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NUR 805Q - Advanced Nursing Practice
Comprehensive Newest Exam Preparation With
Complete Questions And Correct Answers With
Rationales Already Graded A+Brand New Version!!
1. A 68-year-old patient with a history of hypertension and type 2
diabetes mellitus presents with a non-healing ulcer on the plantar
surface of the left foot. The wound base is pale, with minimal
granulation tissue, and the surrounding skin is callused. Which
pathophysiological mechanism is most likely contributing to this
delayed wound healing?
A) Venous insufficiency leading to increased hydrostatic pressure
B) Peripheral neuropathy causing repetitive trauma and microvascular
compromise
C) Arterial insufficiency due to atherosclerosis obliterans
D) Localized infection with biofilm-forming bacteria
Answer: B
Explanation: The plantar surface ulcer with a pale base and surrounding
callus in a diabetic patient is classic for a neuropathic ulcer. Peripheral
neuropathy leads to loss of protective sensation, repetitive trauma, and
altered pressure distribution, which, combined with microvascular
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dysfunction, impair healing. While arterial insufficiency (C) can occur,
the location and appearance are more consistent with neuropathic
etiology. Infection (D) is a secondary concern, and venous insufficiency
(A) typically presents with medial malleolar ulcers and hemosiderin
staining.
2. A 55-year-old patient with a history of chronic obstructive pulmonary
disease (COPD) is prescribed tiotropium bromide via a HandiHaler. The
patient reports difficulty coordinating inhalation with device activation.
Which instruction is most appropriate to optimize drug delivery?
A) Instruct the patient to exhale completely before placing the
mouthpiece in the mouth
B) Advise the patient to inhale rapidly and forcefully to ensure deep
lung deposition
C) Recommend using a spacer device with the HandiHaler to improve
coordination
D) Suggest switching to a soft mist inhaler that does not require breath
coordination
Answer: A
Explanation: For the HandiHaler, proper technique involves exhaling
completely (not into the device), then placing the mouthpiece in the
mouth, closing the lips, and inhaling slowly and deeply (not rapidly, B).
A spacer is not compatible with the HandiHaler (C). While soft mist
inhalers (D) may have lower coordination requirements, the immediate
instruction should focus on correct use of the prescribed device,
beginning with complete exhalation before inhalation.
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3. A 42-year-old female patient is newly diagnosed with systemic lupus
erythematosus (SLE). She presents with malar rash, photosensitivity,
and arthralgias. Laboratory findings reveal ANA positivity and anti-
dsDNA antibodies. Which of the following renal manifestations is most
characteristic of active lupus nephritis and requires prompt
intervention?
A) Microscopic hematuria with dysmorphic red blood cells
B) Subnephrotic proteinuria with sterile pyuria
C) Nephrotic-range proteinuria with active urinary sediment
D) Isolated tubular dysfunction with hypokalemia
Answer: C
Explanation: Nephrotic-range proteinuria (greater than 3.5 g/day) with
active urinary sediment (red cell casts, dysmorphic RBCs) is the hallmark
of proliferative lupus nephritis (Class III or IV), which necessitates
aggressive immunosuppression to prevent progression to end-stage
renal disease. Microscopic hematuria (A) alone is nonspecific, and
tubular dysfunction (D) is rare. Subnephrotic proteinuria (B) may occur
but is less indicative of active, high-risk disease.
4. A 72-year-old male with a history of atrial fibrillation and heart
failure with reduced ejection fraction (HFrEF) is started on digoxin. The
patient's serum creatinine is 1.8 mg/dL, and potassium is 3.2 mEq/L.
Which of the following is the most significant concern regarding digoxin
therapy in this patient?
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A) Increased risk of digitalis toxicity due to reduced renal clearance and
hypokalemia
B) Worsening of heart failure due to negative inotropic effects at
therapeutic doses
C) Development of bradyarrhythmias due to increased vagal tone
D) Drug interaction with warfarin leading to elevated INR
Answer: A
Explanation: Digoxin is primarily renally excreted. In the setting of renal
impairment (creatinine 1.8 mg/dL), clearance is reduced, necessitating
dose adjustment. Additionally, hypokalemia (3.2 mEq/L) potentiates the
binding of digoxin to cardiac sodium-potassium ATPase, increasing the
risk of toxicity even at normally therapeutic serum concentrations.
Digoxin is a positive inotrope (B). Bradyarrhythmias (C) are a
manifestation of toxicity, not the primary concern relative to the
patient's specific risk factors, and warfarin interaction (D) is less directly
related to the renal and electrolyte status.
5. A 35-year-old primigravida at 28 weeks gestation presents with
elevated blood pressure (150/95 mmHg) and new-onset proteinuria
(300 mg/24 hours). She reports headache and epigastric pain. Which of
the following laboratory findings would most strongly support a
diagnosis of preeclampsia with severe features?
A) Platelet count of 145,000/microL
B) Serum AST of 70 U/L
C) Serum creatinine of 1.2 mg/dL
NUR 805Q - Advanced Nursing Practice
Comprehensive Newest Exam Preparation With
Complete Questions And Correct Answers With
Rationales Already Graded A+Brand New Version!!
1. A 68-year-old patient with a history of hypertension and type 2
diabetes mellitus presents with a non-healing ulcer on the plantar
surface of the left foot. The wound base is pale, with minimal
granulation tissue, and the surrounding skin is callused. Which
pathophysiological mechanism is most likely contributing to this
delayed wound healing?
A) Venous insufficiency leading to increased hydrostatic pressure
B) Peripheral neuropathy causing repetitive trauma and microvascular
compromise
C) Arterial insufficiency due to atherosclerosis obliterans
D) Localized infection with biofilm-forming bacteria
Answer: B
Explanation: The plantar surface ulcer with a pale base and surrounding
callus in a diabetic patient is classic for a neuropathic ulcer. Peripheral
neuropathy leads to loss of protective sensation, repetitive trauma, and
altered pressure distribution, which, combined with microvascular
,2|Page
dysfunction, impair healing. While arterial insufficiency (C) can occur,
the location and appearance are more consistent with neuropathic
etiology. Infection (D) is a secondary concern, and venous insufficiency
(A) typically presents with medial malleolar ulcers and hemosiderin
staining.
2. A 55-year-old patient with a history of chronic obstructive pulmonary
disease (COPD) is prescribed tiotropium bromide via a HandiHaler. The
patient reports difficulty coordinating inhalation with device activation.
Which instruction is most appropriate to optimize drug delivery?
A) Instruct the patient to exhale completely before placing the
mouthpiece in the mouth
B) Advise the patient to inhale rapidly and forcefully to ensure deep
lung deposition
C) Recommend using a spacer device with the HandiHaler to improve
coordination
D) Suggest switching to a soft mist inhaler that does not require breath
coordination
Answer: A
Explanation: For the HandiHaler, proper technique involves exhaling
completely (not into the device), then placing the mouthpiece in the
mouth, closing the lips, and inhaling slowly and deeply (not rapidly, B).
A spacer is not compatible with the HandiHaler (C). While soft mist
inhalers (D) may have lower coordination requirements, the immediate
instruction should focus on correct use of the prescribed device,
beginning with complete exhalation before inhalation.
,3|Page
3. A 42-year-old female patient is newly diagnosed with systemic lupus
erythematosus (SLE). She presents with malar rash, photosensitivity,
and arthralgias. Laboratory findings reveal ANA positivity and anti-
dsDNA antibodies. Which of the following renal manifestations is most
characteristic of active lupus nephritis and requires prompt
intervention?
A) Microscopic hematuria with dysmorphic red blood cells
B) Subnephrotic proteinuria with sterile pyuria
C) Nephrotic-range proteinuria with active urinary sediment
D) Isolated tubular dysfunction with hypokalemia
Answer: C
Explanation: Nephrotic-range proteinuria (greater than 3.5 g/day) with
active urinary sediment (red cell casts, dysmorphic RBCs) is the hallmark
of proliferative lupus nephritis (Class III or IV), which necessitates
aggressive immunosuppression to prevent progression to end-stage
renal disease. Microscopic hematuria (A) alone is nonspecific, and
tubular dysfunction (D) is rare. Subnephrotic proteinuria (B) may occur
but is less indicative of active, high-risk disease.
4. A 72-year-old male with a history of atrial fibrillation and heart
failure with reduced ejection fraction (HFrEF) is started on digoxin. The
patient's serum creatinine is 1.8 mg/dL, and potassium is 3.2 mEq/L.
Which of the following is the most significant concern regarding digoxin
therapy in this patient?
, 4|Page
A) Increased risk of digitalis toxicity due to reduced renal clearance and
hypokalemia
B) Worsening of heart failure due to negative inotropic effects at
therapeutic doses
C) Development of bradyarrhythmias due to increased vagal tone
D) Drug interaction with warfarin leading to elevated INR
Answer: A
Explanation: Digoxin is primarily renally excreted. In the setting of renal
impairment (creatinine 1.8 mg/dL), clearance is reduced, necessitating
dose adjustment. Additionally, hypokalemia (3.2 mEq/L) potentiates the
binding of digoxin to cardiac sodium-potassium ATPase, increasing the
risk of toxicity even at normally therapeutic serum concentrations.
Digoxin is a positive inotrope (B). Bradyarrhythmias (C) are a
manifestation of toxicity, not the primary concern relative to the
patient's specific risk factors, and warfarin interaction (D) is less directly
related to the renal and electrolyte status.
5. A 35-year-old primigravida at 28 weeks gestation presents with
elevated blood pressure (150/95 mmHg) and new-onset proteinuria
(300 mg/24 hours). She reports headache and epigastric pain. Which of
the following laboratory findings would most strongly support a
diagnosis of preeclampsia with severe features?
A) Platelet count of 145,000/microL
B) Serum AST of 70 U/L
C) Serum creatinine of 1.2 mg/dL
