NSG 6001 EXAM 2 : Advanced Nursing
Practice I -SOUTH UNIVERSITY -NEWEST
2026-2027 UPDATE
Question 1
A 55-year-old male presents with crushing chest pain radiating to the left arm,
diaphoresis, and nausea. ECG shows ST-segment elevation in V1-V4. Which cardiac
territory is affected?
A. Inferior wall
B. Anterior wall
C. Lateral wall
D. Posterior wall
Correct Answer: B
Rationale: ST elevation in leads V1-V4 indicates an anterior wall STEMI, most
commonly caused by occlusion of the left anterior descending (LAD) artery. Inferior
wall = II, III, aVF. Lateral wall = I, aVL, V5-V6. Posterior wall = tall R waves and ST
depression in V1-V3.
Question 2
A patient with type 2 diabetes presents with numbness and tingling in a stocking-
glove distribution. Which complication is most likely?
A. Diabetic retinopathy
B. Diabetic peripheral neuropathy
C. Diabetic nephropathy
D. Autonomic neuropathy
Correct Answer: B
Rationale: Stocking-glove distribution (distal symmetric polyneuropathy) is the
classic presentation of diabetic peripheral neuropathy, affecting the longest nerves
, first. It typically starts in the feet and progresses upward. Retinopathy affects vision.
Nephropathy is asymptomatic early. Autonomic neuropathy causes gastroparesis,
orthostatic hypotension, and erectile dysfunction.
Question 3
Which of the following is the most appropriate initial treatment for a patient with
acute gout flare affecting the first metatarsophalangeal joint?
A. Allopurinol 300 mg daily
B. Colchicine 1.2 mg then 0.6 mg one hour later
C. Probenecid 500 mg BID
D. Febuxostat 40 mg daily
Correct Answer: B
Rationale: For acute gout flare, first-line treatment is NSAIDs (e.g., indomethacin,
naproxen), colchicine (1.2 mg then 0.6 mg 1 hour later), or corticosteroids.
Allopurinol, probenecid, and febuxostat are urate-lowering therapies used for
chronic gout prophylaxis and should NOT be started during an acute flare (can
worsen it).
Question 4
A patient with chronic hepatitis C infection is being considered for treatment. Which
of the following is the current standard of care?
A. Interferon-alpha monotherapy for 48 weeks
B. Sofosbuvir/velpatasvir (Epclusa) for 12 weeks
C. Ribavirin monotherapy for 24 weeks
D. Lamivudine for 12 months
Correct Answer: B
Rationale: Direct-acting antivirals (DAAs) such as sofosbuvir/velpatasvir (Epclusa),
glecaprevir/pibrentasvir (Mavyret), or sofosbuvir/ledipasvir (Harvoni) are the
current standard of care for HCV, achieving >95% sustained virologic response in 8-12
, weeks. Interferon and ribavirin are obsolete due to poor efficacy and side effects.
Lamivudine is for hepatitis B.
Question 5
A 48-year-old female with obesity and hypertension presents with excessive daytime
sleepiness and loud snoring. Her bed partner reports witnessed apneas. What is the
most likely diagnosis?
A. Narcolepsy
B. Obstructive sleep apnea
C. Restless leg syndrome
D. Central sleep apnea
Correct Answer: B
Rationale: Obstructive sleep apnea (OSA) is characterized by loud snoring, witnessed
apneas, and excessive daytime sleepiness, strongly associated with obesity and
hypertension. Diagnosis is confirmed by polysomnography (sleep study) showing AHI
≥5 with symptoms or AHI ≥15 regardless of symptoms. Narcolepsy causes sudden
sleep attacks and cataplexy. RLS causes urge to move legs. Central sleep apnea lacks
respiratory effort.
Question 6
Which of the following is the most appropriate screening test for colorectal cancer in
an average-risk 55-year-old patient?
A. Colonoscopy every 5 years
B. Fecal immunochemical test (FIT) annually
C. CT colonography every 3 years
D. Flexible sigmoidoscopy every 3 years
Correct Answer: B
Rationale: For average-risk adults aged 45-75, USPSTF recommends several options:
colonoscopy every 10 years, FIT annually, FIT-DNA every 1-3 years, CT colonography
, every 5 years, or flexible sigmoidoscopy every 5 years. FIT annually is a valid and
commonly used non-invasive option. Colonoscopy is every 10 years (not 5) for
average risk.
Question 7
A patient with cirrhosis presents with confusion, asterixis, and elevated ammonia
levels. Which is the first-line treatment?
A. Lactulose and rifaximin
B. Neomycin alone
C. Metronidazole alone
D. Levofloxacin
Correct Answer: A
Rationale: Hepatic encephalopathy is treated with lactulose (reduces ammonia
absorption by acidifying colonic contents and promoting excretion) as first-line.
Rifaximin is added for recurrent or refractory cases. Neomycin is rarely used due to
ototoxicity/nephrotoxicity. Metronidazole and levofloxacin are not standard
treatments.
Question 8
A patient with atrial fibrillation is started on dabigatran (Pradaxa). Which statement is
TRUE about this medication?
A. It is a factor Xa inhibitor
B. It requires routine INR monitoring
C. It is a direct thrombin inhibitor with a specific reversal agent (idarucizumab)
D. It is safe to use in patients with mechanical heart valves
Correct Answer: C
Rationale: Dabigatran is a direct thrombin inhibitor (DTI), NOT a factor Xa inhibitor
(apixaban, rivaroxaban are FXa inhibitors). It does NOT require INR monitoring.
Idarucizumab (Praxbind) is the specific reversal agent. Dabigatran is
Practice I -SOUTH UNIVERSITY -NEWEST
2026-2027 UPDATE
Question 1
A 55-year-old male presents with crushing chest pain radiating to the left arm,
diaphoresis, and nausea. ECG shows ST-segment elevation in V1-V4. Which cardiac
territory is affected?
A. Inferior wall
B. Anterior wall
C. Lateral wall
D. Posterior wall
Correct Answer: B
Rationale: ST elevation in leads V1-V4 indicates an anterior wall STEMI, most
commonly caused by occlusion of the left anterior descending (LAD) artery. Inferior
wall = II, III, aVF. Lateral wall = I, aVL, V5-V6. Posterior wall = tall R waves and ST
depression in V1-V3.
Question 2
A patient with type 2 diabetes presents with numbness and tingling in a stocking-
glove distribution. Which complication is most likely?
A. Diabetic retinopathy
B. Diabetic peripheral neuropathy
C. Diabetic nephropathy
D. Autonomic neuropathy
Correct Answer: B
Rationale: Stocking-glove distribution (distal symmetric polyneuropathy) is the
classic presentation of diabetic peripheral neuropathy, affecting the longest nerves
, first. It typically starts in the feet and progresses upward. Retinopathy affects vision.
Nephropathy is asymptomatic early. Autonomic neuropathy causes gastroparesis,
orthostatic hypotension, and erectile dysfunction.
Question 3
Which of the following is the most appropriate initial treatment for a patient with
acute gout flare affecting the first metatarsophalangeal joint?
A. Allopurinol 300 mg daily
B. Colchicine 1.2 mg then 0.6 mg one hour later
C. Probenecid 500 mg BID
D. Febuxostat 40 mg daily
Correct Answer: B
Rationale: For acute gout flare, first-line treatment is NSAIDs (e.g., indomethacin,
naproxen), colchicine (1.2 mg then 0.6 mg 1 hour later), or corticosteroids.
Allopurinol, probenecid, and febuxostat are urate-lowering therapies used for
chronic gout prophylaxis and should NOT be started during an acute flare (can
worsen it).
Question 4
A patient with chronic hepatitis C infection is being considered for treatment. Which
of the following is the current standard of care?
A. Interferon-alpha monotherapy for 48 weeks
B. Sofosbuvir/velpatasvir (Epclusa) for 12 weeks
C. Ribavirin monotherapy for 24 weeks
D. Lamivudine for 12 months
Correct Answer: B
Rationale: Direct-acting antivirals (DAAs) such as sofosbuvir/velpatasvir (Epclusa),
glecaprevir/pibrentasvir (Mavyret), or sofosbuvir/ledipasvir (Harvoni) are the
current standard of care for HCV, achieving >95% sustained virologic response in 8-12
, weeks. Interferon and ribavirin are obsolete due to poor efficacy and side effects.
Lamivudine is for hepatitis B.
Question 5
A 48-year-old female with obesity and hypertension presents with excessive daytime
sleepiness and loud snoring. Her bed partner reports witnessed apneas. What is the
most likely diagnosis?
A. Narcolepsy
B. Obstructive sleep apnea
C. Restless leg syndrome
D. Central sleep apnea
Correct Answer: B
Rationale: Obstructive sleep apnea (OSA) is characterized by loud snoring, witnessed
apneas, and excessive daytime sleepiness, strongly associated with obesity and
hypertension. Diagnosis is confirmed by polysomnography (sleep study) showing AHI
≥5 with symptoms or AHI ≥15 regardless of symptoms. Narcolepsy causes sudden
sleep attacks and cataplexy. RLS causes urge to move legs. Central sleep apnea lacks
respiratory effort.
Question 6
Which of the following is the most appropriate screening test for colorectal cancer in
an average-risk 55-year-old patient?
A. Colonoscopy every 5 years
B. Fecal immunochemical test (FIT) annually
C. CT colonography every 3 years
D. Flexible sigmoidoscopy every 3 years
Correct Answer: B
Rationale: For average-risk adults aged 45-75, USPSTF recommends several options:
colonoscopy every 10 years, FIT annually, FIT-DNA every 1-3 years, CT colonography
, every 5 years, or flexible sigmoidoscopy every 5 years. FIT annually is a valid and
commonly used non-invasive option. Colonoscopy is every 10 years (not 5) for
average risk.
Question 7
A patient with cirrhosis presents with confusion, asterixis, and elevated ammonia
levels. Which is the first-line treatment?
A. Lactulose and rifaximin
B. Neomycin alone
C. Metronidazole alone
D. Levofloxacin
Correct Answer: A
Rationale: Hepatic encephalopathy is treated with lactulose (reduces ammonia
absorption by acidifying colonic contents and promoting excretion) as first-line.
Rifaximin is added for recurrent or refractory cases. Neomycin is rarely used due to
ototoxicity/nephrotoxicity. Metronidazole and levofloxacin are not standard
treatments.
Question 8
A patient with atrial fibrillation is started on dabigatran (Pradaxa). Which statement is
TRUE about this medication?
A. It is a factor Xa inhibitor
B. It requires routine INR monitoring
C. It is a direct thrombin inhibitor with a specific reversal agent (idarucizumab)
D. It is safe to use in patients with mechanical heart valves
Correct Answer: C
Rationale: Dabigatran is a direct thrombin inhibitor (DTI), NOT a factor Xa inhibitor
(apixaban, rivaroxaban are FXa inhibitors). It does NOT require INR monitoring.
Idarucizumab (Praxbind) is the specific reversal agent. Dabigatran is
