NUR 555 Exam 2026-2027 BANK QUESTIONS WITH
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Question 1
A 72-year-old patient with chronic heart failure presents with
worsening dyspnea, orthopnea, and peripheral edema. His current
medications include lisinopril, furosemide, and carvedilol. Which of the
following laboratory findings is most concerning in this patient?
A) Serum sodium of 134 mEq/L
B) Serum potassium of 5.1 mEq/L
C) Serum creatinine of 2.0 mg/dL (baseline 1.2 mg/dL)
D) B-type natriuretic peptide (BNP) of 250 pg/mL
Answer: C
Explanation: A rise in serum creatinine from baseline in a patient with
heart failure indicates worsening renal function, which can be due to
decreased renal perfusion from over-diuresis, worsening cardiac output,
or nephrotoxic effects. This is more immediately concerning than mild
hyponatremia or borderline hyperkalemia, both of which are common in
heart failure but do not represent an acute change. A BNP of 250
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pg/mL, while elevated, is not as high as typically seen in acute
decompensated heart failure and must be interpreted in the context of
age and renal function. The creatinine change suggests acute kidney
injury, which requires prompt evaluation and medication adjustment.
Question 2
A 55-year-old male with a 30-pack-year smoking history presents with a
new-onset cough, hemoptysis, and weight loss. Chest CT reveals a 3 cm
solitary pulmonary nodule in the right upper lobe with spiculated
margins. Which of the following is the most appropriate next step in
management?
A) Repeat CT scan in 6 months
B) Positron emission tomography (PET) scan
C) CT-guided fine-needle aspiration biopsy
D) Bronchoscopy with biopsy
Answer: D
Explanation: The patient has a suspicious lung lesion with features
concerning for malignancy, including spiculated margins, in a high-risk
individual. Bronchoscopy with biopsy is the preferred initial diagnostic
approach for a centrally located lesion in the right upper lobe because it
allows for tissue sampling and histological diagnosis. While PET scan
can help with staging, it does not provide a definitive diagnosis. CT-
guided biopsy is an option, but bronchoscopy is more appropriate given
the location and the need to evaluate the airway. Repeat imaging
would delay diagnosis in a patient with a high probability of
malignancy.
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Question 3
A 45-year-old woman with systemic lupus erythematosus (SLE) presents
with acute pleuritic chest pain and shortness of breath. She is febrile
and tachycardic. A CT pulmonary angiogram is negative for pulmonary
embolism. Which of the following is the most likely diagnosis?
A) Pneumonia
B) Pericarditis
C) Pleuritis
D) Myocardial infarction
Answer: C
Explanation: In patients with SLE, pleuritis is a common manifestation of
disease activity. The acute onset of pleuritic chest pain, fever, and
tachycardia, with a negative CT pulmonary angiogram for pulmonary
embolism, makes pleuritis the most likely diagnosis. Pericarditis can also
occur but is less commonly associated with pleuritic pain that worsens
with inspiration; pericardial pain is typically positional and relieved by
leaning forward. Pneumonia would show infiltrates on imaging, and
myocardial infarction would present with cardiac enzyme elevation and
ischemic EKG changes.
Question 4
A 68-year-old patient with type 2 diabetes mellitus and hypertension is
started on lisinopril. One week later, she presents with a nonproductive
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cough and angioedema of the lips. Which of the following is the best
alternative antihypertensive agent?
A) Amlodipine
B) Hydrochlorothiazide
C) Losartan
D) Metoprolol
Answer: C
Explanation: The patient is experiencing a classic adverse reaction to an
ACE inhibitor: cough and angioedema. The best alternative is an
angiotensin II receptor blocker (ARB), such as losartan, because it
provides similar antihypertensive and renoprotective effects without the
bradykinin-mediated side effects of ACE inhibitors. Amlodipine,
hydrochlorothiazide, and metoprolol are all acceptable alternatives, but
losartan is the most appropriate switch in this context due to the
mechanism of action and the patient's underlying diabetes and
hypertension.
Question 5
A 30-year-old woman with a history of migraine with aura is requesting
oral contraceptive pills for birth control. Which of the following is the
most significant risk associated with this combination?
A) Increased risk of breast cancer
B) Increased risk of stroke
C) Increased risk of venous thromboembolism