NURS 5433 FINAL EXAM STUDY GUIDE QUESTIONS AND CORRECT SOLUTIONS JUST RELEASED THIS
YEAR………...
Core Domains:
- Advanced Pathophysiology Across the Lifespan
- Advanced Pharmacology and Pharmacotherapeutics
- Advanced Health Assessment and Diagnostic Reasoning
- Evidence-Based Practice and Translational Research
- Leadership, Quality Improvement, and Patient Safety
- Healthcare Policy, Ethics, and Legal Issues
- Health Promotion and Disease Prevention
- Interprofessional Collaboration and Communication
- Care Coordination and Transition Management
Introduction
This comprehensive examination is designed to assess the advanced knowledge and clinical expertise required for
graduate-level nursing practice. It evaluates the student's ability to synthesize complex pathophysiological
concepts, apply pharmacotherapeutic principles, and utilize advanced health assessment skills in clinical decision-
making. The exam emphasizes evidence-based practice, quality improvement, and ethical leadership within
healthcare systems. Through a rigorous multiple-choice and scenario-based format, candidates will demonstrate
their capacity to integrate theory with practice, manage complex patient populations, and lead interprofessional
teams to improve health outcomes and ensure patient safety.
SECTION ONE: QUESTIONS 1 – 100
,1. An advanced practice nurse is evaluating a patient with newly diagnosed hypertension. Which finding
would indicate the patient likely has secondary hypertension?
A. Blood pressure reading of 150/95 mmHg on two separate occasions
B. Onset of hypertension after the age of 50
C. Elevated serum aldosterone level
D. Family history of essential hypertension
🟢 C. Elevated serum aldosterone level
🔴 RATIONALE: Secondary hypertension is caused by an underlying condition such as renal disease, endocrine
disorders (e.g., primary aldosteronism, pheochromocytoma), or coarctation of the aorta. An elevated
aldosterone level suggests primary aldosteronism, a common cause of secondary hypertension that is often
resistant to standard antihypertensive therapy.
2. A patient with chronic stable angina is prescribed isosorbide mononitrate. What is the primary mechanism
of action for this medication?
A. Decreases heart rate and contractility
B. Inhibits platelet aggregation
C. Relaxes vascular smooth muscle, causing vasodilation
D. Reduces serum cholesterol levels
🟢 C. Relaxes vascular smooth muscle, causing vasodilation
🔴 RATIONALE: Isosorbide mononitrate is a nitrate that acts as a vasodilator by relaxing vascular smooth
muscle, primarily through the release of nitric oxide. This leads to venous dilation (decreasing preload) and, to a
lesser extent, arterial dilation (decreasing afterload), which reduces myocardial oxygen demand and relieves
angina.
3. A 65-year-old patient presents with a painful, red, swollen right knee. The patient reports a history of
gout. Which medication is most appropriate for acute management?
,A. Allopurinol
B. Probenecid
C. Indomethacin
D. Febuxostat
🟢 C. Indomethacin
🔴 RATIONALE: Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) used for the acute treatment of
gout to reduce inflammation and pain. Allopurinol, probenecid, and febuxostat are used for chronic
management to lower uric acid levels and prevent future attacks, but they are not effective for acute flare-ups.
4. An advanced practice nurse is counseling a patient about lifestyle modifications to prevent cardiovascular
disease. Which statement by the patient indicates a need for further teaching?
A. "I will aim for at least 150 minutes of moderate-intensity exercise per week."
B. "I will replace saturated fats with monounsaturated fats in my diet."
C. "I will consume no more than 2,300 mg of sodium per day."
D. "I can continue to drink up to three alcoholic beverages per day."
🟢 D. "I can continue to drink up to three alcoholic beverages per day."
🔴 RATIONALE: The American Heart Association recommends limiting alcohol intake to no more than one drink
per day for women and two drinks per day for men. Three alcoholic beverages per day exceeds these
recommendations and can increase blood pressure, triglyceride levels, and caloric intake, thereby increasing
cardiovascular risk.
5. A patient is receiving a continuous infusion of norepinephrine for septic shock. Which assessment finding
indicates the medication is having the desired therapeutic effect?
A. Heart rate of 55 beats per minute
B. Mean arterial pressure (MAP) of 65 mmHg
C. Urine output of 20 mL/hr
, D. Central venous pressure (CVP) of 4 mmHg
🟢 B. Mean arterial pressure (MAP) of 65 mmHg
🔴 RATIONALE: Norepinephrine is a potent vasopressor used to increase systemic vascular resistance and
improve blood pressure in septic shock. The therapeutic goal is to achieve a MAP of 65 mmHg or higher to
ensure adequate perfusion to vital organs. A MAP of 65 mmHg indicates the medication is effective in restoring
hemodynamic stability.
6. A patient with a history of major depressive disorder is prescribed a monoamine oxidase inhibitor (MAOI).
Which dietary instruction is most critical to prevent a hypertensive crisis?
A. "Avoid foods high in tyramine, such as aged cheese and cured meats."
B. "Limit your intake of fruits and vegetables."
C. "Increase your intake of protein-rich foods."
D. "Avoid foods high in calcium."
🟢 A. "Avoid foods high in tyramine, such as aged cheese and cured meats."
🔴 RATIONALE: MAOIs inhibit the breakdown of tyramine, an amino acid found in aged, fermented, or cured
foods. Consuming tyramine-rich foods while on an MAOI can lead to a hypertensive crisis due to excessive
release of norepinephrine. Patients must be educated on a strict low-tyramine diet to prevent this life-
threatening reaction.
7. A 72-year-old patient is admitted with acute respiratory failure secondary to chronic obstructive
pulmonary disease (COPD). The arterial blood gas (ABG) results are: pH 7.28, PaCO2 60 mmHg, HCO3 26
mEq/L, PaO2 55 mmHg. Which of the following acid-base imbalances does this represent?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
YEAR………...
Core Domains:
- Advanced Pathophysiology Across the Lifespan
- Advanced Pharmacology and Pharmacotherapeutics
- Advanced Health Assessment and Diagnostic Reasoning
- Evidence-Based Practice and Translational Research
- Leadership, Quality Improvement, and Patient Safety
- Healthcare Policy, Ethics, and Legal Issues
- Health Promotion and Disease Prevention
- Interprofessional Collaboration and Communication
- Care Coordination and Transition Management
Introduction
This comprehensive examination is designed to assess the advanced knowledge and clinical expertise required for
graduate-level nursing practice. It evaluates the student's ability to synthesize complex pathophysiological
concepts, apply pharmacotherapeutic principles, and utilize advanced health assessment skills in clinical decision-
making. The exam emphasizes evidence-based practice, quality improvement, and ethical leadership within
healthcare systems. Through a rigorous multiple-choice and scenario-based format, candidates will demonstrate
their capacity to integrate theory with practice, manage complex patient populations, and lead interprofessional
teams to improve health outcomes and ensure patient safety.
SECTION ONE: QUESTIONS 1 – 100
,1. An advanced practice nurse is evaluating a patient with newly diagnosed hypertension. Which finding
would indicate the patient likely has secondary hypertension?
A. Blood pressure reading of 150/95 mmHg on two separate occasions
B. Onset of hypertension after the age of 50
C. Elevated serum aldosterone level
D. Family history of essential hypertension
🟢 C. Elevated serum aldosterone level
🔴 RATIONALE: Secondary hypertension is caused by an underlying condition such as renal disease, endocrine
disorders (e.g., primary aldosteronism, pheochromocytoma), or coarctation of the aorta. An elevated
aldosterone level suggests primary aldosteronism, a common cause of secondary hypertension that is often
resistant to standard antihypertensive therapy.
2. A patient with chronic stable angina is prescribed isosorbide mononitrate. What is the primary mechanism
of action for this medication?
A. Decreases heart rate and contractility
B. Inhibits platelet aggregation
C. Relaxes vascular smooth muscle, causing vasodilation
D. Reduces serum cholesterol levels
🟢 C. Relaxes vascular smooth muscle, causing vasodilation
🔴 RATIONALE: Isosorbide mononitrate is a nitrate that acts as a vasodilator by relaxing vascular smooth
muscle, primarily through the release of nitric oxide. This leads to venous dilation (decreasing preload) and, to a
lesser extent, arterial dilation (decreasing afterload), which reduces myocardial oxygen demand and relieves
angina.
3. A 65-year-old patient presents with a painful, red, swollen right knee. The patient reports a history of
gout. Which medication is most appropriate for acute management?
,A. Allopurinol
B. Probenecid
C. Indomethacin
D. Febuxostat
🟢 C. Indomethacin
🔴 RATIONALE: Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) used for the acute treatment of
gout to reduce inflammation and pain. Allopurinol, probenecid, and febuxostat are used for chronic
management to lower uric acid levels and prevent future attacks, but they are not effective for acute flare-ups.
4. An advanced practice nurse is counseling a patient about lifestyle modifications to prevent cardiovascular
disease. Which statement by the patient indicates a need for further teaching?
A. "I will aim for at least 150 minutes of moderate-intensity exercise per week."
B. "I will replace saturated fats with monounsaturated fats in my diet."
C. "I will consume no more than 2,300 mg of sodium per day."
D. "I can continue to drink up to three alcoholic beverages per day."
🟢 D. "I can continue to drink up to three alcoholic beverages per day."
🔴 RATIONALE: The American Heart Association recommends limiting alcohol intake to no more than one drink
per day for women and two drinks per day for men. Three alcoholic beverages per day exceeds these
recommendations and can increase blood pressure, triglyceride levels, and caloric intake, thereby increasing
cardiovascular risk.
5. A patient is receiving a continuous infusion of norepinephrine for septic shock. Which assessment finding
indicates the medication is having the desired therapeutic effect?
A. Heart rate of 55 beats per minute
B. Mean arterial pressure (MAP) of 65 mmHg
C. Urine output of 20 mL/hr
, D. Central venous pressure (CVP) of 4 mmHg
🟢 B. Mean arterial pressure (MAP) of 65 mmHg
🔴 RATIONALE: Norepinephrine is a potent vasopressor used to increase systemic vascular resistance and
improve blood pressure in septic shock. The therapeutic goal is to achieve a MAP of 65 mmHg or higher to
ensure adequate perfusion to vital organs. A MAP of 65 mmHg indicates the medication is effective in restoring
hemodynamic stability.
6. A patient with a history of major depressive disorder is prescribed a monoamine oxidase inhibitor (MAOI).
Which dietary instruction is most critical to prevent a hypertensive crisis?
A. "Avoid foods high in tyramine, such as aged cheese and cured meats."
B. "Limit your intake of fruits and vegetables."
C. "Increase your intake of protein-rich foods."
D. "Avoid foods high in calcium."
🟢 A. "Avoid foods high in tyramine, such as aged cheese and cured meats."
🔴 RATIONALE: MAOIs inhibit the breakdown of tyramine, an amino acid found in aged, fermented, or cured
foods. Consuming tyramine-rich foods while on an MAOI can lead to a hypertensive crisis due to excessive
release of norepinephrine. Patients must be educated on a strict low-tyramine diet to prevent this life-
threatening reaction.
7. A 72-year-old patient is admitted with acute respiratory failure secondary to chronic obstructive
pulmonary disease (COPD). The arterial blood gas (ABG) results are: pH 7.28, PaCO2 60 mmHg, HCO3 26
mEq/L, PaO2 55 mmHg. Which of the following acid-base imbalances does this represent?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
