NUR 5461 Exam 1 Review: 50 Questions with
Correct Answers & Complete Solutions (2026/2027
Edition)
SECTION 1: HEALTH HISTORY AND COMPREHENSIVE ASSESSMENT
Question 1.
A 58-year-old male presents for his annual wellness visit. He reports a 30-pack-year
smoking history and quit 10 years ago. According to the 2026 USPSTF lung cancer
screening guidelines, which action is most appropriate for the advanced practice nurse?
A. Recommend annual low-dose CT (LDCT) screening because he meets age and
smoking history criteria
B. Defer screening because he quit more than 15 years ago
C. Recommend LDCT only if he has a family history of lung cancer
D. Order a chest X-ray as an acceptable alternative to LDCT
Correct Answer: A. Recommend annual low-dose CT (LDCT) screening because he
meets age and smoking history criteria
Rationale: The 2026 USPSTF guidelines recommend annual LDCT for adults aged 50 to
80 years with at least a 20 pack-year smoking history who currently smoke or quit within
the past 15 years. This patient is 58 years old with a 30 pack-year history and quit 10
years ago, meeting all criteria. Option B is incorrect because 10 years is within the
15-year quit threshold. Option C is incorrect because family history is not a prerequisite
for screening in eligible patients. Option D is incorrect because chest X-ray is not
recommended as a screening modality; LDCT is the only recommended screening test
due to its superior sensitivity for detecting early-stage lung cancer.
,Question 2.
During a comprehensive health history, a 42-year-old female reports irregular menses,
hirsutism, and difficulty conceiving. Her BMI is 32 kg/m². Which component of the
health history is most critical to obtain next?
A. Detailed dietary recall for the past 24 hours
B. Family history of cardiovascular disease
C. Menstrual history including age of menarche and cycle characteristics
D. Occupational exposure to environmental toxins
Correct Answer: C. Menstrual history including age of menarche and cycle
characteristics
Rationale: The patient's presentation of irregular menses, hirsutism, and infertility with
obesity is highly suggestive of polycystic ovary syndrome (PCOS). A detailed menstrual
history is essential to establish the diagnosis according to the Rotterdam criteria
(oligo/anovulation, hyperandrogenism, polycystic ovaries on ultrasound). Option A,
while relevant for weight management, is not the most critical next step. Option B is
important for long-term cardiovascular risk assessment but does not address the
immediate diagnostic concern. Option D is less relevant to this clinical presentation.
Question 3.
A 67-year-old patient with type 2 diabetes presents for a follow-up visit. The advanced
practice nurse is reviewing the 2026 ADA Standards of Care for glycemic targets. Which
statement best reflects current evidence-based individualized HbA1c goals?
A. All adults with diabetes should target HbA1c <6.5% to minimize microvascular
complications
B. Most nonpregnant adults should target HbA1c <7%, with less stringent goals for
older, frail adults at <7.5–8%
C. HbA1c targets should be identical for all patients regardless of comorbidities or life
expectancy
,D. The primary glycemic metric should be fasting plasma glucose rather than HbA1c
Correct Answer: B. Most nonpregnant adults should target HbA1c <7%, with less
stringent goals for older, frail adults at <7.5–8%
Rationale: The 2026 ADA Standards of Care emphasize individualized glycemic targets.
The general target for most nonpregnant adults remains <7% (<53 mmol/mol), with
corresponding CGM time-in-range goals >70%. However, for older/frail adults or those
with significant comorbidities, less stringent targets of <7.5–8% (<58–64 mmol/mol)
are recommended to prioritize safety and avoid hypoglycemia. Option A is incorrect
because <6.5% is reserved for healthy adults with low hypoglycemia risk, not all adults.
Option C contradicts the principle of individualization. Option D is incorrect because
HbA1c remains the primary metric, supplemented by CGM metrics.
Question 4.
When performing a comprehensive health history on a patient from a Southeast Asian
cultural background, the advanced practice nurse notes that the patient avoids direct
eye contact and responds through a family member. Which culturally competent
response is most appropriate?
A. Insist that the patient make direct eye contact to establish rapport
B. Recognize that indirect communication may reflect cultural norms and adapt the
interview approach accordingly
C. Document the behavior as suspicious and indicative of cognitive impairment
D. Proceed with the physical examination without completing the health history
Correct Answer: B. Recognize that indirect communication may reflect cultural norms
and adapt the interview approach accordingly
Rationale: In many Southeast Asian cultures, direct eye contact with authority figures
may be considered disrespectful, and family-centered decision-making is common. The
, advanced practice nurse must demonstrate cultural humility by adapting
communication strategies rather than imposing Western norms. Option A demonstrates
cultural imposition. Option C is a biased interpretation that could lead to diagnostic
error. Option D abandons a critical component of the patient encounter.
Question 5.
A 55-year-old male with no significant past medical history presents for a physical
examination. According to the 2026 ACC/AHA Hypertension Guideline, at what blood
pressure threshold should pharmacologic therapy be initiated in this patient?
A. SBP ≥140 mm Hg or DBP ≥90 mm Hg regardless of cardiovascular risk
B. SBP 130–139 mm Hg or DBP 80–89 mm Hg with lifestyle modification only
C. SBP ≥130 mm Hg or DBP ≥80 mm Hg for all adults over age 50
D. SBP ≥150 mm Hg or DBP ≥90 mm Hg for adults without diabetes
Correct Answer: A. SBP ≥140 mm Hg or DBP ≥90 mm Hg regardless of cardiovascular
risk
Rationale: The 2025/2026 ACC/AHA guideline recommends that all adults with stage 2
hypertension (BP ≥140/90 mm Hg) initiate medication therapy with first-line agents
(ACEI/ARB, long-acting CCB, or thiazide diuretic). For stage 1 hypertension
(130–139/80–89 mm Hg), treatment initiation depends on overall cardiovascular risk
using the PREVENT calculator; those with lower risk (<7.5% 10-year CVD risk) should
first attempt 3–6 months of lifestyle modification. Option B is incomplete because it
does not address the risk-stratified approach for stage 1. Option C is incorrect because
age alone does not mandate treatment at stage 1. Option D reflects outdated
thresholds.
Question 6.
Correct Answers & Complete Solutions (2026/2027
Edition)
SECTION 1: HEALTH HISTORY AND COMPREHENSIVE ASSESSMENT
Question 1.
A 58-year-old male presents for his annual wellness visit. He reports a 30-pack-year
smoking history and quit 10 years ago. According to the 2026 USPSTF lung cancer
screening guidelines, which action is most appropriate for the advanced practice nurse?
A. Recommend annual low-dose CT (LDCT) screening because he meets age and
smoking history criteria
B. Defer screening because he quit more than 15 years ago
C. Recommend LDCT only if he has a family history of lung cancer
D. Order a chest X-ray as an acceptable alternative to LDCT
Correct Answer: A. Recommend annual low-dose CT (LDCT) screening because he
meets age and smoking history criteria
Rationale: The 2026 USPSTF guidelines recommend annual LDCT for adults aged 50 to
80 years with at least a 20 pack-year smoking history who currently smoke or quit within
the past 15 years. This patient is 58 years old with a 30 pack-year history and quit 10
years ago, meeting all criteria. Option B is incorrect because 10 years is within the
15-year quit threshold. Option C is incorrect because family history is not a prerequisite
for screening in eligible patients. Option D is incorrect because chest X-ray is not
recommended as a screening modality; LDCT is the only recommended screening test
due to its superior sensitivity for detecting early-stage lung cancer.
,Question 2.
During a comprehensive health history, a 42-year-old female reports irregular menses,
hirsutism, and difficulty conceiving. Her BMI is 32 kg/m². Which component of the
health history is most critical to obtain next?
A. Detailed dietary recall for the past 24 hours
B. Family history of cardiovascular disease
C. Menstrual history including age of menarche and cycle characteristics
D. Occupational exposure to environmental toxins
Correct Answer: C. Menstrual history including age of menarche and cycle
characteristics
Rationale: The patient's presentation of irregular menses, hirsutism, and infertility with
obesity is highly suggestive of polycystic ovary syndrome (PCOS). A detailed menstrual
history is essential to establish the diagnosis according to the Rotterdam criteria
(oligo/anovulation, hyperandrogenism, polycystic ovaries on ultrasound). Option A,
while relevant for weight management, is not the most critical next step. Option B is
important for long-term cardiovascular risk assessment but does not address the
immediate diagnostic concern. Option D is less relevant to this clinical presentation.
Question 3.
A 67-year-old patient with type 2 diabetes presents for a follow-up visit. The advanced
practice nurse is reviewing the 2026 ADA Standards of Care for glycemic targets. Which
statement best reflects current evidence-based individualized HbA1c goals?
A. All adults with diabetes should target HbA1c <6.5% to minimize microvascular
complications
B. Most nonpregnant adults should target HbA1c <7%, with less stringent goals for
older, frail adults at <7.5–8%
C. HbA1c targets should be identical for all patients regardless of comorbidities or life
expectancy
,D. The primary glycemic metric should be fasting plasma glucose rather than HbA1c
Correct Answer: B. Most nonpregnant adults should target HbA1c <7%, with less
stringent goals for older, frail adults at <7.5–8%
Rationale: The 2026 ADA Standards of Care emphasize individualized glycemic targets.
The general target for most nonpregnant adults remains <7% (<53 mmol/mol), with
corresponding CGM time-in-range goals >70%. However, for older/frail adults or those
with significant comorbidities, less stringent targets of <7.5–8% (<58–64 mmol/mol)
are recommended to prioritize safety and avoid hypoglycemia. Option A is incorrect
because <6.5% is reserved for healthy adults with low hypoglycemia risk, not all adults.
Option C contradicts the principle of individualization. Option D is incorrect because
HbA1c remains the primary metric, supplemented by CGM metrics.
Question 4.
When performing a comprehensive health history on a patient from a Southeast Asian
cultural background, the advanced practice nurse notes that the patient avoids direct
eye contact and responds through a family member. Which culturally competent
response is most appropriate?
A. Insist that the patient make direct eye contact to establish rapport
B. Recognize that indirect communication may reflect cultural norms and adapt the
interview approach accordingly
C. Document the behavior as suspicious and indicative of cognitive impairment
D. Proceed with the physical examination without completing the health history
Correct Answer: B. Recognize that indirect communication may reflect cultural norms
and adapt the interview approach accordingly
Rationale: In many Southeast Asian cultures, direct eye contact with authority figures
may be considered disrespectful, and family-centered decision-making is common. The
, advanced practice nurse must demonstrate cultural humility by adapting
communication strategies rather than imposing Western norms. Option A demonstrates
cultural imposition. Option C is a biased interpretation that could lead to diagnostic
error. Option D abandons a critical component of the patient encounter.
Question 5.
A 55-year-old male with no significant past medical history presents for a physical
examination. According to the 2026 ACC/AHA Hypertension Guideline, at what blood
pressure threshold should pharmacologic therapy be initiated in this patient?
A. SBP ≥140 mm Hg or DBP ≥90 mm Hg regardless of cardiovascular risk
B. SBP 130–139 mm Hg or DBP 80–89 mm Hg with lifestyle modification only
C. SBP ≥130 mm Hg or DBP ≥80 mm Hg for all adults over age 50
D. SBP ≥150 mm Hg or DBP ≥90 mm Hg for adults without diabetes
Correct Answer: A. SBP ≥140 mm Hg or DBP ≥90 mm Hg regardless of cardiovascular
risk
Rationale: The 2025/2026 ACC/AHA guideline recommends that all adults with stage 2
hypertension (BP ≥140/90 mm Hg) initiate medication therapy with first-line agents
(ACEI/ARB, long-acting CCB, or thiazide diuretic). For stage 1 hypertension
(130–139/80–89 mm Hg), treatment initiation depends on overall cardiovascular risk
using the PREVENT calculator; those with lower risk (<7.5% 10-year CVD risk) should
first attempt 3–6 months of lifestyle modification. Option B is incomplete because it
does not address the risk-stratified approach for stage 1. Option C is incorrect because
age alone does not mandate treatment at stage 1. Option D reflects outdated
thresholds.
Question 6.
