1|Page
NSG 6020 3P /APPROVED NSG 6020 3P EXAM TEST
BANK Exam Preparation With Complete Questions And
Correct Answers With Rationales | Already Graded
A+||Brand New Version!!
Question 1
A 45-year-old female presents with a two-week history of progressive
weakness in her lower extremities, urinary incontinence, and a band-
like sensation of tightness around her chest. Her past medical history is
significant for hypertension and hypothyroidism. On examination,
lower extremity muscle strength is 3/5 bilaterally, deep tendon reflexes
are hyperactive, and plantar responses are extensor. Sensation to
pinprick is decreased below the T4 level. Which of the following is the
most appropriate next step in management?
A) Oral corticosteroids
B) Immediate magnetic resonance imaging of the spine
C) Lumbar puncture for cerebrospinal fluid analysis
D) Electromyography and nerve conduction studies
Answer: B) Immediate magnetic resonance imaging of the spine
Explanation: This patient presents with acute-onset myelopathy
characterized by bilateral lower extremity weakness, a sensory level,
,2|Page
and upper motor neuron signs. The clinical picture is highly concerning
for spinal cord compression, which is a neurologic emergency. The most
appropriate next step is immediate MRI of the spine to identify the level
and etiology of the compression, such as a herniated disc, tumor, or
epidural abscess. While corticosteroids may be indicated for conditions
like multiple sclerosis, they should not be given without ruling out a
compressive lesion. Lumbar puncture is contraindicated if there is
suspicion of increased intracranial pressure or spinal mass due to risk of
herniation. Electromyography evaluates peripheral nerve disorders and
is not the initial study for suspected spinal cord pathology.
Question 2
A 60-year-old male with a 40-pack-year smoking history presents with a
chronic cough, hemoptysis, and weight loss over the past three months.
Chest imaging reveals a large right hilar mass with mediastinal
lymphadenopathy. A bronchoscopy with biopsy is performed and
reveals small cell lung carcinoma. Which of the following is the most
characteristic paraneoplastic syndrome associated with this
malignancy?
A) Hyponatremia due to syndrome of inappropriate antidiuretic
hormone secretion
B) Hypercalcemia due to parathyroid hormone-related peptide
C) Clubbing and hypertrophic pulmonary osteoarthropathy
D) Eaton-Lambert myasthenic syndrome
Answer: A) Hyponatremia due to syndrome of inappropriate antidiuretic
hormone secretion
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Explanation: Small cell lung carcinoma is strongly associated with the
syndrome of inappropriate antidiuretic hormone secretion, which leads
to hyponatremia due to impaired water excretion. This occurs because
the tumor ectopically produces antidiuretic hormone. Hypercalcemia
and hypertrophic pulmonary osteoarthropathy are more characteristic
of squamous cell carcinoma. Eaton-Lambert myasthenic syndrome is
associated with small cell lung cancer but is less common than SIADH as
a presenting paraneoplastic phenomenon.
Question 3
A 35-year-old woman presents with a three-month history of fatigue,
arthralgias, and a malar rash that worsens with sun exposure.
Laboratory studies reveal leukopenia, positive antinuclear antibody,
and positive anti-double-stranded DNA antibodies. Which of the
following renal findings is most characteristic of this disease?
A) Focal segmental glomerulosclerosis
B) Membranous nephropathy
C) Diffuse proliferative glomerulonephritis
D) Minimal change disease
Answer: C) Diffuse proliferative glomerulonephritis
Explanation: This clinical scenario is classic for systemic lupus
erythematosus. Diffuse proliferative glomerulonephritis is the most
common and severe form of lupus nephritis. It is characterized by
diffuse endocapillary hypercellularity and subendothelial immune
complex deposition, often associated with hypertension, proteinuria,
and hematuria. Focal segmental glomerulosclerosis and membranous
, 4|Page
nephropathy can occur in SLE but are less specific. Minimal change
disease is not a typical renal manifestation of SLE.
Question 4
A 70-year-old male with a history of coronary artery disease and heart
failure with reduced ejection fraction presents with progressive
dyspnea, orthopnea, and pedal edema. His medications include
lisinopril, carvedilol, and furosemide. On examination, jugular venous
pressure is elevated, and crackles are heard at both lung bases.
Laboratory results show a brain natriuretic peptide level of 1200 pg/mL.
Which of the following is the most appropriate additional medication to
reduce morbidity and mortality in this patient?
A) Digoxin
B) Spironolactone
C) Hydralazine and isosorbide dinitrate
D) Dofetilide
Answer: B) Spironolactone
Explanation: This patient has heart failure with reduced ejection
fraction who remains symptomatic despite standard therapy with an
ACE inhibitor and beta-blocker. The addition of a mineralocorticoid
receptor antagonist such as spironolactone has been shown to reduce
morbidity and mortality in patients with NYHA class II-IV heart failure
and reduced ejection fraction. Digoxin improves symptoms but does not
reduce mortality. Hydralazine and isosorbide dinitrate are beneficial in
African American patients and those who cannot tolerate ACE
NSG 6020 3P /APPROVED NSG 6020 3P EXAM TEST
BANK Exam Preparation With Complete Questions And
Correct Answers With Rationales | Already Graded
A+||Brand New Version!!
Question 1
A 45-year-old female presents with a two-week history of progressive
weakness in her lower extremities, urinary incontinence, and a band-
like sensation of tightness around her chest. Her past medical history is
significant for hypertension and hypothyroidism. On examination,
lower extremity muscle strength is 3/5 bilaterally, deep tendon reflexes
are hyperactive, and plantar responses are extensor. Sensation to
pinprick is decreased below the T4 level. Which of the following is the
most appropriate next step in management?
A) Oral corticosteroids
B) Immediate magnetic resonance imaging of the spine
C) Lumbar puncture for cerebrospinal fluid analysis
D) Electromyography and nerve conduction studies
Answer: B) Immediate magnetic resonance imaging of the spine
Explanation: This patient presents with acute-onset myelopathy
characterized by bilateral lower extremity weakness, a sensory level,
,2|Page
and upper motor neuron signs. The clinical picture is highly concerning
for spinal cord compression, which is a neurologic emergency. The most
appropriate next step is immediate MRI of the spine to identify the level
and etiology of the compression, such as a herniated disc, tumor, or
epidural abscess. While corticosteroids may be indicated for conditions
like multiple sclerosis, they should not be given without ruling out a
compressive lesion. Lumbar puncture is contraindicated if there is
suspicion of increased intracranial pressure or spinal mass due to risk of
herniation. Electromyography evaluates peripheral nerve disorders and
is not the initial study for suspected spinal cord pathology.
Question 2
A 60-year-old male with a 40-pack-year smoking history presents with a
chronic cough, hemoptysis, and weight loss over the past three months.
Chest imaging reveals a large right hilar mass with mediastinal
lymphadenopathy. A bronchoscopy with biopsy is performed and
reveals small cell lung carcinoma. Which of the following is the most
characteristic paraneoplastic syndrome associated with this
malignancy?
A) Hyponatremia due to syndrome of inappropriate antidiuretic
hormone secretion
B) Hypercalcemia due to parathyroid hormone-related peptide
C) Clubbing and hypertrophic pulmonary osteoarthropathy
D) Eaton-Lambert myasthenic syndrome
Answer: A) Hyponatremia due to syndrome of inappropriate antidiuretic
hormone secretion
,3|Page
Explanation: Small cell lung carcinoma is strongly associated with the
syndrome of inappropriate antidiuretic hormone secretion, which leads
to hyponatremia due to impaired water excretion. This occurs because
the tumor ectopically produces antidiuretic hormone. Hypercalcemia
and hypertrophic pulmonary osteoarthropathy are more characteristic
of squamous cell carcinoma. Eaton-Lambert myasthenic syndrome is
associated with small cell lung cancer but is less common than SIADH as
a presenting paraneoplastic phenomenon.
Question 3
A 35-year-old woman presents with a three-month history of fatigue,
arthralgias, and a malar rash that worsens with sun exposure.
Laboratory studies reveal leukopenia, positive antinuclear antibody,
and positive anti-double-stranded DNA antibodies. Which of the
following renal findings is most characteristic of this disease?
A) Focal segmental glomerulosclerosis
B) Membranous nephropathy
C) Diffuse proliferative glomerulonephritis
D) Minimal change disease
Answer: C) Diffuse proliferative glomerulonephritis
Explanation: This clinical scenario is classic for systemic lupus
erythematosus. Diffuse proliferative glomerulonephritis is the most
common and severe form of lupus nephritis. It is characterized by
diffuse endocapillary hypercellularity and subendothelial immune
complex deposition, often associated with hypertension, proteinuria,
and hematuria. Focal segmental glomerulosclerosis and membranous
, 4|Page
nephropathy can occur in SLE but are less specific. Minimal change
disease is not a typical renal manifestation of SLE.
Question 4
A 70-year-old male with a history of coronary artery disease and heart
failure with reduced ejection fraction presents with progressive
dyspnea, orthopnea, and pedal edema. His medications include
lisinopril, carvedilol, and furosemide. On examination, jugular venous
pressure is elevated, and crackles are heard at both lung bases.
Laboratory results show a brain natriuretic peptide level of 1200 pg/mL.
Which of the following is the most appropriate additional medication to
reduce morbidity and mortality in this patient?
A) Digoxin
B) Spironolactone
C) Hydralazine and isosorbide dinitrate
D) Dofetilide
Answer: B) Spironolactone
Explanation: This patient has heart failure with reduced ejection
fraction who remains symptomatic despite standard therapy with an
ACE inhibitor and beta-blocker. The addition of a mineralocorticoid
receptor antagonist such as spironolactone has been shown to reduce
morbidity and mortality in patients with NYHA class II-IV heart failure
and reduced ejection fraction. Digoxin improves symptoms but does not
reduce mortality. Hydralazine and isosorbide dinitrate are beneficial in
African American patients and those who cannot tolerate ACE
