NUR 565 final exam graded A+ EXAM with
Questions and Answers/Plus a Rationale Updated
2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Pathophysiology and Pharmacotherapeutics
2. Clinical Decision-Making and Diagnostic Reasoning
3. Evidence-Based Practice (EBP) in Primary Care
4. Management of Chronic Complex Conditions
5. Health Promotion and Disease Prevention Across the Lifespan
6. Legal, Ethical, and Professional Role Standards
7. Assessment and Management of Acute Episodic Illness
1. A 68-year-old patient with stable heart failure and comorbid type 2 diabetes presents for a
follow-up. The patient is currently on Lisinopril and Metformin. Which diagnostic finding would
necessitate a change in the pharmacologic management plan?
A. Serum creatinine increase of 0.2 mg/dL from baseline.
B. eGFR decline to 28 mL/min/1.73m².
C. HbA1c of 7.2%.
D. Potassium level of 4.8 mEq/L.
CORRECT ANSWER : B
Rationale: Metformin is contraindicated in patients with an eGFR below 30 mL/min/1.73m² due
to the risk of lactic acidosis. An increase of 0.2 mg/dL in creatinine is often clinically acceptable
, in chronic management, while A1c and potassium levels are within acceptable therapeutic
ranges.
2. A 45-year-old female presents with persistent fatigue and a thyroid stimulating hormone (TSH)
level of 8.5 mIU/L, with a normal Free T4. What is the most appropriate next step in clinical
management?
A. Initiate Levothyroxine 100 mcg daily immediately.
B. Order Thyroid Peroxidase (TPO) antibodies to assess for autoimmune thyroiditis.
C. Recheck TSH in 6 months as this is likely transient.
D. Refer to endocrinology for immediate thyroid ultrasound.
CORRECT ANSWER : B
Rationale: The patient has subclinical hypothyroidism. Assessing TPO antibodies helps
determine the risk of progression to overt hypothyroidism and guides the decision to treat.
Starting high-dose levothyroxine is premature, and delaying action entirely ignores the potential
for autoimmune progression.
3. A patient with hypertension and known gout presents for a medication review. Which
antihypertensive agent should be avoided due to its potential to increase serum uric acid levels?
A. Amlodipine.
B. Lisinopril.
C. Hydrochlorothiazide.
D. Losartan.
CORRECT ANSWER : C
Rationale: Thiazide diuretics like hydrochlorothiazide compete with uric acid for excretion in the
renal tubules, which often exacerbates gout. Amlodipine, Lisinopril, and Losartan (which has a
unique uricosuric effect) are preferred in patients with gout.
4. A patient in an outpatient setting is diagnosed with community-acquired pneumonia. According
to IDSA guidelines, which factor determines the necessity of inpatient hospitalization versus
outpatient management?
A. Age of the patient.
B. CURB-65 score or PSI/PORT index.
, C. Presence of a productive cough.
D. Elevated White Blood Cell count.
CORRECT ANSWER : B
Rationale: Validated clinical decision tools like CURB-65 or the PSI (Pneumonia Severity Index)
are evidence-based standards for determining mortality risk and hospitalization needs. Age,
cough characteristics, and WBC counts are components, but the tools provide the formal
framework for clinical judgment.
5. A patient with chronic obstructive pulmonary disease (COPD) is optimized on long-acting
bronchodilators but continues to experience frequent exacerbations. What is the next logical step
according to GOLD guidelines?
A. Add an inhaled corticosteroid (ICS) if the blood eosinophil count is ≥ 300 cells/μL.
B. Start systemic corticosteroids for daily maintenance.
C. Increase the frequency of SABA rescue medication.
D. Switch to oral theophylline.
CORRECT ANSWER : A
Rationale: GOLD guidelines recommend ICS in patients with a history of frequent exacerbations
and elevated blood eosinophil counts to reduce airway inflammation. Systemic steroids are for
acute exacerbations, not maintenance, and theophylline has a narrow therapeutic index.
6. In evaluating a patient for potential major depressive disorder, which finding is essential to
distinguish from transient sadness?
A. Duration of symptoms lasting at least 2 weeks with impaired functional status.
B. Loss of appetite and sleep disturbances.
C. Feeling sad after a significant life loss.
D. History of depressive episodes in family members.
CORRECT ANSWER : A
Rationale: Clinical diagnostic criteria (DSM-5-TR) require a 2-week duration with functional
impairment. Transient sadness is reactive and lacks the chronicity and severity associated with a
major depressive disorder diagnosis.
, 7. A patient presents with a suspicious skin lesion. Which characteristics (ABCDE criteria) are
most concerning for malignant melanoma?
A. Symmetry, uniform color, and small diameter.
B. Asymmetry, irregular borders, and color variegation.
C. Uniform elevation and smooth edges.
D. Presence of hair within the lesion.
CORRECT ANSWER : B
Rationale: Asymmetry, irregular borders, and color variegation are hallmark signs of melanoma
requiring biopsy. The other options describe benign nevi or normal skin findings.
8. Which pharmacologic intervention is recommended as first-line therapy for a patient with new-
onset osteoarthritis of the knee and no history of gastrointestinal bleeding?
A. Celecoxib.
B. Acetaminophen (scheduled) or topical NSAIDs.
C. Oral Ibuprofen 800mg TID.
D. Tramadol.
CORRECT ANSWER : B
Rationale: Current clinical practice guidelines suggest starting with non-pharmacologic
interventions and topical NSAIDs or acetaminophen to minimize systemic risks, especially
gastrointestinal or renal. Long-term high-dose oral NSAIDs carry higher risks, and opioids like
Tramadol are not first-line.
9. A patient with a history of recurrent urinary tract infections (UTIs) is post-menopausal. What is a
specific, evidence-based non-antibiotic intervention for this patient?
A. Increased intake of cranberry juice only.
B. Vaginal estrogen therapy.
C. Daily intake of alkaline water.
D. Prophylactic antibiotics for one year.
CORRECT ANSWER : B
Questions and Answers/Plus a Rationale Updated
2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Pathophysiology and Pharmacotherapeutics
2. Clinical Decision-Making and Diagnostic Reasoning
3. Evidence-Based Practice (EBP) in Primary Care
4. Management of Chronic Complex Conditions
5. Health Promotion and Disease Prevention Across the Lifespan
6. Legal, Ethical, and Professional Role Standards
7. Assessment and Management of Acute Episodic Illness
1. A 68-year-old patient with stable heart failure and comorbid type 2 diabetes presents for a
follow-up. The patient is currently on Lisinopril and Metformin. Which diagnostic finding would
necessitate a change in the pharmacologic management plan?
A. Serum creatinine increase of 0.2 mg/dL from baseline.
B. eGFR decline to 28 mL/min/1.73m².
C. HbA1c of 7.2%.
D. Potassium level of 4.8 mEq/L.
CORRECT ANSWER : B
Rationale: Metformin is contraindicated in patients with an eGFR below 30 mL/min/1.73m² due
to the risk of lactic acidosis. An increase of 0.2 mg/dL in creatinine is often clinically acceptable
, in chronic management, while A1c and potassium levels are within acceptable therapeutic
ranges.
2. A 45-year-old female presents with persistent fatigue and a thyroid stimulating hormone (TSH)
level of 8.5 mIU/L, with a normal Free T4. What is the most appropriate next step in clinical
management?
A. Initiate Levothyroxine 100 mcg daily immediately.
B. Order Thyroid Peroxidase (TPO) antibodies to assess for autoimmune thyroiditis.
C. Recheck TSH in 6 months as this is likely transient.
D. Refer to endocrinology for immediate thyroid ultrasound.
CORRECT ANSWER : B
Rationale: The patient has subclinical hypothyroidism. Assessing TPO antibodies helps
determine the risk of progression to overt hypothyroidism and guides the decision to treat.
Starting high-dose levothyroxine is premature, and delaying action entirely ignores the potential
for autoimmune progression.
3. A patient with hypertension and known gout presents for a medication review. Which
antihypertensive agent should be avoided due to its potential to increase serum uric acid levels?
A. Amlodipine.
B. Lisinopril.
C. Hydrochlorothiazide.
D. Losartan.
CORRECT ANSWER : C
Rationale: Thiazide diuretics like hydrochlorothiazide compete with uric acid for excretion in the
renal tubules, which often exacerbates gout. Amlodipine, Lisinopril, and Losartan (which has a
unique uricosuric effect) are preferred in patients with gout.
4. A patient in an outpatient setting is diagnosed with community-acquired pneumonia. According
to IDSA guidelines, which factor determines the necessity of inpatient hospitalization versus
outpatient management?
A. Age of the patient.
B. CURB-65 score or PSI/PORT index.
, C. Presence of a productive cough.
D. Elevated White Blood Cell count.
CORRECT ANSWER : B
Rationale: Validated clinical decision tools like CURB-65 or the PSI (Pneumonia Severity Index)
are evidence-based standards for determining mortality risk and hospitalization needs. Age,
cough characteristics, and WBC counts are components, but the tools provide the formal
framework for clinical judgment.
5. A patient with chronic obstructive pulmonary disease (COPD) is optimized on long-acting
bronchodilators but continues to experience frequent exacerbations. What is the next logical step
according to GOLD guidelines?
A. Add an inhaled corticosteroid (ICS) if the blood eosinophil count is ≥ 300 cells/μL.
B. Start systemic corticosteroids for daily maintenance.
C. Increase the frequency of SABA rescue medication.
D. Switch to oral theophylline.
CORRECT ANSWER : A
Rationale: GOLD guidelines recommend ICS in patients with a history of frequent exacerbations
and elevated blood eosinophil counts to reduce airway inflammation. Systemic steroids are for
acute exacerbations, not maintenance, and theophylline has a narrow therapeutic index.
6. In evaluating a patient for potential major depressive disorder, which finding is essential to
distinguish from transient sadness?
A. Duration of symptoms lasting at least 2 weeks with impaired functional status.
B. Loss of appetite and sleep disturbances.
C. Feeling sad after a significant life loss.
D. History of depressive episodes in family members.
CORRECT ANSWER : A
Rationale: Clinical diagnostic criteria (DSM-5-TR) require a 2-week duration with functional
impairment. Transient sadness is reactive and lacks the chronicity and severity associated with a
major depressive disorder diagnosis.
, 7. A patient presents with a suspicious skin lesion. Which characteristics (ABCDE criteria) are
most concerning for malignant melanoma?
A. Symmetry, uniform color, and small diameter.
B. Asymmetry, irregular borders, and color variegation.
C. Uniform elevation and smooth edges.
D. Presence of hair within the lesion.
CORRECT ANSWER : B
Rationale: Asymmetry, irregular borders, and color variegation are hallmark signs of melanoma
requiring biopsy. The other options describe benign nevi or normal skin findings.
8. Which pharmacologic intervention is recommended as first-line therapy for a patient with new-
onset osteoarthritis of the knee and no history of gastrointestinal bleeding?
A. Celecoxib.
B. Acetaminophen (scheduled) or topical NSAIDs.
C. Oral Ibuprofen 800mg TID.
D. Tramadol.
CORRECT ANSWER : B
Rationale: Current clinical practice guidelines suggest starting with non-pharmacologic
interventions and topical NSAIDs or acetaminophen to minimize systemic risks, especially
gastrointestinal or renal. Long-term high-dose oral NSAIDs carry higher risks, and opioids like
Tramadol are not first-line.
9. A patient with a history of recurrent urinary tract infections (UTIs) is post-menopausal. What is a
specific, evidence-based non-antibiotic intervention for this patient?
A. Increased intake of cranberry juice only.
B. Vaginal estrogen therapy.
C. Daily intake of alkaline water.
D. Prophylactic antibiotics for one year.
CORRECT ANSWER : B
