NUR 529 Exam 3 Actual Exam 2026/2027
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Section 1: Advanced Health Assessment & Diagnostic Reasoning (Questions 1–9)
Q1: A 45-year-old patient presents with fatigue, weight loss, and night sweats. Physical exam reveals
cervical lymphadenopathy and splenomegaly. Which diagnostic test should the APRN order first to
evaluate for lymphoproliferative disorders?
A. CT scan of the chest, abdomen, and pelvis
B. Complete blood count with differential and peripheral blood smear [CORRECT]
C. Bone marrow biopsy
D. PET-CT scan
Correct Answer: B
Rationale: The best answer is B. A CBC with differential and peripheral smear is the appropriate first
step—it provides immediate information about cell counts, identifies abnormal cells, and guides
whether further hematologic workup is needed. CT and PET are useful for staging but not initial
diagnosis, and bone marrow biopsy is invasive and reserved for when peripheral blood is inconclusive.
Correct Answer: B
Q2: A 62-year-old patient reports progressive dyspnea on exertion, orthopnea, and paroxysmal
nocturnal dyspnea. On examination, the APRN hears an S3 gallop and notes bilateral crackles and
peripheral edema. Which additional finding on echocardiogram would best support a diagnosis of heart
failure with reduced ejection fraction?
A. Preserved ejection fraction >50% with thickened ventricular walls
B. Dilated left ventricle with EF 30% and reduced wall motion [CORRECT]
C. Normal chamber sizes with pericardial effusion
D. Hypertrophic septum with dynamic outflow tract obstruction
Correct Answer: B
Rationale: The best answer is B. HFrEF is defined by a left ventricular ejection fraction ≤40% with
chamber dilation and impaired contractility—the clinical picture of volume overload with an S3 gallop
,fits this physiology. Preserved EF with thick walls describes HFpEF, pericardial effusion causes restrictive
physiology, and septal hypertrophy with outflow obstruction is HCM.
Correct Answer: B
Q3: A 55-year-old patient presents with epigastric pain radiating to the back, nausea, and vomiting.
Serum lipase is 1200 U/L (normal <160). Which diagnostic finding on CT abdomen would confirm the
most common complication the APRN should monitor for?
A. Gallstones in the common bile duct
B. Peripancreatic fluid collections and necrosis [CORRECT]
C. Hepatic metastases
D. Splenic artery aneurysm
Correct Answer: B
Rationale: The best answer is B. With lipase >3 times normal, this patient has acute pancreatitis—CT
findings of peripancreatic fluid collections or necrosis indicate severe disease and the complications
(infected necrosis, pseudocyst, organ failure) that drive mortality. While gallstones may be the etiology,
the question asks about complications of the disease itself, not the cause.
Correct Answer: B
Q4: A 38-year-old patient presents with recurrent oral ulcers, genital ulcers, and painful nodules on the
lower legs. Eye examination reveals anterior uveitis. Which diagnostic criterion is most specific for the
suspected condition?
A. Positive ANA titer
B. Recurrent oral ulcers plus genital ulcers plus ocular inflammation [CORRECT]
C. Elevated rheumatoid factor
D. HLA-B27 positivity
Correct Answer: B
Rationale: The best answer is B. The triad of recurrent oral ulcers, genital ulcers, and ocular
inflammation is pathognomonic for Behçet disease—this combination is highly specific and distinguishes
it from other vasculitides and autoimmune conditions. ANA and RF are nonspecific, and while HLA-B51 is
associated with Behçet's, it's not diagnostic.
Correct Answer: B
Q5: A patient with suspected pulmonary embolism has a Wells score of 6.5 (high probability). D-dimer is
2200 ng/mL. Which is the most appropriate next diagnostic test?
A. Repeat D-dimer in 24 hours
B. CT pulmonary angiography [CORRECT]
, C. Ventilation-perfusion scan
D. Lower extremity venous duplex ultrasound
Correct Answer: B
Rationale: The best answer is B. In a patient with high pretest probability for PE, D-dimer is not useful—
it will be elevated and doesn't change management. CTPA is the diagnostic test of choice with high
sensitivity and specificity for PE, and it can also evaluate for alternative diagnoses. V/Q scan is reserved
for CTPA contraindications, and duplex ultrasound evaluates for DVT but doesn't diagnose PE.
Correct Answer: B
Q6: A 50-year-old patient with a history of smoking presents with hemoptysis, weight loss, and a
persistent cough. Chest X-ray shows a 3 cm spiculated mass in the right upper lobe. Which diagnostic
procedure should the APRN order next?
A. Sputum cytology
B. CT-guided fine needle aspiration or bronchoscopy with biopsy [CORRECT]
C. PET-CT scan alone
D. Thoracotomy with wedge resection
Correct Answer: B
Rationale: The best answer is B. A spiculated mass in a smoker is highly suspicious for lung cancer—
tissue diagnosis via CT-guided FNA or bronchoscopic biopsy is required before staging and treatment
planning. Sputum cytology has low yield, PET-CT is for staging after diagnosis, and thoracotomy without
tissue diagnosis is premature.
Correct Answer: B
Q7: A patient with new-onset confusion has the following labs: sodium 118 mEq/L, serum osmolality 250
mOsm/kg, urine osmolality 450 mOsm/kg, and urine sodium 65 mEq/L. Which is the most likely
diagnosis?
A. Hypovolemic hyponatremia from diuretic overuse
B. Syndrome of inappropriate antidiuretic hormone (SIADH) [CORRECT]
C. Psychogenic polydipsia
D. Hypervolemic hyponatremia from heart failure
Correct Answer: B
Rationale: The best answer is B. Hyponatremia with inappropriately concentrated urine (urine
osmolality >100), elevated urine sodium (>20), and low serum osmolality in a euvolemic patient is classic
SIADH. Hypovolemic hyponatremia would show low urine sodium, psychogenic polydipsia causes dilute
urine, and heart failure would show signs of volume overload.
Correct Answer: B
100% Verified | Detailed Rationales –
Pass Guaranteed – A+ Graded
Section 1: Advanced Health Assessment & Diagnostic Reasoning (Questions 1–9)
Q1: A 45-year-old patient presents with fatigue, weight loss, and night sweats. Physical exam reveals
cervical lymphadenopathy and splenomegaly. Which diagnostic test should the APRN order first to
evaluate for lymphoproliferative disorders?
A. CT scan of the chest, abdomen, and pelvis
B. Complete blood count with differential and peripheral blood smear [CORRECT]
C. Bone marrow biopsy
D. PET-CT scan
Correct Answer: B
Rationale: The best answer is B. A CBC with differential and peripheral smear is the appropriate first
step—it provides immediate information about cell counts, identifies abnormal cells, and guides
whether further hematologic workup is needed. CT and PET are useful for staging but not initial
diagnosis, and bone marrow biopsy is invasive and reserved for when peripheral blood is inconclusive.
Correct Answer: B
Q2: A 62-year-old patient reports progressive dyspnea on exertion, orthopnea, and paroxysmal
nocturnal dyspnea. On examination, the APRN hears an S3 gallop and notes bilateral crackles and
peripheral edema. Which additional finding on echocardiogram would best support a diagnosis of heart
failure with reduced ejection fraction?
A. Preserved ejection fraction >50% with thickened ventricular walls
B. Dilated left ventricle with EF 30% and reduced wall motion [CORRECT]
C. Normal chamber sizes with pericardial effusion
D. Hypertrophic septum with dynamic outflow tract obstruction
Correct Answer: B
Rationale: The best answer is B. HFrEF is defined by a left ventricular ejection fraction ≤40% with
chamber dilation and impaired contractility—the clinical picture of volume overload with an S3 gallop
,fits this physiology. Preserved EF with thick walls describes HFpEF, pericardial effusion causes restrictive
physiology, and septal hypertrophy with outflow obstruction is HCM.
Correct Answer: B
Q3: A 55-year-old patient presents with epigastric pain radiating to the back, nausea, and vomiting.
Serum lipase is 1200 U/L (normal <160). Which diagnostic finding on CT abdomen would confirm the
most common complication the APRN should monitor for?
A. Gallstones in the common bile duct
B. Peripancreatic fluid collections and necrosis [CORRECT]
C. Hepatic metastases
D. Splenic artery aneurysm
Correct Answer: B
Rationale: The best answer is B. With lipase >3 times normal, this patient has acute pancreatitis—CT
findings of peripancreatic fluid collections or necrosis indicate severe disease and the complications
(infected necrosis, pseudocyst, organ failure) that drive mortality. While gallstones may be the etiology,
the question asks about complications of the disease itself, not the cause.
Correct Answer: B
Q4: A 38-year-old patient presents with recurrent oral ulcers, genital ulcers, and painful nodules on the
lower legs. Eye examination reveals anterior uveitis. Which diagnostic criterion is most specific for the
suspected condition?
A. Positive ANA titer
B. Recurrent oral ulcers plus genital ulcers plus ocular inflammation [CORRECT]
C. Elevated rheumatoid factor
D. HLA-B27 positivity
Correct Answer: B
Rationale: The best answer is B. The triad of recurrent oral ulcers, genital ulcers, and ocular
inflammation is pathognomonic for Behçet disease—this combination is highly specific and distinguishes
it from other vasculitides and autoimmune conditions. ANA and RF are nonspecific, and while HLA-B51 is
associated with Behçet's, it's not diagnostic.
Correct Answer: B
Q5: A patient with suspected pulmonary embolism has a Wells score of 6.5 (high probability). D-dimer is
2200 ng/mL. Which is the most appropriate next diagnostic test?
A. Repeat D-dimer in 24 hours
B. CT pulmonary angiography [CORRECT]
, C. Ventilation-perfusion scan
D. Lower extremity venous duplex ultrasound
Correct Answer: B
Rationale: The best answer is B. In a patient with high pretest probability for PE, D-dimer is not useful—
it will be elevated and doesn't change management. CTPA is the diagnostic test of choice with high
sensitivity and specificity for PE, and it can also evaluate for alternative diagnoses. V/Q scan is reserved
for CTPA contraindications, and duplex ultrasound evaluates for DVT but doesn't diagnose PE.
Correct Answer: B
Q6: A 50-year-old patient with a history of smoking presents with hemoptysis, weight loss, and a
persistent cough. Chest X-ray shows a 3 cm spiculated mass in the right upper lobe. Which diagnostic
procedure should the APRN order next?
A. Sputum cytology
B. CT-guided fine needle aspiration or bronchoscopy with biopsy [CORRECT]
C. PET-CT scan alone
D. Thoracotomy with wedge resection
Correct Answer: B
Rationale: The best answer is B. A spiculated mass in a smoker is highly suspicious for lung cancer—
tissue diagnosis via CT-guided FNA or bronchoscopic biopsy is required before staging and treatment
planning. Sputum cytology has low yield, PET-CT is for staging after diagnosis, and thoracotomy without
tissue diagnosis is premature.
Correct Answer: B
Q7: A patient with new-onset confusion has the following labs: sodium 118 mEq/L, serum osmolality 250
mOsm/kg, urine osmolality 450 mOsm/kg, and urine sodium 65 mEq/L. Which is the most likely
diagnosis?
A. Hypovolemic hyponatremia from diuretic overuse
B. Syndrome of inappropriate antidiuretic hormone (SIADH) [CORRECT]
C. Psychogenic polydipsia
D. Hypervolemic hyponatremia from heart failure
Correct Answer: B
Rationale: The best answer is B. Hyponatremia with inappropriately concentrated urine (urine
osmolality >100), elevated urine sodium (>20), and low serum osmolality in a euvolemic patient is classic
SIADH. Hypovolemic hyponatremia would show low urine sodium, psychogenic polydipsia causes dilute
urine, and heart failure would show signs of volume overload.
Correct Answer: B
