9/5/26, 12:34 PM A
NUR 690: Adult Health for DE
Questions And Correct Answers
(Verified Answers) Plus Rationale 2026
Q&A| Instant Download Pdf
1. A 62-year-old patient in rural New Mexico presents with fatigue, weight loss, and a persistent
cough for two months. The patient is a former smoker and works in construction. Which of the
following is the most appropriate initial screening test for lung cancer in this patient?
A) Chest X-ray
B) Sputum cytology
C) Low-dose computed tomography (LDCT)
D) Positron emission tomography (PET) scan
Answer: C) Low-dose computed tomography (LDCT)
Explanation: In New Mexico, lung cancer is a significant health concern, particularly in rural areas with
higher rates of smoking and occupational exposures. The USPSTF recommends annual screening for lung
cancer with LDCT in adults aged 50-80 years who have a 20 pack-year smoking history and currently smoke
or have quit within the past 15 years. Chest X-rays have not been shown to reduce mortality, and sputum
cytology is not a screening tool. A PET scan is used for staging, not initial screening.
2. A 45-year-old Native American patient from the Navajo Nation is admitted with uncontrolled type
2 diabetes mellitus (HbA1c of 10.2%). The patient reports difficulty adhering to the prescribed insulin
regimen due to fear of needles and cost. What is the most appropriate initial nursing intervention?
A) Refer the patient to a diabetes educator and a social worker.
B) Increase the patient's metformin dose.
C) Switch the patient to a once-daily injectable GLP-1 agonist.
D) Discharge the patient with a strict insulin sliding scale.
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Answer: A) Refer the patient to a diabetes educator and a social worker.
Explanation: New Mexico has a high prevalence of diabetes, especially among Native American populations.
Addressing the patient's fear (needle phobia) and financial barriers is crucial. A diabetes educator can teach
alternative administration techniques, and a social worker can help with financial assistance programs.
Simply increasing metformin or switching medications doesn't address the root causes of non-adherence. A
sliding scale is reactive and not ideal for long-term management.
3. A patient with chronic obstructive pulmonary disease (COPD) is being discharged from a hospital in
Albuquerque. Which medication should the nurse emphasize is the most important for reducing
exacerbations and improving quality of life?
A) Short-acting beta-agonist (SABA) inhaler
B) Long-acting muscarinic antagonist (LAMA) inhaler
C) Oral corticosteroids
D) Antibiotics
Answer: B) Long-acting muscarinic antagonist (LAMA) inhaler
Explanation: For stable COPD, long-acting bronchodilators like LAMAs (e.g., tiotropium) are the cornerstone
of maintenance therapy. They reduce exacerbations and improve symptoms. SABAs are rescue medications.
Oral corticosteroids are for acute exacerbations, not routine maintenance, and antibiotics are for infections.
The New Mexico Department of Health emphasizes proper inhaler technique and adherence to prevent
hospital readmissions, which are high in the state.
4. A 68-year-old patient in Santa Fe is newly diagnosed with heart failure with reduced ejection
fraction (HFrEF). Which of the following medication classes has been shown to provide the greatest
mortality benefit?
A) Angiotensin-converting enzyme inhibitors (ACEIs)
B) Beta-blockers
C) Aldosterone antagonists
D) Sodium-glucose cotransporter-2 (SGLT2) inhibitors
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, 9/5/26, 12:34 PM A
Answer: A) Angiotensin-converting enzyme inhibitors (ACEIs)
Explanation: While all options are guideline-directed medical therapy, ACEIs (or ARBs) are foundational and
have a Class I recommendation for reducing mortality in HFrEF. Beta-blockers also improve mortality, but the
question asks for the greatest mortality benefit when used together, but ACEI is the starting point. SGLT2
inhibitors are newer and have shown benefit but are often added later. In New Mexico, where access to
cardiologists can be limited, primary care providers must be adept at initiating these therapies.
5. A patient presents with acute onset of severe right upper quadrant pain, nausea, and vomiting. The
pain radiates to the right shoulder. An ultrasound reveals cholelithiasis. What is the priority nursing
intervention?
A) Administer morphine for pain.
B) Prepare the patient for an ERCP.
C) Maintain NPO status and prepare for possible surgery.
D) Administer an antiemetic.
Answer: C) Maintain NPO status and prepare for possible surgery.
Explanation: Acute cholecystitis (inflammation of the gallbladder) from cholelithiasis is a surgical
emergency. The priority is to keep the patient NPO to prevent gallbladder stimulation and prepare for a
cholecystectomy. While pain management and antiemetics are important, they are secondary to preparing
for the definitive intervention. ERCP is more for common bile duct stones, not gallbladder stones.
6. A 55-year-old patient in Las Cruces with a history of hypertension and hyperlipidemia reports a
sudden, severe headache described as "the worst headache of my life," followed by nausea and
photophobia. What is the most likely diagnosis?
A) Migraine headache
B) Tension headache
C) Subarachnoid hemorrhage
D) Cluster headache
Answer: C) Subarachnoid hemorrhage
Explanation: A sudden, severe "thunderclap" headache is a classic sign of a subarachnoid hemorrhage,
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often from a ruptured aneurysm. This is a neurological emergency requiring immediate CT and possibly a
lumbar puncture. Migraines, tension headaches, and cluster headaches do not typically present with this
sudden severity. In New Mexico, where stroke is a leading cause of death, recognizing this early is critical.
7. A patient on warfarin for atrial fibrillation has an International Normalized Ratio (INR) of 5.5. The
patient has no signs of bleeding. What is the most appropriate nursing action?
A) Administer vitamin K 10 mg orally.
B) Hold the warfarin dose and notify the provider.
C) Administer fresh frozen plasma.
D) Increase the warfarin dose.
Answer: B) Hold the warfarin dose and notify the provider.
Explanation: An INR of 5.5 is above the therapeutic range (usually 2-3 for atrial fibrillation) but not at a
critical level (usually >5.0 without bleeding). The standard practice is to hold the warfarin dose and monitor.
Vitamin K is reserved for higher INRs (>10) or if there is bleeding. Fresh frozen plasma is for active bleeding.
In rural New Mexico, access to lab monitoring can be a challenge, making patient education on INR
management vital.
8. A 70-year-old patient with osteoarthritis reports knee pain that is worse at the end of the day and
improves with rest. Which non-pharmacological intervention should the nurse recommend first?
A) Acetaminophen
B) Weight loss and low-impact exercise
C) Intra-articular corticosteroid injections
D) Opioid analgesics
Answer: B) Weight loss and low-impact exercise
Explanation: For osteoarthritis, initial management should be non-pharmacological. Weight loss reduces
stress on joints, and low-impact exercises (like swimming or walking) strengthen muscles and improve
function. Acetaminophen is a pharmacological option, but weight loss and exercise are foundational.
Corticosteroids and opioids are for more advanced or refractory cases. The New Mexico aging population
benefits greatly from lifestyle interventions.
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81
NUR 690: Adult Health for DE
Questions And Correct Answers
(Verified Answers) Plus Rationale 2026
Q&A| Instant Download Pdf
1. A 62-year-old patient in rural New Mexico presents with fatigue, weight loss, and a persistent
cough for two months. The patient is a former smoker and works in construction. Which of the
following is the most appropriate initial screening test for lung cancer in this patient?
A) Chest X-ray
B) Sputum cytology
C) Low-dose computed tomography (LDCT)
D) Positron emission tomography (PET) scan
Answer: C) Low-dose computed tomography (LDCT)
Explanation: In New Mexico, lung cancer is a significant health concern, particularly in rural areas with
higher rates of smoking and occupational exposures. The USPSTF recommends annual screening for lung
cancer with LDCT in adults aged 50-80 years who have a 20 pack-year smoking history and currently smoke
or have quit within the past 15 years. Chest X-rays have not been shown to reduce mortality, and sputum
cytology is not a screening tool. A PET scan is used for staging, not initial screening.
2. A 45-year-old Native American patient from the Navajo Nation is admitted with uncontrolled type
2 diabetes mellitus (HbA1c of 10.2%). The patient reports difficulty adhering to the prescribed insulin
regimen due to fear of needles and cost. What is the most appropriate initial nursing intervention?
A) Refer the patient to a diabetes educator and a social worker.
B) Increase the patient's metformin dose.
C) Switch the patient to a once-daily injectable GLP-1 agonist.
D) Discharge the patient with a strict insulin sliding scale.
1/
81
, 9/5/26, 12:34 PM A
Answer: A) Refer the patient to a diabetes educator and a social worker.
Explanation: New Mexico has a high prevalence of diabetes, especially among Native American populations.
Addressing the patient's fear (needle phobia) and financial barriers is crucial. A diabetes educator can teach
alternative administration techniques, and a social worker can help with financial assistance programs.
Simply increasing metformin or switching medications doesn't address the root causes of non-adherence. A
sliding scale is reactive and not ideal for long-term management.
3. A patient with chronic obstructive pulmonary disease (COPD) is being discharged from a hospital in
Albuquerque. Which medication should the nurse emphasize is the most important for reducing
exacerbations and improving quality of life?
A) Short-acting beta-agonist (SABA) inhaler
B) Long-acting muscarinic antagonist (LAMA) inhaler
C) Oral corticosteroids
D) Antibiotics
Answer: B) Long-acting muscarinic antagonist (LAMA) inhaler
Explanation: For stable COPD, long-acting bronchodilators like LAMAs (e.g., tiotropium) are the cornerstone
of maintenance therapy. They reduce exacerbations and improve symptoms. SABAs are rescue medications.
Oral corticosteroids are for acute exacerbations, not routine maintenance, and antibiotics are for infections.
The New Mexico Department of Health emphasizes proper inhaler technique and adherence to prevent
hospital readmissions, which are high in the state.
4. A 68-year-old patient in Santa Fe is newly diagnosed with heart failure with reduced ejection
fraction (HFrEF). Which of the following medication classes has been shown to provide the greatest
mortality benefit?
A) Angiotensin-converting enzyme inhibitors (ACEIs)
B) Beta-blockers
C) Aldosterone antagonists
D) Sodium-glucose cotransporter-2 (SGLT2) inhibitors
2/
81
, 9/5/26, 12:34 PM A
Answer: A) Angiotensin-converting enzyme inhibitors (ACEIs)
Explanation: While all options are guideline-directed medical therapy, ACEIs (or ARBs) are foundational and
have a Class I recommendation for reducing mortality in HFrEF. Beta-blockers also improve mortality, but the
question asks for the greatest mortality benefit when used together, but ACEI is the starting point. SGLT2
inhibitors are newer and have shown benefit but are often added later. In New Mexico, where access to
cardiologists can be limited, primary care providers must be adept at initiating these therapies.
5. A patient presents with acute onset of severe right upper quadrant pain, nausea, and vomiting. The
pain radiates to the right shoulder. An ultrasound reveals cholelithiasis. What is the priority nursing
intervention?
A) Administer morphine for pain.
B) Prepare the patient for an ERCP.
C) Maintain NPO status and prepare for possible surgery.
D) Administer an antiemetic.
Answer: C) Maintain NPO status and prepare for possible surgery.
Explanation: Acute cholecystitis (inflammation of the gallbladder) from cholelithiasis is a surgical
emergency. The priority is to keep the patient NPO to prevent gallbladder stimulation and prepare for a
cholecystectomy. While pain management and antiemetics are important, they are secondary to preparing
for the definitive intervention. ERCP is more for common bile duct stones, not gallbladder stones.
6. A 55-year-old patient in Las Cruces with a history of hypertension and hyperlipidemia reports a
sudden, severe headache described as "the worst headache of my life," followed by nausea and
photophobia. What is the most likely diagnosis?
A) Migraine headache
B) Tension headache
C) Subarachnoid hemorrhage
D) Cluster headache
Answer: C) Subarachnoid hemorrhage
Explanation: A sudden, severe "thunderclap" headache is a classic sign of a subarachnoid hemorrhage,
3/
81
, 9/5/26, 12:34 PM A
often from a ruptured aneurysm. This is a neurological emergency requiring immediate CT and possibly a
lumbar puncture. Migraines, tension headaches, and cluster headaches do not typically present with this
sudden severity. In New Mexico, where stroke is a leading cause of death, recognizing this early is critical.
7. A patient on warfarin for atrial fibrillation has an International Normalized Ratio (INR) of 5.5. The
patient has no signs of bleeding. What is the most appropriate nursing action?
A) Administer vitamin K 10 mg orally.
B) Hold the warfarin dose and notify the provider.
C) Administer fresh frozen plasma.
D) Increase the warfarin dose.
Answer: B) Hold the warfarin dose and notify the provider.
Explanation: An INR of 5.5 is above the therapeutic range (usually 2-3 for atrial fibrillation) but not at a
critical level (usually >5.0 without bleeding). The standard practice is to hold the warfarin dose and monitor.
Vitamin K is reserved for higher INRs (>10) or if there is bleeding. Fresh frozen plasma is for active bleeding.
In rural New Mexico, access to lab monitoring can be a challenge, making patient education on INR
management vital.
8. A 70-year-old patient with osteoarthritis reports knee pain that is worse at the end of the day and
improves with rest. Which non-pharmacological intervention should the nurse recommend first?
A) Acetaminophen
B) Weight loss and low-impact exercise
C) Intra-articular corticosteroid injections
D) Opioid analgesics
Answer: B) Weight loss and low-impact exercise
Explanation: For osteoarthritis, initial management should be non-pharmacological. Weight loss reduces
stress on joints, and low-impact exercises (like swimming or walking) strengthen muscles and improve
function. Acetaminophen is a pharmacological option, but weight loss and exercise are foundational.
Corticosteroids and opioids are for more advanced or refractory cases. The New Mexico aging population
benefits greatly from lifestyle interventions.
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