NRNP 6560 Final Exam Review (Version-
3, Latest-2023) / NRNP6560 Final Exam:
Walden University
1. A 71-year-old male presents with weakness, nausea, dizziness, and shortness
of breath with minimal exertion. His ECG shows inverted T waves in leads V1 to
V5. The AGACNP is suspicious that most of his symptoms are:
A. Psychosomatic
B. Early congestive heart failure (CHF)
C. Anginal equivalents
D. Normal age-related changes
Correct Answer: C. Anginal equivalents
Rationale: Anginal equivalents are symptoms of myocardial ischemia that occur
without chest pain. They are more common in the elderly, women, and patients
with diabetes. Symptoms can include dyspnea, weakness, nausea, and dizziness.
While the ECG changes and symptoms could suggest CHF, the presentation of
ischemia without classic chest pain is characteristic of anginal equivalents.
2. A 59-year-old female with an acute MI is short of breath with coarse rales.
Exam reveals a grade V/VI systolic murmur, loudest at the point of maximal
impulse with radiation to the midaxillary line. The AGACNP recognizes this as:
A. Acute mitral valve regurgitation
B. Acute aortic valve regurgitation
C. Acute cardiac tamponade
D. Acute pulmonary embolus
Correct Answer: A. Acute mitral valve regurgitation
Rationale: Acute mitral regurgitation is a complication of MI, often due to
papillary muscle rupture. It causes a systolic murmur that is loudest at the apex
,(PMI) and radiates to the axilla. The presentation includes acute shortness of
breath and signs of heart failure (coarse rales).
3. A 16-year-old male presents with fever, nausea, vomiting, and right lower
quadrant pain. His WBC count is 19,100/μL. Physical examination will most likely
reveal:
A. + Murphy's sign
B. + Chvostek's sign
C. + Rovsing's sign
D. + Kernig's sign
Correct Answer: C. + Rovsing's sign
Rationale: Rovsing's sign (pain in the right lower quadrant upon palpation of the
left lower quadrant) is a classic sign of peritoneal irritation associated with
appendicitis. The patient's age, symptoms, and leukocytosis are highly suggestive
of appendicitis. Murphy's sign is associated with cholecystitis, while Chvostek's
and Kernig's signs are neurological.
4. A 30-year-old female has epigastric pain that awakens her at night. She takes
2400 mg of ibuprofen 5-6 times a week for menstrual cramps. She has positive
heme stools. An upper endoscopy reveals a duodenal ulcer. What is the most
likely etiology?
A. Non-steroidal anti-inflammatory drug (NSAID) use
B. Stress-related ulcerations
C. Helicobacter pylori infection
D. Cigarette smoking
Correct Answer: A. Non-steroidal anti-inflammatory drug (NSAID) use
Rationale: This patient has a clear history of heavy NSAID use, which is a major
risk factor for peptic ulcer disease. While H. pylori is the most common cause
overall, the heavy ibuprofen use is the most likely etiology in this specific case,
especially given the history of menstrual cramps and back pain prompting its use.
,5. An 81-year-old female presents with left lower quadrant pain, fever, and
hypotension. She has had this pain before and treated it with antibiotics. She
has a temperature of 100.9°F and a BP of 94/60 mm Hg. The leading diagnosis is:
A. Irritable bowel syndrome
B. Inflammatory bowel disease
C. Diverticulitis
D. Appendicitis
Correct Answer: C. Diverticulitis
Rationale: Left lower quadrant pain, fever, and a history of recurrent episodes
treated with antibiotics are classic presentations of diverticulitis in an older adult.
While her age and location of pain make it the most likely diagnosis, other causes
like IBS or IBD could be considered.
6. A 48-year-old female with biliary colic and right upper quadrant pain, nausea,
and vomiting has a fever of 101.5°F. Which of the following findings suggests a
complication that requires surgical evaluation?
A. A temperature of 101.5°F
B. A leukocyte count of 18,000/μL
C. A palpable gallbladder
D. A positive Murphy’s sign
Correct Answer: C. A palpable gallbladder
Rationale: A palpable gallbladder in the setting of biliary colic and fever suggests
acute cholecystitis with gallbladder distention, which is a surgical emergency.
While fever and leukocytosis are concerning, a palpable gallbladder indicates a
more advanced and potentially complicated process that often requires surgical
intervention.
7. A 52-year-old female presents with severe abdominal pain. Her abdomen is
tensely rigid and tympanic to percussion. There is rebound tenderness. The
, AGACNP suspects:
A. Perforated bowel
B. Peritonitis
C. Ischemic bowel
D. Intestinal abscess
Correct Answer: B. Peritonitis
Rationale: The presentation of severe abdominal pain with a rigid, tympanic
abdomen and rebound tenderness is highly indicative of generalized peritonitis.
Peritonitis is inflammation of the peritoneum, often caused by a perforated bowel,
but the diagnosis here is the peritonitis itself based on the physical exam findings.
8. A 70-year-old male with poorly controlled hypertension, headaches,
palpitations, and tremors has elevated metanephrines in a 24-hour urine. This
patient likely has a:
A. Malignant hyperthyroidism
B. Catecholamine-secreting tumor
C. Pituitary adenoma
D. Hyperaldosteronism
Correct Answer: B. Catecholamine-secreting tumor
Rationale: The classic triad of headaches, palpitations, and diaphoresis (tremors
and anxiety in this case) in a patient with difficult-to-control hypertension and
elevated urinary metanephrines is characteristic of a pheochromocytoma, which
is a catecholamine-secreting tumor.
9. A 70-year-old African American male with a history of 4 months of severe
HTN, intermittent pounding headaches, palpitations, and anxiety. A 24-hour
urine demonstrated elevated metanephrines. The AGACNP recognizes this
patient has a:
A. Malignant hyperthyroidism
B. Catecholamine-secreting tumor
3, Latest-2023) / NRNP6560 Final Exam:
Walden University
1. A 71-year-old male presents with weakness, nausea, dizziness, and shortness
of breath with minimal exertion. His ECG shows inverted T waves in leads V1 to
V5. The AGACNP is suspicious that most of his symptoms are:
A. Psychosomatic
B. Early congestive heart failure (CHF)
C. Anginal equivalents
D. Normal age-related changes
Correct Answer: C. Anginal equivalents
Rationale: Anginal equivalents are symptoms of myocardial ischemia that occur
without chest pain. They are more common in the elderly, women, and patients
with diabetes. Symptoms can include dyspnea, weakness, nausea, and dizziness.
While the ECG changes and symptoms could suggest CHF, the presentation of
ischemia without classic chest pain is characteristic of anginal equivalents.
2. A 59-year-old female with an acute MI is short of breath with coarse rales.
Exam reveals a grade V/VI systolic murmur, loudest at the point of maximal
impulse with radiation to the midaxillary line. The AGACNP recognizes this as:
A. Acute mitral valve regurgitation
B. Acute aortic valve regurgitation
C. Acute cardiac tamponade
D. Acute pulmonary embolus
Correct Answer: A. Acute mitral valve regurgitation
Rationale: Acute mitral regurgitation is a complication of MI, often due to
papillary muscle rupture. It causes a systolic murmur that is loudest at the apex
,(PMI) and radiates to the axilla. The presentation includes acute shortness of
breath and signs of heart failure (coarse rales).
3. A 16-year-old male presents with fever, nausea, vomiting, and right lower
quadrant pain. His WBC count is 19,100/μL. Physical examination will most likely
reveal:
A. + Murphy's sign
B. + Chvostek's sign
C. + Rovsing's sign
D. + Kernig's sign
Correct Answer: C. + Rovsing's sign
Rationale: Rovsing's sign (pain in the right lower quadrant upon palpation of the
left lower quadrant) is a classic sign of peritoneal irritation associated with
appendicitis. The patient's age, symptoms, and leukocytosis are highly suggestive
of appendicitis. Murphy's sign is associated with cholecystitis, while Chvostek's
and Kernig's signs are neurological.
4. A 30-year-old female has epigastric pain that awakens her at night. She takes
2400 mg of ibuprofen 5-6 times a week for menstrual cramps. She has positive
heme stools. An upper endoscopy reveals a duodenal ulcer. What is the most
likely etiology?
A. Non-steroidal anti-inflammatory drug (NSAID) use
B. Stress-related ulcerations
C. Helicobacter pylori infection
D. Cigarette smoking
Correct Answer: A. Non-steroidal anti-inflammatory drug (NSAID) use
Rationale: This patient has a clear history of heavy NSAID use, which is a major
risk factor for peptic ulcer disease. While H. pylori is the most common cause
overall, the heavy ibuprofen use is the most likely etiology in this specific case,
especially given the history of menstrual cramps and back pain prompting its use.
,5. An 81-year-old female presents with left lower quadrant pain, fever, and
hypotension. She has had this pain before and treated it with antibiotics. She
has a temperature of 100.9°F and a BP of 94/60 mm Hg. The leading diagnosis is:
A. Irritable bowel syndrome
B. Inflammatory bowel disease
C. Diverticulitis
D. Appendicitis
Correct Answer: C. Diverticulitis
Rationale: Left lower quadrant pain, fever, and a history of recurrent episodes
treated with antibiotics are classic presentations of diverticulitis in an older adult.
While her age and location of pain make it the most likely diagnosis, other causes
like IBS or IBD could be considered.
6. A 48-year-old female with biliary colic and right upper quadrant pain, nausea,
and vomiting has a fever of 101.5°F. Which of the following findings suggests a
complication that requires surgical evaluation?
A. A temperature of 101.5°F
B. A leukocyte count of 18,000/μL
C. A palpable gallbladder
D. A positive Murphy’s sign
Correct Answer: C. A palpable gallbladder
Rationale: A palpable gallbladder in the setting of biliary colic and fever suggests
acute cholecystitis with gallbladder distention, which is a surgical emergency.
While fever and leukocytosis are concerning, a palpable gallbladder indicates a
more advanced and potentially complicated process that often requires surgical
intervention.
7. A 52-year-old female presents with severe abdominal pain. Her abdomen is
tensely rigid and tympanic to percussion. There is rebound tenderness. The
, AGACNP suspects:
A. Perforated bowel
B. Peritonitis
C. Ischemic bowel
D. Intestinal abscess
Correct Answer: B. Peritonitis
Rationale: The presentation of severe abdominal pain with a rigid, tympanic
abdomen and rebound tenderness is highly indicative of generalized peritonitis.
Peritonitis is inflammation of the peritoneum, often caused by a perforated bowel,
but the diagnosis here is the peritonitis itself based on the physical exam findings.
8. A 70-year-old male with poorly controlled hypertension, headaches,
palpitations, and tremors has elevated metanephrines in a 24-hour urine. This
patient likely has a:
A. Malignant hyperthyroidism
B. Catecholamine-secreting tumor
C. Pituitary adenoma
D. Hyperaldosteronism
Correct Answer: B. Catecholamine-secreting tumor
Rationale: The classic triad of headaches, palpitations, and diaphoresis (tremors
and anxiety in this case) in a patient with difficult-to-control hypertension and
elevated urinary metanephrines is characteristic of a pheochromocytoma, which
is a catecholamine-secreting tumor.
9. A 70-year-old African American male with a history of 4 months of severe
HTN, intermittent pounding headaches, palpitations, and anxiety. A 24-hour
urine demonstrated elevated metanephrines. The AGACNP recognizes this
patient has a:
A. Malignant hyperthyroidism
B. Catecholamine-secreting tumor
