1 hypertension
B. Stage 2 hypertension [CORRECT]
C. Elevated blood pressure
D. Hypertensive crisis
Correct Answer: B
Rationale: The 2017 ACC/AHA guidelines classify BP 140/90 mmHg or higher as Stage 2 hypertension;
this patient's readings meet criteria and warrant intensification of therapy.
Q4: During cardiac auscultation of a 55-year-old patient, you hear a harsh, crescendo-decrescendo
systolic murmur at the right upper sternal border radiating to the carotids. The murmur decreases with
Valsalva maneuver. Which valvular lesion is most likely?
A. Mitral regurgitation
B. Aortic stenosis [CORRECT]
C. Hypertrophic cardiomyopathy
D. Mitral valve prolapse
Correct Answer: B
Rationale: A crescendo-decrescendo systolic murmur at the right upper sternal border with carotid
radiation is pathognomonic for aortic stenosis; the decrease with Valsalva distinguishes it from HCM,
which increases with Valsalva.
Q5: A 38-year-old female presents with fatigue, joint pain in her hands and knees, and a malar rash.
Physical exam reveals synovitis in the MCP and PIP joints. Which antibody test is most specific for
confirming the suspected diagnosis?
A. Rheumatoid factor (RF)
B. Anti-cyclic citrullinated peptide (anti-CCP)
C. Anti-double stranded DNA (anti-dsDNA) [CORRECT]
,D. Anti-Smith antibody
Correct Answer: C
Rationale: Anti-dsDNA is highly specific for systemic lupus erythematosus and correlates with disease
activity; this patient's malar rash, symmetric polyarthritis, and fatigue are classic SLE presentation.
Q6: A 50-year-old male with a 30 pack-year smoking history presents with hemoptysis and a 20-pound
weight loss. Chest X-ray reveals a spiculated mass in the left upper lobe. What is the next most
appropriate step in the diagnostic workup?
A. Positron emission tomography (PET) scan
B. CT-guided needle biopsy or bronchoscopy with tissue sampling [CORRECT]
C. Empiric antibiotic therapy for 6 weeks
D. Observation with repeat imaging in 3 months
Correct Answer: B
Rationale: Tissue diagnosis is mandatory before initiating cancer treatment; bronchoscopy or CT-guided
biopsy provides histopathological confirmation and molecular profiling needed for staging and therapy
selection.
Q7: A 28-year-old female presents with acute onset right lower quadrant pain, nausea, and vomiting.
She reports her last menstrual period was 6 weeks ago. Which diagnostic test is most appropriate to
evaluate for ectopic pregnancy?
A. Urinalysis and culture
B. Transvaginal ultrasound with quantitative β-hCG [CORRECT]
C. CT abdomen/pelvis with contrast
D. Diagnostic laparoscopy
Correct Answer: B
Rationale: Transvaginal ultrasound with serial β-hCG is the standard for ectopic pregnancy evaluation;
ultrasound identifies gestational location while β-hCG trends determine viability and guide management
decisions.
Q8: A 62-year-old male with diabetes presents with numbness and tingling in a stocking-glove
distribution. Monofilament testing reveals loss of protective sensation bilaterally. Which additional
finding would most suggest diabetic autonomic neuropathy?
A. Decreased ankle jerk reflexes
, B. Orthostatic hypotension with resting tachycardia [CORRECT]
C. Muscle atrophy in the intrinsic foot muscles
D. Charcot arthropathy of the midfoot
Correct Answer: B
Rationale: Orthostatic hypotension and resting tachycardia indicate cardiovascular autonomic
dysfunction; this is a distinct manifestation of autonomic neuropathy separate from somatic
sensorimotor deficits.
Q9: A 45-year-old female presents with episodic severe headache, visual scotoma, and unilateral
throbbing pain associated with nausea. She reports these occur 2–3 times monthly and last 12–24
hours. Which feature on history would most support the diagnosis of migraine with aura?
A. Bilateral pressure-like pain
B. Visual disturbance preceding headache onset by 20–30 minutes [CORRECT]
C. Pain triggered by chewing or jaw movement
D. Sudden "thunderclap" onset reaching maximum intensity in seconds
Correct Answer: B
Rationale: Migraine with aura requires fully reversible focal neurological symptoms that precede or
accompany headache; visual scotoma or fortification spectra lasting 20–60 minutes is the classic
presentation.
Q10: During abdominal examination of a 60-year-old male, you palpate a pulsatile, expansile mass in the
epigastrium measuring approximately 5 cm. Which imaging modality is the gold standard for confirming
and characterizing this finding?
A. Plain abdominal X-ray
B. Abdominal ultrasound with Doppler
C. CT angiography of the abdomen and pelvis [CORRECT]
D. Magnetic resonance cholangiopancreatography (MRCP)
Correct Answer: C
Rationale: CT angiography provides precise aneurysm diameter, extent, branch vessel involvement, and
suitability for endovascular repair; it is the gold standard for preoperative planning in abdominal aortic
aneurysm evaluation.
Update ACTUAL EXAM 2026/2027 |
NURS 5432 Test 1 | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: ADVANCED HEALTH ASSESSMENT & DIAGNOSTIC REASONING (30 Questions)
Q1: A 58-year-old male presents with progressive dyspnea on exertion and orthopnea. On exam, you
note a displaced apical impulse, an S3 gallop, and bilateral basilar crackles. Which finding on chest X-ray
would most support your suspected diagnosis?
A. Hyperinflation with flattened diaphragms
B. Bilateral pleural effusions with cephalization of pulmonary vessels [CORRECT]
C. Unilateral hilar mass with mediastinal shift
D. Pneumothorax with absent lung markings
Correct Answer: B
Rationale: Cephalization of vessels and effusions indicate elevated pulmonary capillary pressure from
left ventricular failure; these are classic radiographic findings in decompensated heart failure with
pulmonary venous hypertension.
Q2: A 42-year-old female reports episodes of palpitations, heat intolerance, and 15-pound weight loss
over 3 months. Physical exam reveals lid lag, fine tremor, and brisk reflexes. Which laboratory test is the
most appropriate initial diagnostic step?
A. Serum cortisol level
B. Thyroid-stimulating hormone (TSH) with free T4 [CORRECT]
C. Hemoglobin A1c
D. Antinuclear antibody (ANA)
Correct Answer: B
,Rationale: Hyperthyroidism is the leading differential for this presentation; TSH with free T4 is the
standard initial screening test that reliably identifies primary thyroid dysfunction.
Q3: A 65-year-old African American male with hypertension presents for routine follow-up. His BP today
is 158/92 mmHg (averaged over three readings). According to the 2017 ACC/AHA guidelines, what is his
BP classification?
A. Stage 1 hypertension
B. Stage 2 hypertension [CORRECT]
C. Elevated blood pressure
D. Hypertensive crisis
Correct Answer: B
Rationale: The 2017 ACC/AHA guidelines classify BP 140/90 mmHg or higher as Stage 2 hypertension;
this patient's readings meet criteria and warrant intensification of therapy.
Q4: During cardiac auscultation of a 55-year-old patient, you hear a harsh, crescendo-decrescendo
systolic murmur at the right upper sternal border radiating to the carotids. The murmur decreases with
Valsalva maneuver. Which valvular lesion is most likely?
A. Mitral regurgitation
B. Aortic stenosis [CORRECT]
C. Hypertrophic cardiomyopathy
D. Mitral valve prolapse
Correct Answer: B
Rationale: A crescendo-decrescendo systolic murmur at the right upper sternal border with carotid
radiation is pathognomonic for aortic stenosis; the decrease with Valsalva distinguishes it from HCM,
which increases with Valsalva.
Q5: A 38-year-old female presents with fatigue, joint pain in her hands and knees, and a malar rash.
Physical exam reveals synovitis in the MCP and PIP joints. Which antibody test is most specific for
confirming the suspected diagnosis?
A. Rheumatoid factor (RF)
B. Anti-cyclic citrullinated peptide (anti-CCP)
C. Anti-double stranded DNA (anti-dsDNA) [CORRECT]
,D. Anti-Smith antibody
Correct Answer: C
Rationale: Anti-dsDNA is highly specific for systemic lupus erythematosus and correlates with disease
activity; this patient's malar rash, symmetric polyarthritis, and fatigue are classic SLE presentation.
Q6: A 50-year-old male with a 30 pack-year smoking history presents with hemoptysis and a 20-pound
weight loss. Chest X-ray reveals a spiculated mass in the left upper lobe. What is the next most
appropriate step in the diagnostic workup?
A. Positron emission tomography (PET) scan
B. CT-guided needle biopsy or bronchoscopy with tissue sampling [CORRECT]
C. Empiric antibiotic therapy for 6 weeks
D. Observation with repeat imaging in 3 months
Correct Answer: B
Rationale: Tissue diagnosis is mandatory before initiating cancer treatment; bronchoscopy or CT-guided
biopsy provides histopathological confirmation and molecular profiling needed for staging and therapy
selection.
Q7: A 28-year-old female presents with acute onset right lower quadrant pain, nausea, and vomiting.
She reports her last menstrual period was 6 weeks ago. Which diagnostic test is most appropriate to
evaluate for ectopic pregnancy?
A. Urinalysis and culture
B. Transvaginal ultrasound with quantitative β-hCG [CORRECT]
C. CT abdomen/pelvis with contrast
D. Diagnostic laparoscopy
Correct Answer: B
Rationale: Transvaginal ultrasound with serial β-hCG is the standard for ectopic pregnancy evaluation;
ultrasound identifies gestational location while β-hCG trends determine viability and guide management
decisions.
Q8: A 62-year-old male with diabetes presents with numbness and tingling in a stocking-glove
distribution. Monofilament testing reveals loss of protective sensation bilaterally. Which additional
finding would most suggest diabetic autonomic neuropathy?
A. Decreased ankle jerk reflexes
, B. Orthostatic hypotension with resting tachycardia [CORRECT]
C. Muscle atrophy in the intrinsic foot muscles
D. Charcot arthropathy of the midfoot
Correct Answer: B
Rationale: Orthostatic hypotension and resting tachycardia indicate cardiovascular autonomic
dysfunction; this is a distinct manifestation of autonomic neuropathy separate from somatic
sensorimotor deficits.
Q9: A 45-year-old female presents with episodic severe headache, visual scotoma, and unilateral
throbbing pain associated with nausea. She reports these occur 2–3 times monthly and last 12–24
hours. Which feature on history would most support the diagnosis of migraine with aura?
A. Bilateral pressure-like pain
B. Visual disturbance preceding headache onset by 20–30 minutes [CORRECT]
C. Pain triggered by chewing or jaw movement
D. Sudden "thunderclap" onset reaching maximum intensity in seconds
Correct Answer: B
Rationale: Migraine with aura requires fully reversible focal neurological symptoms that precede or
accompany headache; visual scotoma or fortification spectra lasting 20–60 minutes is the classic
presentation.
Q10: During abdominal examination of a 60-year-old male, you palpate a pulsatile, expansile mass in the
epigastrium measuring approximately 5 cm. Which imaging modality is the gold standard for confirming
and characterizing this finding?
A. Plain abdominal X-ray
B. Abdominal ultrasound with Doppler
C. CT angiography of the abdomen and pelvis [CORRECT]
D. Magnetic resonance cholangiopancreatography (MRCP)
Correct Answer: C
Rationale: CT angiography provides precise aneurysm diameter, extent, branch vessel involvement, and
suitability for endovascular repair; it is the gold standard for preoperative planning in abdominal aortic
aneurysm evaluation.
