NR 661 Exam 1, Exam 2, Exam 3, Midterm & Final
Exam Bundle (2026/2027) | Complete Nursing Exam
Study Guide MOST TESTED FROM PAST PAPERS
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (VERIFIED ANSWERS) |ALREADY
GRADED A+||NEWEST VERSION
Contents
NR 661 Exam 1 ................................................................................................................................ 1
NR 661 Exam 2 .............................................................................................................................. 51
NR 661 Exam 3 .............................................................................................................................. 82
NR 661 Exam midterm ............................................................................................................... 114
NR 661 final exam…………………………………………………………………………..140
NR 661 Exam 1
Question 1
A 54-year-old woman presents for routine care. Her BP on two separate visits is
148/92 mmHg. She has no symptoms and no end-organ damage. What is the most
appropriate initial management?
A. Start high-dose beta-blocker immediately
B. Recommend lifestyle modifications and start a thiazide-type diuretic
C. Reassure the client and repeat BP in one year
D. Refer directly for cardiac catheterization
Correct Answer: B. Recommend lifestyle modifications and start a thiazide-type
diuretic
,Rationale:
Stage 2 hypertension usually requires both lifestyle changes (diet, exercise, weight
loss, reduced sodium) and pharmacologic therapy, with thiazide diuretics a
common first-line choice unless contraindicated.
Question 2
A client with type 2 diabetes has an A1C of 9.1% despite metformin monotherapy.
Which action is most appropriate?
A. Discontinue metformin and start lifestyle changes only
B. Add a second agent (e.g., GLP-1 agonist or SGLT2 inhibitor) based on
comorbidities and cost
C. Increase metformin beyond the maximum recommended dose
D. Ignore the A1C and recheck in 2 years
Correct Answer: B. Add a second agent (e.g., GLP-1 agonist or SGLT2 inhibitor)
based on comorbidities and cost
Rationale:
An A1C >9% despite maximized metformin indicates need for additional therapy;
second-line agents are chosen based on cardiovascular status, renal function,
weight, and patient factors.
Question 3
A 38-year-old man presents with chest burning after large meals, worse when
lying down, relieved by antacids. He denies exertional chest pain. What is the
most likely diagnosis?
A. Acute coronary syndrome
B. Gastroesophageal reflux disease (GERD)
C. Peptic ulcer perforation
D. Pulmonary embolism
Correct Answer: B. Gastroesophageal reflux disease (GERD)
,Rationale:
Typical GERD presents with substernal burning related to meals and position,
relieved by antacids. Cardiac or PE etiologies usually involve exertional symptoms,
dyspnea, or other red flags.
Question 4
A client on long-term NSAIDs for osteoarthritis reports black, tarry stools. What is
the most appropriate action?
A. Reassure that this is a normal side effect
B. Stop NSAIDs and evaluate urgently for possible upper GI bleeding
C. Increase NSAID dose
D. Add acetaminophen and ignore the stool change
Correct Answer: B. Stop NSAIDs and evaluate urgently for possible upper GI
bleeding
Rationale:
Melena suggests upper GI bleeding, and NSAIDs increase risk for ulcers and
bleeding; immediate evaluation and NSAID discontinuation are indicated.
Question 5
Which finding in a hypertensive client most strongly suggests chronic end-organ
damage?
A. Occasional mild headaches
B. Retinal arteriovenous nicking and left ventricular hypertrophy
C. Mild anxiety about health
D. Normal creatinine and normal EKG
Correct Answer: B. Retinal arteriovenous nicking and left ventricular hypertrophy
, Rationale:
Retinopathy and LVH represent target organ damage, indicating long-standing
uncontrolled hypertension and influencing treatment intensity.
Question 6
A 29-year-old woman reports episodes of palpitations and excessive worry lasting
most days for 6 months, with muscle tension and sleep disturbance. What is the
most likely diagnosis?
A. Panic disorder
B. Generalized anxiety disorder
C. Major depressive disorder
D. Acute stress reaction
Correct Answer: B. Generalized anxiety disorder
Rationale:
GAD involves excessive worry more days than not for at least 6 months plus
physical symptoms like restlessness, fatigue, muscle tension, and sleep
disturbance.
Question 7
A client newly diagnosed with generalized anxiety disorder prefers
nonpharmacologic options. Which initial intervention is most appropriate?
A. Hospitalization for observation
B. Cognitive-behavioral therapy and relaxation training
C. High-dose benzodiazepines immediately
D. Ignore symptoms and encourage “toughening up”
Correct Answer: B. Cognitive-behavioral therapy and relaxation training
Rationale:
Evidence-based first-line nonpharmacologic treatment for anxiety includes CBT,
Exam Bundle (2026/2027) | Complete Nursing Exam
Study Guide MOST TESTED FROM PAST PAPERS
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (VERIFIED ANSWERS) |ALREADY
GRADED A+||NEWEST VERSION
Contents
NR 661 Exam 1 ................................................................................................................................ 1
NR 661 Exam 2 .............................................................................................................................. 51
NR 661 Exam 3 .............................................................................................................................. 82
NR 661 Exam midterm ............................................................................................................... 114
NR 661 final exam…………………………………………………………………………..140
NR 661 Exam 1
Question 1
A 54-year-old woman presents for routine care. Her BP on two separate visits is
148/92 mmHg. She has no symptoms and no end-organ damage. What is the most
appropriate initial management?
A. Start high-dose beta-blocker immediately
B. Recommend lifestyle modifications and start a thiazide-type diuretic
C. Reassure the client and repeat BP in one year
D. Refer directly for cardiac catheterization
Correct Answer: B. Recommend lifestyle modifications and start a thiazide-type
diuretic
,Rationale:
Stage 2 hypertension usually requires both lifestyle changes (diet, exercise, weight
loss, reduced sodium) and pharmacologic therapy, with thiazide diuretics a
common first-line choice unless contraindicated.
Question 2
A client with type 2 diabetes has an A1C of 9.1% despite metformin monotherapy.
Which action is most appropriate?
A. Discontinue metformin and start lifestyle changes only
B. Add a second agent (e.g., GLP-1 agonist or SGLT2 inhibitor) based on
comorbidities and cost
C. Increase metformin beyond the maximum recommended dose
D. Ignore the A1C and recheck in 2 years
Correct Answer: B. Add a second agent (e.g., GLP-1 agonist or SGLT2 inhibitor)
based on comorbidities and cost
Rationale:
An A1C >9% despite maximized metformin indicates need for additional therapy;
second-line agents are chosen based on cardiovascular status, renal function,
weight, and patient factors.
Question 3
A 38-year-old man presents with chest burning after large meals, worse when
lying down, relieved by antacids. He denies exertional chest pain. What is the
most likely diagnosis?
A. Acute coronary syndrome
B. Gastroesophageal reflux disease (GERD)
C. Peptic ulcer perforation
D. Pulmonary embolism
Correct Answer: B. Gastroesophageal reflux disease (GERD)
,Rationale:
Typical GERD presents with substernal burning related to meals and position,
relieved by antacids. Cardiac or PE etiologies usually involve exertional symptoms,
dyspnea, or other red flags.
Question 4
A client on long-term NSAIDs for osteoarthritis reports black, tarry stools. What is
the most appropriate action?
A. Reassure that this is a normal side effect
B. Stop NSAIDs and evaluate urgently for possible upper GI bleeding
C. Increase NSAID dose
D. Add acetaminophen and ignore the stool change
Correct Answer: B. Stop NSAIDs and evaluate urgently for possible upper GI
bleeding
Rationale:
Melena suggests upper GI bleeding, and NSAIDs increase risk for ulcers and
bleeding; immediate evaluation and NSAID discontinuation are indicated.
Question 5
Which finding in a hypertensive client most strongly suggests chronic end-organ
damage?
A. Occasional mild headaches
B. Retinal arteriovenous nicking and left ventricular hypertrophy
C. Mild anxiety about health
D. Normal creatinine and normal EKG
Correct Answer: B. Retinal arteriovenous nicking and left ventricular hypertrophy
, Rationale:
Retinopathy and LVH represent target organ damage, indicating long-standing
uncontrolled hypertension and influencing treatment intensity.
Question 6
A 29-year-old woman reports episodes of palpitations and excessive worry lasting
most days for 6 months, with muscle tension and sleep disturbance. What is the
most likely diagnosis?
A. Panic disorder
B. Generalized anxiety disorder
C. Major depressive disorder
D. Acute stress reaction
Correct Answer: B. Generalized anxiety disorder
Rationale:
GAD involves excessive worry more days than not for at least 6 months plus
physical symptoms like restlessness, fatigue, muscle tension, and sleep
disturbance.
Question 7
A client newly diagnosed with generalized anxiety disorder prefers
nonpharmacologic options. Which initial intervention is most appropriate?
A. Hospitalization for observation
B. Cognitive-behavioral therapy and relaxation training
C. High-dose benzodiazepines immediately
D. Ignore symptoms and encourage “toughening up”
Correct Answer: B. Cognitive-behavioral therapy and relaxation training
Rationale:
Evidence-based first-line nonpharmacologic treatment for anxiety includes CBT,
