NUR 668 FINAL EXAM] – QUESTIONS AND ANSWERS | VERIFIED AND
WELL DETAILED ANSWERS PLUS RATIONALES | GUARANTEED PASS |
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1. A patient with a history of heart failure presents with increased dyspnea and peripheral
edema. Which assessment finding best indicates that the patient's condition has progressed
to acute decompensated heart failure?
A. S3 heart sound
B. Bilateral crackles at the lung bases
C. Jugular venous distention
D. Weight gain of 3 pounds in 24 hours
While weight gain, JVD, and S3 are indicators of fluid volume excess in heart failure, the
presence of bilateral crackles (pulmonary edema) signifies that the heart's pumping capacity is
unable to manage the venous return, leading to fluid backup into the alveoli, which is the
hallmark of acute decompensation.
2. A 65-year-old patient is prescribed a new medication for hypertension. During the
follow-up visit, the patient reports a persistent, dry, hacking cough. Which medication class
is most likely responsible?
A. Calcium channel blockers
B. Angiotensin-converting enzyme (ACE) inhibitors
C. Beta-blockers
D. Angiotensin II receptor blockers (ARBs)
The dry, non-productive cough is a well-documented side effect of ACE inhibitors, caused by
the accumulation of bradykinin in the lungs. ARBs do not affect bradykinin levels and are
typically the alternative prescribed if a patient cannot tolerate an ACE inhibitor due to this
side effect.
3. When evaluating a patient for metabolic syndrome, which of the following criteria must
be met according to NCEP ATP III guidelines?
A. BMI over 30 and fasting glucose over 100 mg/dL
,B. Waist circumference >40 inches in men and >35 inches in women, plus two additional
risk factors
C. HDL cholesterol <50 mg/dL in men and <40 mg/dL in women
D. Triglycerides <150 mg/dL
Metabolic syndrome is diagnosed by the presence of three or more of five criteria: increased
waist circumference, elevated triglycerides, reduced HDL, elevated blood pressure, and
elevated fasting glucose. Waist circumference thresholds are specific to gender to define
abdominal obesity.
4. A patient presents with sudden onset of severe right lower quadrant pain. Which
diagnostic test is the most appropriate first-line imaging modality to rule out appendicitis?
A. Abdominal X-ray
B. Transvaginal ultrasound
C. CT scan of the abdomen and pelvis with contrast
D. MRI without contrast
A CT scan with contrast is the gold standard for diagnosing appendicitis due to its high
sensitivity and specificity in visualizing the appendix and identifying potential complications
like perforation or abscess.
5. Which of the following lab values is the most sensitive indicator of early renal
impairment in a patient with diabetes?
A. Serum creatinine
B. Blood urea nitrogen (BUN)
C. Urine albumin-to-creatinine ratioHGH
D. Estimated glomerular filtration rate (eGFR)
Microalbuminuria, detected via the urine albumin-to-creatinine ratio, is the earliest clinical
manifestation of diabetic nephropathy. Serum creatinine and eGFR may remain within
normal limits until significant renal damage has already occurred.
, 6. A patient with hyperthyroidism is being managed with methimazole. Which of the
following side effects requires immediate discontinuation of the drug and emergency
evaluation?
A. Mild skin rash
B. Joint pain
C. Sore throat and fever
D. Metallic taste in the mouth
Agranulocytosis is a rare but life-threatening side effect of methimazole. Any patient
presenting with signs of infection, such as fever or a sore throat, must be evaluated
immediately with a complete blood count (CBC) to check for neutropenia.
7. Which primary care intervention is most effective for reducing the risk of cardiovascular
disease in a patient with dyslipidemia?
A. Increasing intake of dietary cholesterol
B. Initiation of high-intensity statin therapy
C. Monthly monitoring of lipid panels
D. Stress management counseling
Statin therapy is the cornerstone of lipid management and cardiovascular risk reduction.
While lifestyle changes are essential, high-intensity statin therapy has the most robust
evidence for preventing major adverse cardiovascular events in high-risk patients.
8. An elderly patient is diagnosed with iron deficiency anemia. What is the most critical
next step in the clinical management of this patient?
A. Start oral iron supplementation
B. Order a fecal occult blood test and consider endoscopy/colonoscopy
C. Increase dietary intake of leafy greens
D. Re-check hemoglobin in 6 months
In post-menopausal women and men, iron deficiency anemia is considered blood loss until
proven otherwise. It is imperative to investigate the source of the bleeding, particularly
malignancies of the gastrointestinal tract, before simply treating with supplementation.
WELL DETAILED ANSWERS PLUS RATIONALES | GUARANTEED PASS |
LATEST EXAM UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
| DOWNLOAD INSTANT PDF
1. A patient with a history of heart failure presents with increased dyspnea and peripheral
edema. Which assessment finding best indicates that the patient's condition has progressed
to acute decompensated heart failure?
A. S3 heart sound
B. Bilateral crackles at the lung bases
C. Jugular venous distention
D. Weight gain of 3 pounds in 24 hours
While weight gain, JVD, and S3 are indicators of fluid volume excess in heart failure, the
presence of bilateral crackles (pulmonary edema) signifies that the heart's pumping capacity is
unable to manage the venous return, leading to fluid backup into the alveoli, which is the
hallmark of acute decompensation.
2. A 65-year-old patient is prescribed a new medication for hypertension. During the
follow-up visit, the patient reports a persistent, dry, hacking cough. Which medication class
is most likely responsible?
A. Calcium channel blockers
B. Angiotensin-converting enzyme (ACE) inhibitors
C. Beta-blockers
D. Angiotensin II receptor blockers (ARBs)
The dry, non-productive cough is a well-documented side effect of ACE inhibitors, caused by
the accumulation of bradykinin in the lungs. ARBs do not affect bradykinin levels and are
typically the alternative prescribed if a patient cannot tolerate an ACE inhibitor due to this
side effect.
3. When evaluating a patient for metabolic syndrome, which of the following criteria must
be met according to NCEP ATP III guidelines?
A. BMI over 30 and fasting glucose over 100 mg/dL
,B. Waist circumference >40 inches in men and >35 inches in women, plus two additional
risk factors
C. HDL cholesterol <50 mg/dL in men and <40 mg/dL in women
D. Triglycerides <150 mg/dL
Metabolic syndrome is diagnosed by the presence of three or more of five criteria: increased
waist circumference, elevated triglycerides, reduced HDL, elevated blood pressure, and
elevated fasting glucose. Waist circumference thresholds are specific to gender to define
abdominal obesity.
4. A patient presents with sudden onset of severe right lower quadrant pain. Which
diagnostic test is the most appropriate first-line imaging modality to rule out appendicitis?
A. Abdominal X-ray
B. Transvaginal ultrasound
C. CT scan of the abdomen and pelvis with contrast
D. MRI without contrast
A CT scan with contrast is the gold standard for diagnosing appendicitis due to its high
sensitivity and specificity in visualizing the appendix and identifying potential complications
like perforation or abscess.
5. Which of the following lab values is the most sensitive indicator of early renal
impairment in a patient with diabetes?
A. Serum creatinine
B. Blood urea nitrogen (BUN)
C. Urine albumin-to-creatinine ratioHGH
D. Estimated glomerular filtration rate (eGFR)
Microalbuminuria, detected via the urine albumin-to-creatinine ratio, is the earliest clinical
manifestation of diabetic nephropathy. Serum creatinine and eGFR may remain within
normal limits until significant renal damage has already occurred.
, 6. A patient with hyperthyroidism is being managed with methimazole. Which of the
following side effects requires immediate discontinuation of the drug and emergency
evaluation?
A. Mild skin rash
B. Joint pain
C. Sore throat and fever
D. Metallic taste in the mouth
Agranulocytosis is a rare but life-threatening side effect of methimazole. Any patient
presenting with signs of infection, such as fever or a sore throat, must be evaluated
immediately with a complete blood count (CBC) to check for neutropenia.
7. Which primary care intervention is most effective for reducing the risk of cardiovascular
disease in a patient with dyslipidemia?
A. Increasing intake of dietary cholesterol
B. Initiation of high-intensity statin therapy
C. Monthly monitoring of lipid panels
D. Stress management counseling
Statin therapy is the cornerstone of lipid management and cardiovascular risk reduction.
While lifestyle changes are essential, high-intensity statin therapy has the most robust
evidence for preventing major adverse cardiovascular events in high-risk patients.
8. An elderly patient is diagnosed with iron deficiency anemia. What is the most critical
next step in the clinical management of this patient?
A. Start oral iron supplementation
B. Order a fecal occult blood test and consider endoscopy/colonoscopy
C. Increase dietary intake of leafy greens
D. Re-check hemoglobin in 6 months
In post-menopausal women and men, iron deficiency anemia is considered blood loss until
proven otherwise. It is imperative to investigate the source of the bleeding, particularly
malignancies of the gastrointestinal tract, before simply treating with supplementation.
