NSG6020 WEEK 10 FINAL EXAM NSG6020
WEEK 10 FINAL EXAM (LATEST 2026) SOUTH
UNIVERSITY] Verified Questions With Correct
Answers 2026/2027
1. A 65-year-old patient with chronic kidney disease (eGFR 25 mL/min/1.73m²) presents with new-
onset atrial fibrillation. Which anticoagulation strategy is most appropriate?
A) Warfarin with INR target 2-3
B) Apixaban 5 mg twice daily
C) Apixaban 2.5 mg twice daily
D) Rivaroxaban 20 mg daily
Answer C: Apixaban 2.5 mg twice daily
Rationale: Apixaban is preferred in severe renal impairment with reduced dose (2.5 mg BID) if criteria are
met. Rivaroxaban is contraindicated in CrCl <15.
2. A patient with suspected bacterial meningitis requires empirical antibiotics. Which combination
provides the most comprehensive coverage?
A) Ceftriaxone plus vancomycin
B) Cefepime plus vancomycin
C) Ampicillin plus gentamicin
D) Meropenem plus ampicillin
Answer B: Cefepime plus vancomycin
Rationale: Cefepime (fourth-generation cephalosporin) provides broader gram-negative coverage
including Pseudomonas; vancomycin covers MRSA and resistant pneumococci.
,3. A patient presents with acute severe headache, neck stiffness, and photophobia. CSF shows
lymphocytic pleocytosis with normal glucose. Which pathogen is most likely, and what is the
appropriate therapy?
A) HSV; acyclovir 10 mg/kg IV q8h
B) Neisseria meningitidis; ceftriaxone
C) Streptococcus pneumoniae; vancomycin + cefotaxime
D) West Nile virus; supportive care
Answer A: HSV; acyclovir 10 mg/kg IV q8h
Rationale: Lymphocytic pleocytosis with normal glucose is classic for viral meningitis, particularly HSV.
Acyclovir is empirical therapy while awaiting PCR.
4. A patient with type 2 diabetes and CKD (eGFR 35 mL/min, UACR 300 mg/g) is not at glycemic
target despite metformin and GLP-1 agonist. Which additional agent is most appropriate?
A) SGLT2 inhibitor
B) Sulfonylurea
C) DPP-4 inhibitor
D) Insulin glargine
Answer A: SGLT2 inhibitor
Rationale: SGLT2 inhibitors are preferred in CKD with albuminuria due to renoprotective and
cardioprotective benefits independent of glycemic control.
5. A patient with recurrent Clostridioides difficile infection (third episode) is being considered for
fecal microbiota transplantation (FMT). Which is the most critical contraindication?
A) Active inflammatory bowel disease
B) Current use of PPIs
C) Immunocompromised status
D) Pregnancy
,Answer D: Pregnancy
Rationale: Pregnancy is an absolute contraindication due to unknown risks to the fetus.
Immunocompromise is a relative contraindication.
6. A 41-year-old woman with diabetes is unable to feel vibrations on the great toe and ankle
bilaterally but can feel vibrations on both patellae. What does the nurse suspect?
A) Hyperalgesia
B) Hyperesthesia
C) Peripheral neuropathy
D) Lesion of sensory cortex
Answer C: Peripheral neuropathy
Rationale: Peripheral neuropathy often presents with a "stocking-glove" distribution, where sensation is
lost first in the feet and then improves as you move up the leg.
7. A nurse documents radial pulses as "2+." What does this indicate?
A) Bounding pulse
B) Normal pulse
C) Weak pulse
D) Absent pulse
Answer B: Normal pulse
Rationale: Pulse grading: 0 = absent, 1+ = weak, 2+ = normal, 3+ = increased, 4+ = bounding.
8. A male patient has a red, round, superficial ulcer with yellowish-serous discharge on his penis
with a nontender base that feels like a small button. What does this suggest?
A) Herpes simplex
B) Syphilitic chancre
C) Chancroid
D) Carcinoma
, Answer B: Syphilitic chancre
Rationale: A painless, indurated ulcer (chancre) with a "button-like" base is characteristic of primary
syphilis caused by Treponema pallidum.
9. To palpate the temporomandibular joint, the nurse's finger should be placed:
A) In the ear canal
B) Anterior to the tragus
C) Posterior to the tragus
D) On the mandibular angle
Answer B: Anterior to the tragus
Rationale: The TMJ is palpated anterior to the tragus as the patient opens and closes the mouth.
10. A 45-year-old woman reports "losing urine when I sneeze." The nurse documents this as:
A) Urge incontinence
B) Stress incontinence
C) Overflow incontinence
D) Functional incontinence
Answer B: Stress incontinence
Rationale: Stress incontinence is the involuntary loss of urine during activities that increase intra-
abdominal pressure (coughing, sneezing, laughing).
11. Before a Papanicolaou (Pap) smear, the nurse should instruct the patient to:
A) Douche the night before
B) Have intercourse 24 hours before
C) Avoid intercourse, inserting anything into the vagina, or douching within 24 hours
D) Take a bath before the appointment
Answer C: Avoid intercourse, inserting anything into the vagina, or douching within 24 hours
WEEK 10 FINAL EXAM (LATEST 2026) SOUTH
UNIVERSITY] Verified Questions With Correct
Answers 2026/2027
1. A 65-year-old patient with chronic kidney disease (eGFR 25 mL/min/1.73m²) presents with new-
onset atrial fibrillation. Which anticoagulation strategy is most appropriate?
A) Warfarin with INR target 2-3
B) Apixaban 5 mg twice daily
C) Apixaban 2.5 mg twice daily
D) Rivaroxaban 20 mg daily
Answer C: Apixaban 2.5 mg twice daily
Rationale: Apixaban is preferred in severe renal impairment with reduced dose (2.5 mg BID) if criteria are
met. Rivaroxaban is contraindicated in CrCl <15.
2. A patient with suspected bacterial meningitis requires empirical antibiotics. Which combination
provides the most comprehensive coverage?
A) Ceftriaxone plus vancomycin
B) Cefepime plus vancomycin
C) Ampicillin plus gentamicin
D) Meropenem plus ampicillin
Answer B: Cefepime plus vancomycin
Rationale: Cefepime (fourth-generation cephalosporin) provides broader gram-negative coverage
including Pseudomonas; vancomycin covers MRSA and resistant pneumococci.
,3. A patient presents with acute severe headache, neck stiffness, and photophobia. CSF shows
lymphocytic pleocytosis with normal glucose. Which pathogen is most likely, and what is the
appropriate therapy?
A) HSV; acyclovir 10 mg/kg IV q8h
B) Neisseria meningitidis; ceftriaxone
C) Streptococcus pneumoniae; vancomycin + cefotaxime
D) West Nile virus; supportive care
Answer A: HSV; acyclovir 10 mg/kg IV q8h
Rationale: Lymphocytic pleocytosis with normal glucose is classic for viral meningitis, particularly HSV.
Acyclovir is empirical therapy while awaiting PCR.
4. A patient with type 2 diabetes and CKD (eGFR 35 mL/min, UACR 300 mg/g) is not at glycemic
target despite metformin and GLP-1 agonist. Which additional agent is most appropriate?
A) SGLT2 inhibitor
B) Sulfonylurea
C) DPP-4 inhibitor
D) Insulin glargine
Answer A: SGLT2 inhibitor
Rationale: SGLT2 inhibitors are preferred in CKD with albuminuria due to renoprotective and
cardioprotective benefits independent of glycemic control.
5. A patient with recurrent Clostridioides difficile infection (third episode) is being considered for
fecal microbiota transplantation (FMT). Which is the most critical contraindication?
A) Active inflammatory bowel disease
B) Current use of PPIs
C) Immunocompromised status
D) Pregnancy
,Answer D: Pregnancy
Rationale: Pregnancy is an absolute contraindication due to unknown risks to the fetus.
Immunocompromise is a relative contraindication.
6. A 41-year-old woman with diabetes is unable to feel vibrations on the great toe and ankle
bilaterally but can feel vibrations on both patellae. What does the nurse suspect?
A) Hyperalgesia
B) Hyperesthesia
C) Peripheral neuropathy
D) Lesion of sensory cortex
Answer C: Peripheral neuropathy
Rationale: Peripheral neuropathy often presents with a "stocking-glove" distribution, where sensation is
lost first in the feet and then improves as you move up the leg.
7. A nurse documents radial pulses as "2+." What does this indicate?
A) Bounding pulse
B) Normal pulse
C) Weak pulse
D) Absent pulse
Answer B: Normal pulse
Rationale: Pulse grading: 0 = absent, 1+ = weak, 2+ = normal, 3+ = increased, 4+ = bounding.
8. A male patient has a red, round, superficial ulcer with yellowish-serous discharge on his penis
with a nontender base that feels like a small button. What does this suggest?
A) Herpes simplex
B) Syphilitic chancre
C) Chancroid
D) Carcinoma
, Answer B: Syphilitic chancre
Rationale: A painless, indurated ulcer (chancre) with a "button-like" base is characteristic of primary
syphilis caused by Treponema pallidum.
9. To palpate the temporomandibular joint, the nurse's finger should be placed:
A) In the ear canal
B) Anterior to the tragus
C) Posterior to the tragus
D) On the mandibular angle
Answer B: Anterior to the tragus
Rationale: The TMJ is palpated anterior to the tragus as the patient opens and closes the mouth.
10. A 45-year-old woman reports "losing urine when I sneeze." The nurse documents this as:
A) Urge incontinence
B) Stress incontinence
C) Overflow incontinence
D) Functional incontinence
Answer B: Stress incontinence
Rationale: Stress incontinence is the involuntary loss of urine during activities that increase intra-
abdominal pressure (coughing, sneezing, laughing).
11. Before a Papanicolaou (Pap) smear, the nurse should instruct the patient to:
A) Douche the night before
B) Have intercourse 24 hours before
C) Avoid intercourse, inserting anything into the vagina, or douching within 24 hours
D) Take a bath before the appointment
Answer C: Avoid intercourse, inserting anything into the vagina, or douching within 24 hours
