NU 674 MIDTERM EXAM– QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
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1. A 68-year-old male with a history of hypertension and chronic kidney disease presents to
the outpatient advanced practice nursing clinic for routine management. His current
medication regimen includes lisinopril, furosemide, and atorvastatin. Laboratory results
show a serum potassium level of 5.8 mEq/L and a serum creatinine of 2.1 mg/dL. Which
clinical action should the nurse practitioner take first?
A. Increase the lisinopril dosage to provide further renal protection.
B. Initiate a low-dose potassium-sparing diuretic to balance electrolytes.
C. Discontinue the lisinopril and notify the nephrology specialist immediately.
D. Schedule a repeat basic metabolic panel in four weeks without changing medications.
ANSWER: C. Discontinue the lisinopril and notify the nephrology specialist immediately.
ACE inhibitors such as lisinopril decrease angiotensin II-mediated vasoconstriction of the
efferent arterioles, reducing glomerular filtration pressure and predisposing patients with
baseline renal impairment to hyperkalemia and acute kidney injury. A potassium level of 5.8
mEq/L is critically elevated and requires immediate withdrawal of the offending agent,
whereas increasing the dose or adding potassium-sparing agents would worsen hyperkalemia.
Delaying action places the patient at high risk for fatal cardiac arrhythmias.
2. A nurse practitioner is evaluating a 45-year-old female presenting with fatigue, weight
gain, constipation, and cold intolerance over the past six months. Laboratory findings
reveal a serum thyroid-stimulating hormone level of 9.2 mIU/L and a free thyroxine level
below the normal reference range. Which pharmacotherapeutic agent is indicated for
initial management?
A. Liothyronine sodium
B. Levothyroxine sodium
C. Methimazole
D. Propylthiouracil
ANSWER: B. Levothyroxine sodium
,Levothyroxine is the synthetic form of thyroxine (T4) and is the gold standard, first-line
monotherapy for primary hypothyroidism due to its stable hormonal conversion, once-daily
dosing profile, and favorable side effect profile. Liothyronine contains triiodothyronine (T3)
and carries a higher risk of cardiac side effects. Methimazole and propylthiouracil are
antithyroid medications utilized exclusively for hyperthyroidism.
3. A nurse practitioner in an urgent care setting is assessing a 52-year-old male
complaining of sudden onset sharp, pleuritic chest pain and severe shortness of breath that
began two hours ago. He returned from a 14-hour international flight yesterday. His vital
signs are: blood pressure 118/76 mmHg, heart rate 118 beats per minute, respiratory rate
26 breaths per minute, and oxygen saturation 89% on room air. Which diagnostic
evaluation is the most appropriate next step?
A. 12-lead electrocardiogram and sublingual nitroglycerin administration
B. Computed tomography pulmonary angiography
C. Transthoracic echocardiogram and outpatient follow-up
D. Plain chest radiography and routine complete blood count
ANSWER: B. Computed tomography pulmonary angiography
The clinical presentation of acute dyspnea, tachycardia, and pleuritic chest pain following
prolonged immobilization strongly suggests a pulmonary embolism. Computed tomography
pulmonary angiography is the definitive gold standard diagnostic test to visualize thrombi
within the pulmonary arterial tree. Electrocardiography and chest radiography lack the
specificity required to rule out acute pulmonary embolism in a high-risk presentation.
4. A nurse practitioner is managing a 60-year-old male with chronic heart failure with
reduced ejection fraction. His current regimen includes carvedilol, lisinopril, and
furosemide. He reports increasing lower extremity edema and a 4-pound weight gain over
48 hours. Which adjustment to therapy is clinically indicated?
A. Temporarily double the daily dose of carvedilol.
B. Increase the daily dose of furosemide temporarily.
C. Discontinue lisinopril and initiate an angiotensin receptor-neprilysin inhibitor.
D. Restrict total daily protein intake to 30 grams.
ANSWER: B. Increase the daily dose of furosemide temporarily.
Acute weight gain and dependent edema indicate fluid retention secondary to decompensated
heart failure, requiring prompt diuresis via an increased loop diuretic dose. Upregulating
,beta-blocker therapy during acute fluid overload can worsen heart failure symptoms. Dietary
protein restriction is inappropriate for chronic heart failure management.
5. A nurse practitioner is reviewing laboratory results for a 30-year-old female diagnosed
with major depressive disorder who is initiating sertraline therapy. Which baseline
laboratory screening is essential prior to starting selective serotonin reuptake inhibitors?
A. Serum cortisol and urinary free metanephrines
B. Serum lipid panel and glycated hemoglobin
C. Serum pregnancy test and basic metabolic panel
D. Arterial blood gases and serum iron profile
ANSWER: C. Serum pregnancy test and basic metabolic panel
Selective serotonin reuptake inhibitors carry potential teratogenic considerations and can
occasionally induce hyponatremia, making baseline pregnancy testing and electrolyte
evaluation vital components of safe psychiatric pharmacology management. The other panels
are not routinely mandated prior to initiating selective serotonin reuptake inhibitors unless
specific comorbidities are suspected.
6. A nurse practitioner is assessing a 72-year-old female presenting with progressive
memory decline, word-finding difficulty, and getting lost in familiar neighborhoods over
the past two years. Her family reports gradual functional deterioration. Which diagnostic
screening tool is best suited for clinical assessment of cognitive impairment in this setting?
A. Beck Depression Inventory
B. Montreal Cognitive Assessment
C. CAGE Questionnaire
D. Clinical Institute Withdrawal Assessment Scale
ANSWER: B. Montreal Cognitive Assessment
The Montreal Cognitive Assessment is a validated, sensitive screening instrument designed to
detect mild cognitive impairment and early dementia by evaluating multiple cognitive domains
including visuospatial, executive function, and delayed recall. The CAGE questionnaire
screens for alcoholism, the Beck Inventory assesses depression, and the Clinical Institute
Withdrawal tool monitors alcohol withdrawal.
7. A nurse practitioner is evaluating a 28-year-old female presenting with intermittent
wheezing, dry cough, and chest tightness primarily occurring during exercise and exposure
, to cold air. Spirometry demonstrates a post-bronchodilator improvement in forced
expiratory volume in one second of 15%. What is the most appropriate initial controller
medication to prescribe?
A. Inhaled long-acting muscarinic antagonist monotherapy
B. Low-dose inhaled corticosteroid combined with formoterol as needed
C. Daily systemic oral prednisone burst for 14 days
D. Leukotriene receptor antagonist monotherapy without rescue inhaler
ANSWER: B. Inhaled low-dose corticosteroid combined with formoterol as needed
Current asthma management guidelines recommend low-dose inhaled corticosteroids
combined with a fast-acting bronchodilator like formoterol as the cornerstone anti-
inflammatory controller therapy to reduce exacerbation risks. Long-acting muscarinic
antagonists are primarily indicated for chronic obstructive pulmonary disease, and systemic
corticosteroids are reserved for severe acute exacerbations.
8. A nurse practitioner is providing outpatient care for a 55-year-old male with type 2
diabetes mellitus. His glycated hemoglobin is 8.4% despite lifestyle modifications and
maximum-dose metformin therapy. He has a documented history of atherosclerotic
cardiovascular disease. Which additional antidiabetic medication class provides proven
cardiovascular risk reduction?
A. Sulfonylureas
B. Sodium-glucose cotransporter-2 inhibitors
C. Thiazolidinediones
D. Dipeptidyl peptidase-4 inhibitors
ANSWER: B. Sodium-glucose cotransporter-2 inhibitors
Sodium-glucose cotransporter-2 inhibitors demonstrate significant clinical trial evidence
reducing major adverse cardiovascular events, hospitalization for heart failure, and
progression of renal disease in patients with established cardiovascular disease. Sulfonylureas
carry a high risk of hypoglycemia and lack cardiovascular protective benefits.
9. A nurse practitioner is examining a 65-year-old male who presents with a 3-centimeter
firm, nontender nodule on his right pinna with rolled borders and a central ulceration. He
has a 40-pack-year smoking history and worked outdoors as a construction worker for
decades. Which diagnostic procedure is indicated?
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A 68-year-old male with a history of hypertension and chronic kidney disease presents to
the outpatient advanced practice nursing clinic for routine management. His current
medication regimen includes lisinopril, furosemide, and atorvastatin. Laboratory results
show a serum potassium level of 5.8 mEq/L and a serum creatinine of 2.1 mg/dL. Which
clinical action should the nurse practitioner take first?
A. Increase the lisinopril dosage to provide further renal protection.
B. Initiate a low-dose potassium-sparing diuretic to balance electrolytes.
C. Discontinue the lisinopril and notify the nephrology specialist immediately.
D. Schedule a repeat basic metabolic panel in four weeks without changing medications.
ANSWER: C. Discontinue the lisinopril and notify the nephrology specialist immediately.
ACE inhibitors such as lisinopril decrease angiotensin II-mediated vasoconstriction of the
efferent arterioles, reducing glomerular filtration pressure and predisposing patients with
baseline renal impairment to hyperkalemia and acute kidney injury. A potassium level of 5.8
mEq/L is critically elevated and requires immediate withdrawal of the offending agent,
whereas increasing the dose or adding potassium-sparing agents would worsen hyperkalemia.
Delaying action places the patient at high risk for fatal cardiac arrhythmias.
2. A nurse practitioner is evaluating a 45-year-old female presenting with fatigue, weight
gain, constipation, and cold intolerance over the past six months. Laboratory findings
reveal a serum thyroid-stimulating hormone level of 9.2 mIU/L and a free thyroxine level
below the normal reference range. Which pharmacotherapeutic agent is indicated for
initial management?
A. Liothyronine sodium
B. Levothyroxine sodium
C. Methimazole
D. Propylthiouracil
ANSWER: B. Levothyroxine sodium
,Levothyroxine is the synthetic form of thyroxine (T4) and is the gold standard, first-line
monotherapy for primary hypothyroidism due to its stable hormonal conversion, once-daily
dosing profile, and favorable side effect profile. Liothyronine contains triiodothyronine (T3)
and carries a higher risk of cardiac side effects. Methimazole and propylthiouracil are
antithyroid medications utilized exclusively for hyperthyroidism.
3. A nurse practitioner in an urgent care setting is assessing a 52-year-old male
complaining of sudden onset sharp, pleuritic chest pain and severe shortness of breath that
began two hours ago. He returned from a 14-hour international flight yesterday. His vital
signs are: blood pressure 118/76 mmHg, heart rate 118 beats per minute, respiratory rate
26 breaths per minute, and oxygen saturation 89% on room air. Which diagnostic
evaluation is the most appropriate next step?
A. 12-lead electrocardiogram and sublingual nitroglycerin administration
B. Computed tomography pulmonary angiography
C. Transthoracic echocardiogram and outpatient follow-up
D. Plain chest radiography and routine complete blood count
ANSWER: B. Computed tomography pulmonary angiography
The clinical presentation of acute dyspnea, tachycardia, and pleuritic chest pain following
prolonged immobilization strongly suggests a pulmonary embolism. Computed tomography
pulmonary angiography is the definitive gold standard diagnostic test to visualize thrombi
within the pulmonary arterial tree. Electrocardiography and chest radiography lack the
specificity required to rule out acute pulmonary embolism in a high-risk presentation.
4. A nurse practitioner is managing a 60-year-old male with chronic heart failure with
reduced ejection fraction. His current regimen includes carvedilol, lisinopril, and
furosemide. He reports increasing lower extremity edema and a 4-pound weight gain over
48 hours. Which adjustment to therapy is clinically indicated?
A. Temporarily double the daily dose of carvedilol.
B. Increase the daily dose of furosemide temporarily.
C. Discontinue lisinopril and initiate an angiotensin receptor-neprilysin inhibitor.
D. Restrict total daily protein intake to 30 grams.
ANSWER: B. Increase the daily dose of furosemide temporarily.
Acute weight gain and dependent edema indicate fluid retention secondary to decompensated
heart failure, requiring prompt diuresis via an increased loop diuretic dose. Upregulating
,beta-blocker therapy during acute fluid overload can worsen heart failure symptoms. Dietary
protein restriction is inappropriate for chronic heart failure management.
5. A nurse practitioner is reviewing laboratory results for a 30-year-old female diagnosed
with major depressive disorder who is initiating sertraline therapy. Which baseline
laboratory screening is essential prior to starting selective serotonin reuptake inhibitors?
A. Serum cortisol and urinary free metanephrines
B. Serum lipid panel and glycated hemoglobin
C. Serum pregnancy test and basic metabolic panel
D. Arterial blood gases and serum iron profile
ANSWER: C. Serum pregnancy test and basic metabolic panel
Selective serotonin reuptake inhibitors carry potential teratogenic considerations and can
occasionally induce hyponatremia, making baseline pregnancy testing and electrolyte
evaluation vital components of safe psychiatric pharmacology management. The other panels
are not routinely mandated prior to initiating selective serotonin reuptake inhibitors unless
specific comorbidities are suspected.
6. A nurse practitioner is assessing a 72-year-old female presenting with progressive
memory decline, word-finding difficulty, and getting lost in familiar neighborhoods over
the past two years. Her family reports gradual functional deterioration. Which diagnostic
screening tool is best suited for clinical assessment of cognitive impairment in this setting?
A. Beck Depression Inventory
B. Montreal Cognitive Assessment
C. CAGE Questionnaire
D. Clinical Institute Withdrawal Assessment Scale
ANSWER: B. Montreal Cognitive Assessment
The Montreal Cognitive Assessment is a validated, sensitive screening instrument designed to
detect mild cognitive impairment and early dementia by evaluating multiple cognitive domains
including visuospatial, executive function, and delayed recall. The CAGE questionnaire
screens for alcoholism, the Beck Inventory assesses depression, and the Clinical Institute
Withdrawal tool monitors alcohol withdrawal.
7. A nurse practitioner is evaluating a 28-year-old female presenting with intermittent
wheezing, dry cough, and chest tightness primarily occurring during exercise and exposure
, to cold air. Spirometry demonstrates a post-bronchodilator improvement in forced
expiratory volume in one second of 15%. What is the most appropriate initial controller
medication to prescribe?
A. Inhaled long-acting muscarinic antagonist monotherapy
B. Low-dose inhaled corticosteroid combined with formoterol as needed
C. Daily systemic oral prednisone burst for 14 days
D. Leukotriene receptor antagonist monotherapy without rescue inhaler
ANSWER: B. Inhaled low-dose corticosteroid combined with formoterol as needed
Current asthma management guidelines recommend low-dose inhaled corticosteroids
combined with a fast-acting bronchodilator like formoterol as the cornerstone anti-
inflammatory controller therapy to reduce exacerbation risks. Long-acting muscarinic
antagonists are primarily indicated for chronic obstructive pulmonary disease, and systemic
corticosteroids are reserved for severe acute exacerbations.
8. A nurse practitioner is providing outpatient care for a 55-year-old male with type 2
diabetes mellitus. His glycated hemoglobin is 8.4% despite lifestyle modifications and
maximum-dose metformin therapy. He has a documented history of atherosclerotic
cardiovascular disease. Which additional antidiabetic medication class provides proven
cardiovascular risk reduction?
A. Sulfonylureas
B. Sodium-glucose cotransporter-2 inhibitors
C. Thiazolidinediones
D. Dipeptidyl peptidase-4 inhibitors
ANSWER: B. Sodium-glucose cotransporter-2 inhibitors
Sodium-glucose cotransporter-2 inhibitors demonstrate significant clinical trial evidence
reducing major adverse cardiovascular events, hospitalization for heart failure, and
progression of renal disease in patients with established cardiovascular disease. Sulfonylureas
carry a high risk of hypoglycemia and lack cardiovascular protective benefits.
9. A nurse practitioner is examining a 65-year-old male who presents with a 3-centimeter
firm, nontender nodule on his right pinna with rolled borders and a central ulceration. He
has a 40-pack-year smoking history and worked outdoors as a construction worker for
decades. Which diagnostic procedure is indicated?
