NU 578 Unit 1 Exam (2026/2027) | Advanced Practice
Nurses | University of South Alabama - PDF
1. A 45-year-old patient with a history of hypertension and type 2 diabetes presents with acute
onset of severe right flank pain radiating to the groin, accompanied by hematuria. Urinalysis
shows pH 5.5, specific gravity 1.020, and numerous red blood cells. Which pathophysiological
mechanism best explains the pain pattern?
A. Distal tubular obstruction leading to increased hydrostatic pressure in Bowman's capsule
B. Ureteral smooth muscle spasm due to irritation from a calculus
C. Stretching of the renal capsule due to acute inflammation
D. Ischemia of the renal medulla from increased interstitial pressure
Answer: B
Rationale: The pain from ureteral colic is primarily due to ureteral smooth muscle spasm and peristaltic
waves in response to an obstructing stone, causing intense, colicky flank pain that radiates to the groin.
Options A and C are incorrect because pain from renal capsule stretch (C) is typically a dull ache and
not colicky, while obstruction causes increased pressure but not primarily in Bowman's capsule. Option
D is a late finding in renal artery occlusion, not typical of ureteral colic.
2. A 60-year-old patient with chronic kidney disease (stage 3) is prescribed a new medication for
hypertension. The drug is primarily eliminated renally and has a narrow therapeutic index. Which
of the following pharmacokinetic parameters is most likely to be significantly altered in this
patient, requiring dose adjustment?
A. Bioavailability due to increased gastric pH
B. Volume of distribution due to decreased plasma protein binding
C. Half-life due to reduced renal clearance
D. Absorption rate due to delayed gastric emptying
Answer: C
Rationale: In chronic kidney disease, renal elimination is impaired, leading to prolonged half-life for
drugs that are primarily renally excreted. This necessitates dose adjustment to avoid toxicity.
Bioavailability (A) and absorption (D) are less affected in CKD, though uremia may alter gastric pH,
but this is not the primary concern for a renally eliminated drug with narrow therapeutic index. Volume
of distribution (B) can be altered due to fluid shifts or protein binding, but half-life prolongation is the
most direct and significant effect.
3. A 35-year-old patient presents with a pruritic, erythematous, annular rash with central clearing
on the trunk and proximal extremities. The patient recently returned from a camping trip in a
wooded area. Which of the following is the most likely causative organism?
A. Borrelia burgdorferi
B. Rickettsia rickettsii
Page 1
,C. Ehrlichia chaffeensis
D. Anaplasma phagocytophilum
Answer: A
Rationale: Erythema migrans, an annular rash with central clearing, is pathognomonic for Lyme disease
caused by Borrelia burgdorferi. Rickettsia rickettsii causes Rocky Mountain spotted fever, which
presents with a petechial rash starting on wrists and ankles. Ehrlichia and Anaplasma cause ehrlichiosis
and anaplasmosis, respectively, which typically do not present with this specific rash pattern.
4. A 52-year-old patient with a history of atrial fibrillation on warfarin therapy presents with acute
onset of severe headache, nausea, and photophobia. A non-contrast CT head is negative for
hemorrhage. Lumbar puncture reveals xanthochromia. Which of the following is the most
appropriate next step in management?
A. Administer intravenous tissue plasminogen activator (tPA)
B. Start oral nimodipine therapy
C. Perform CT angiography of the head
D. Administer fresh frozen plasma and vitamin K
Answer: B
Rationale: Xanthochromia indicates subarachnoid hemorrhage (SAH) even if CT is negative. Nimodipine,
a calcium channel blocker, is given to prevent cerebral vasospasm, a major complication of SAH. tPA
(A) is contraindicated in any hemorrhage. CT angiography (C) may be done to identify an aneurysm but
is not the immediate next step; the priority is to prevent vasospasm. Reversing warfarin (D) is important
but not the most specific next step for SAH management; however, nimodipine is directly indicated for
SAH.
5. A 28-year-old patient with no significant medical history presents with acute onset of severe
epigastric pain radiating to the back, nausea, and vomiting. Serum amylase is 1,200 U/L, and lipase
is 2,500 U/L. Which of the following is the most common etiology in this age group?
A. Gallstones
B. Alcohol use
C. Hypertriglyceridemia
D. Medication-induced
Answer: B
Rationale: In young to middle-aged adults, alcohol use is the most common cause of acute pancreatitis,
followed by gallstones. However, gallstones become more common in older age groups.
Hypertriglyceridemia and medications are less common etiologies overall. The patient's age and lack of
prior history point toward alcohol as the most likely cause.
6. A 70-year-old patient with a history of chronic obstructive pulmonary disease (COPD) and
hypertension presents with progressive dyspnea and cough. Chest X-ray shows bilateral interstitial
infiltrates and a small pleural effusion. Echocardiogram reveals normal left ventricular function
but elevated right ventricular systolic pressure. Which of the following is the most likely cause of
the patient's symptoms?
Page 2
,A. Left heart failure with pulmonary edema
B. Pulmonary embolism
C. Cor pulmonale secondary to COPD
D. Community-acquired pneumonia
Answer: C
Rationale: Cor pulmonale is right heart failure due to pulmonary hypertension from chronic lung
disease, such as COPD. The patient has signs of right heart strain (elevated RVSP) without left heart
dysfunction, making cor pulmonale likely. Left heart failure (A) would show reduced LV function.
Pulmonary embolism (B) could cause acute right heart strain but is less likely with bilateral infiltrates
and a history of COPD. Pneumonia (D) would typically present with focal consolidation and fever.
7. A 48-year-old patient with a history of HIV (CD4 count 180 cells/¼L) not on antiretroviral
therapy presents with fever, headache, and confusion. MRI brain shows ring-enhancing lesions in
the basal ganglia. Which of the following is the most likely causative organism?
A. Toxoplasma gondii
B. Cryptococcus neoformans
C. Mycobacterium tuberculosis
D. Cytomegalovirus
Answer: A
Rationale: In HIV patients with low CD4 counts, ring-enhancing lesions in the basal ganglia are classic
for cerebral toxoplasmosis caused by Toxoplasma gondii. Cryptococcal meningitis (B) typically presents
with meningeal enhancement, not ring-enhancing lesions. Tuberculomas (C) may appear as
ring-enhancing but are less common in this location. CMV (D) usually causes ventriculitis or retinitis,
not ring-enhancing masses.
8. A 55-year-old patient with a history of gout presents with acute onset of severe pain, swelling,
and erythema of the first metatarsophalangeal joint. Serum uric acid is 9.2 mg/dL. Which of the
following is the most appropriate initial pharmacotherapy for acute management?
A. Allopurinol
B. Colchicine
C. Probenecid
D. Febuxostat
Answer: B
Rationale: For acute gout flare, first-line therapy includes NSAIDs, colchicine, or corticosteroids.
Colchicine is effective if started early. Allopurinol (A) and febuxostat (D) are urate-lowering therapies
used for chronic management, not acute flares, and may even worsen an acute attack if started during a
flare. Probenecid (C) is a uricosuric agent also used for chronic management.
9. A 30-year-old patient presents with acute onset of high fever, severe headache, myalgias, and a
petechial rash that started on the wrists and ankles and spread centrally. The patient recently
traveled to a rural area in the southeastern United States. Which of the following is the most likely
diagnosis?
A. Lyme disease
Page 3
, B. Rocky Mountain spotted fever
C. Ehrlichiosis
D. Dengue fever
Answer: B
Rationale: Rocky Mountain spotted fever (RMSF) caused by Rickettsia rickettsii presents with fever,
headache, myalgias, and a characteristic petechial rash that starts on the wrists and ankles and spreads
centrally. The travel history to the southeastern US is consistent with RMSF. Lyme disease (A) presents
with erythema migrans and does not have a petechial rash starting on extremities. Ehrlichiosis (C) and
dengue (D) may have rash but not the classic distribution of RMSF.
10. A 65-year-old patient with a history of hypertension and diabetes presents with acute onset of
chest pain that is substernal, pressure-like, radiating to the left arm, and associated with
diaphoresis. ECG shows ST-segment elevation in leads V1-V4. Which of the following is the most
appropriate immediate intervention?
A. Administer sublingual nitroglycerin and assess response
B. Obtain a stat echocardiogram
C. Start intravenous heparin and arrange for percutaneous coronary intervention
D. Administer tissue plasminogen activator (tPA)
Answer: C
Rationale: This patient presents with ST-elevation myocardial infarction (STEMI). The standard of care is
immediate reperfusion, preferably with primary percutaneous coronary intervention (PCI) within 90
minutes. Heparin is given as an adjunct. Sublingual nitroglycerin (A) may be given for pain but is not
the definitive intervention. Echocardiogram (B) is not immediately necessary. tPA (D) is used if PCI is
not available, but PCI is preferred if timely access exists.
11. A 35-year-old patient with a history of recurrent urinary tract infections (UTIs) presents with
acute dysuria, frequency, and suprapubic pain. Urinalysis shows pyuria and bacteriuria. The
patient has a documented allergy to sulfonamides. Given current antimicrobial stewardship
guidelines and the need to avoid fluoroquinolones due to adverse effects, which of the following is
the most appropriate first-line treatment?
A. Nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for 5 days
B. Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days
C. Ciprofloxacin 250 mg twice daily for 3 days
D. Amoxicillin-clavulanate 875/125 mg twice daily for 7 days
Answer: A
Rationale: Nitrofurantoin is recommended as first-line for uncomplicated cystitis due to low resistance
rates and minimal systemic effects, and it is safe in sulfa allergy. Trimethoprim-sulfamethoxazole is
contraindicated due to allergy. Fluoroquinolones are reserved for complicated infections due to adverse
effects. Amoxicillin-clavulanate has higher resistance and is not first-line.
Page 4
Nurses | University of South Alabama - PDF
1. A 45-year-old patient with a history of hypertension and type 2 diabetes presents with acute
onset of severe right flank pain radiating to the groin, accompanied by hematuria. Urinalysis
shows pH 5.5, specific gravity 1.020, and numerous red blood cells. Which pathophysiological
mechanism best explains the pain pattern?
A. Distal tubular obstruction leading to increased hydrostatic pressure in Bowman's capsule
B. Ureteral smooth muscle spasm due to irritation from a calculus
C. Stretching of the renal capsule due to acute inflammation
D. Ischemia of the renal medulla from increased interstitial pressure
Answer: B
Rationale: The pain from ureteral colic is primarily due to ureteral smooth muscle spasm and peristaltic
waves in response to an obstructing stone, causing intense, colicky flank pain that radiates to the groin.
Options A and C are incorrect because pain from renal capsule stretch (C) is typically a dull ache and
not colicky, while obstruction causes increased pressure but not primarily in Bowman's capsule. Option
D is a late finding in renal artery occlusion, not typical of ureteral colic.
2. A 60-year-old patient with chronic kidney disease (stage 3) is prescribed a new medication for
hypertension. The drug is primarily eliminated renally and has a narrow therapeutic index. Which
of the following pharmacokinetic parameters is most likely to be significantly altered in this
patient, requiring dose adjustment?
A. Bioavailability due to increased gastric pH
B. Volume of distribution due to decreased plasma protein binding
C. Half-life due to reduced renal clearance
D. Absorption rate due to delayed gastric emptying
Answer: C
Rationale: In chronic kidney disease, renal elimination is impaired, leading to prolonged half-life for
drugs that are primarily renally excreted. This necessitates dose adjustment to avoid toxicity.
Bioavailability (A) and absorption (D) are less affected in CKD, though uremia may alter gastric pH,
but this is not the primary concern for a renally eliminated drug with narrow therapeutic index. Volume
of distribution (B) can be altered due to fluid shifts or protein binding, but half-life prolongation is the
most direct and significant effect.
3. A 35-year-old patient presents with a pruritic, erythematous, annular rash with central clearing
on the trunk and proximal extremities. The patient recently returned from a camping trip in a
wooded area. Which of the following is the most likely causative organism?
A. Borrelia burgdorferi
B. Rickettsia rickettsii
Page 1
,C. Ehrlichia chaffeensis
D. Anaplasma phagocytophilum
Answer: A
Rationale: Erythema migrans, an annular rash with central clearing, is pathognomonic for Lyme disease
caused by Borrelia burgdorferi. Rickettsia rickettsii causes Rocky Mountain spotted fever, which
presents with a petechial rash starting on wrists and ankles. Ehrlichia and Anaplasma cause ehrlichiosis
and anaplasmosis, respectively, which typically do not present with this specific rash pattern.
4. A 52-year-old patient with a history of atrial fibrillation on warfarin therapy presents with acute
onset of severe headache, nausea, and photophobia. A non-contrast CT head is negative for
hemorrhage. Lumbar puncture reveals xanthochromia. Which of the following is the most
appropriate next step in management?
A. Administer intravenous tissue plasminogen activator (tPA)
B. Start oral nimodipine therapy
C. Perform CT angiography of the head
D. Administer fresh frozen plasma and vitamin K
Answer: B
Rationale: Xanthochromia indicates subarachnoid hemorrhage (SAH) even if CT is negative. Nimodipine,
a calcium channel blocker, is given to prevent cerebral vasospasm, a major complication of SAH. tPA
(A) is contraindicated in any hemorrhage. CT angiography (C) may be done to identify an aneurysm but
is not the immediate next step; the priority is to prevent vasospasm. Reversing warfarin (D) is important
but not the most specific next step for SAH management; however, nimodipine is directly indicated for
SAH.
5. A 28-year-old patient with no significant medical history presents with acute onset of severe
epigastric pain radiating to the back, nausea, and vomiting. Serum amylase is 1,200 U/L, and lipase
is 2,500 U/L. Which of the following is the most common etiology in this age group?
A. Gallstones
B. Alcohol use
C. Hypertriglyceridemia
D. Medication-induced
Answer: B
Rationale: In young to middle-aged adults, alcohol use is the most common cause of acute pancreatitis,
followed by gallstones. However, gallstones become more common in older age groups.
Hypertriglyceridemia and medications are less common etiologies overall. The patient's age and lack of
prior history point toward alcohol as the most likely cause.
6. A 70-year-old patient with a history of chronic obstructive pulmonary disease (COPD) and
hypertension presents with progressive dyspnea and cough. Chest X-ray shows bilateral interstitial
infiltrates and a small pleural effusion. Echocardiogram reveals normal left ventricular function
but elevated right ventricular systolic pressure. Which of the following is the most likely cause of
the patient's symptoms?
Page 2
,A. Left heart failure with pulmonary edema
B. Pulmonary embolism
C. Cor pulmonale secondary to COPD
D. Community-acquired pneumonia
Answer: C
Rationale: Cor pulmonale is right heart failure due to pulmonary hypertension from chronic lung
disease, such as COPD. The patient has signs of right heart strain (elevated RVSP) without left heart
dysfunction, making cor pulmonale likely. Left heart failure (A) would show reduced LV function.
Pulmonary embolism (B) could cause acute right heart strain but is less likely with bilateral infiltrates
and a history of COPD. Pneumonia (D) would typically present with focal consolidation and fever.
7. A 48-year-old patient with a history of HIV (CD4 count 180 cells/¼L) not on antiretroviral
therapy presents with fever, headache, and confusion. MRI brain shows ring-enhancing lesions in
the basal ganglia. Which of the following is the most likely causative organism?
A. Toxoplasma gondii
B. Cryptococcus neoformans
C. Mycobacterium tuberculosis
D. Cytomegalovirus
Answer: A
Rationale: In HIV patients with low CD4 counts, ring-enhancing lesions in the basal ganglia are classic
for cerebral toxoplasmosis caused by Toxoplasma gondii. Cryptococcal meningitis (B) typically presents
with meningeal enhancement, not ring-enhancing lesions. Tuberculomas (C) may appear as
ring-enhancing but are less common in this location. CMV (D) usually causes ventriculitis or retinitis,
not ring-enhancing masses.
8. A 55-year-old patient with a history of gout presents with acute onset of severe pain, swelling,
and erythema of the first metatarsophalangeal joint. Serum uric acid is 9.2 mg/dL. Which of the
following is the most appropriate initial pharmacotherapy for acute management?
A. Allopurinol
B. Colchicine
C. Probenecid
D. Febuxostat
Answer: B
Rationale: For acute gout flare, first-line therapy includes NSAIDs, colchicine, or corticosteroids.
Colchicine is effective if started early. Allopurinol (A) and febuxostat (D) are urate-lowering therapies
used for chronic management, not acute flares, and may even worsen an acute attack if started during a
flare. Probenecid (C) is a uricosuric agent also used for chronic management.
9. A 30-year-old patient presents with acute onset of high fever, severe headache, myalgias, and a
petechial rash that started on the wrists and ankles and spread centrally. The patient recently
traveled to a rural area in the southeastern United States. Which of the following is the most likely
diagnosis?
A. Lyme disease
Page 3
, B. Rocky Mountain spotted fever
C. Ehrlichiosis
D. Dengue fever
Answer: B
Rationale: Rocky Mountain spotted fever (RMSF) caused by Rickettsia rickettsii presents with fever,
headache, myalgias, and a characteristic petechial rash that starts on the wrists and ankles and spreads
centrally. The travel history to the southeastern US is consistent with RMSF. Lyme disease (A) presents
with erythema migrans and does not have a petechial rash starting on extremities. Ehrlichiosis (C) and
dengue (D) may have rash but not the classic distribution of RMSF.
10. A 65-year-old patient with a history of hypertension and diabetes presents with acute onset of
chest pain that is substernal, pressure-like, radiating to the left arm, and associated with
diaphoresis. ECG shows ST-segment elevation in leads V1-V4. Which of the following is the most
appropriate immediate intervention?
A. Administer sublingual nitroglycerin and assess response
B. Obtain a stat echocardiogram
C. Start intravenous heparin and arrange for percutaneous coronary intervention
D. Administer tissue plasminogen activator (tPA)
Answer: C
Rationale: This patient presents with ST-elevation myocardial infarction (STEMI). The standard of care is
immediate reperfusion, preferably with primary percutaneous coronary intervention (PCI) within 90
minutes. Heparin is given as an adjunct. Sublingual nitroglycerin (A) may be given for pain but is not
the definitive intervention. Echocardiogram (B) is not immediately necessary. tPA (D) is used if PCI is
not available, but PCI is preferred if timely access exists.
11. A 35-year-old patient with a history of recurrent urinary tract infections (UTIs) presents with
acute dysuria, frequency, and suprapubic pain. Urinalysis shows pyuria and bacteriuria. The
patient has a documented allergy to sulfonamides. Given current antimicrobial stewardship
guidelines and the need to avoid fluoroquinolones due to adverse effects, which of the following is
the most appropriate first-line treatment?
A. Nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for 5 days
B. Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days
C. Ciprofloxacin 250 mg twice daily for 3 days
D. Amoxicillin-clavulanate 875/125 mg twice daily for 7 days
Answer: A
Rationale: Nitrofurantoin is recommended as first-line for uncomplicated cystitis due to low resistance
rates and minimal systemic effects, and it is safe in sulfa allergy. Trimethoprim-sulfamethoxazole is
contraindicated due to allergy. Fluoroquinolones are reserved for complicated infections due to adverse
effects. Amoxicillin-clavulanate has higher resistance and is not first-line.
Page 4
