NURS 4426: NCLEX Advanced Geriatric and Multi-
System Practice Prep with Detailed Rationales
Course Code: NURS-4426
Course Name: Advanced Clinical Judgment and Licensure Readiness,
CEA_Practice_Exam_2026_2027
Topic: Adult-Gerontology, Advanced Cardiology, Endocrine Crises, and
Jurisprudence
Academic Year: 2026/2027
Question 1
An African American adult male client presents to the primary care clinic for a
follow-up blood pressure evaluation. Despite strict compliance with a low-sodium
lifestyle, a rigid DASH diet, and an optimized 60-minute daily moderate-to-high
intensity exercise program, his blood pressure remains chronically elevated at
158/94 mm Hg. Following JNC8 Hypertension Guidelines, which of the following
pharmacological agents represents the best choice for this client?
A. Lisinopril (Zestril)
B. Amlodipine (Norvasc)
C. Metformin (Glucophage)
D. Propranolol (Inderal)
CORRECT ANSWER: B
RATIONALE: According to the JNC8 Hypertension Guidelines, African
American clients with hypertension should be initiated on a dihydropyridine
calcium channel blocker (such as amlodipine/Norvasc) or a thiazide diuretic
as first-line therapy. Clinical trials demonstrate that this population has a more
robust blood pressure reduction with calcium channel blockers compared to ACE
inhibitors or beta-blockers when lifestyle modifications are not at goal. Lisinopril
is less effective as a first-line monotherapy in this demographic, metformin is an
anti-diabetic biguanide, and propranolol is a non-selective beta-blocker primarily
used for migraine prophylaxis or arrhythmia control rather than initial hypertension
monotherapy.
,Question 2
A 50-year-old woman with a chronic history of hypertension and Type 2 diabetes
mellitus presents with worsening dyspnea on exertion, paroxysmal nocturnal
dyspnea, and orthopnea. Upon physical examination, the nurse notes jugular
venous distention (JVD) and bilateral pulmonary crackles during lung
auscultation. The nurse should recognize that this specific clinical clustering is
diagnostic of which of the following conditions?
A. Acute localized lobar pneumonia.
B. Congestive heart failure (CHF).
C. Uncomplicated acute myocardial infarction.
D. Primary vasomotor rhinitis.
CORRECT ANSWER: B
RATIONALE: This client's presentation reflects volume overload secondary to
congestive heart failure (CHF). The presence of bilateral pulmonary crackles
reflects a left ventricular backup causing pulmonary edema, while the presence
of jugular venous distention (JVD) reflects a right ventricular volume backup
into the systemic venous circuit. Dyspnea on exertion and orthopnea are classic
symptoms of fluid overload. While an acute myocardial infarction can precipitate
heart failure, an isolated MI does not inherently define this multi-axis state of
systemic fluid backup without cardiac dysfunction. Pneumonia presents with fever
and localized consolidations rather than bilateral heart failure symptoms.
Question 3
A nurse is reviewing the diagnostic workup for a client who has a confirmed 4.5
cm ascending aortic aneurysm. Which of the following medical imaging
modalities represents the standard of care for serial surveillance and precise multi-
axis measurement of this vascular lesion?
A. Transesophageal echocardiogram (TEE) under deep procedural sedation.
B. CT Angiography (CTA) of the chest.
C. Standard CT pulmonary embolism (PE) protocol.
D. Plain anteroposterior (PA) view chest X-ray.
CORRECT ANSWER: B
RATIONALE: CT Angiography (CTA) of the chest is the absolute clinical
,gold standard for the serial surveillance of an ascending aortic aneurysm, as it
provides the multi-axis cross-sectional reconstruction needed to measure the
dimensions of the vascular lumen. A standard CT PE protocol is timed for the
pulmonary artery, not the aorta, making it inappropriate for tracking aneurysm
expansion. Plain chest X-rays can detect a wide mediastinum but lack the precision
to measure subtle growth. A TEE is invasive and requires unnecessary procedural
sedation.
Question 4
A nurse is reviewing the provider's choices for a client who requires immediate
vasoconstrictive therapy but must avoid any direct chronotropic or inotropic
cardiac stimulation. Which of the following adrenergic medications does not cause
any beta-1 receptor stimulation?
A. Epinephrine.
B. Isoproterenol.
C. Phenylephrine.
D. Albuterol.
CORRECT ANSWER: C
RATIONALE: Phenylephrine is a pure, selective alpha-1 adrenergic agonist
that does not cause any beta-1 or beta-2 stimulation. It increases blood pressure
strictly by inducing intense systemic vasoconstriction without direct cardiac
chronotropic or inotropic effects. Epinephrine and isoproterenol stimulate both
alpha and beta receptors, causing significant cardiac overstimulation. Albuterol is a
beta-2 agonist that can cross-react and cause mild beta-1 cardiac stimulation at
high doses.
Question 5
A nurse is performing a physical assessment on a client who has a history of an
untreated perioral abscess noted on a maxillofacial CT scan. The client suddenly
develops a high fever, severe tachycardia, and is diagnosed with a Streptococcus
viridans endocarditis. The nurse should understand that the primary source of this
systemic infection was introduced through which route?
A. A new intravenous catheter placed in the operating room today.
, B. The oral mucosa and gumline tissues adjacent to the dental abscess.
C. Infestation of scabies across the webs of the lower extremities.
D. A viral infection pathognomonic for a common cold.
CORRECT ANSWER: B
RATIONALE: Streptococcus viridans is a primary resident of the normal
oral flora. In the presence of a perioral dental abscess or gumline infection,
these bacteria can easily gain entry into the bloodstream, resulting in bacteremia
and subsequent seeding of the heart valves, which leads to infective endocarditis.
Scabies infestations do not carry a risk for S. viridans bacterial sepsis, common
colds are viral, and a newly placed IV catheter is an unlikely source for an
infection that has already manifested.
Question 6
A nurse is caring for an adult client who was admitted with an acute embolic
stroke. A comprehensive workup is ordered to fully evaluate and rule out a
cardiac source of the embolus, such as valvular vegetation from infective
endocarditis. Which of the following diagnostic procedures should the nurse
prepare the client for?
A. 12-Lead Electrocardiogram (ECG) tracking.
B. Transthoracic (TTE) or Transesophageal Echocardiogram (TEE).
C. High-resolution CT scan of the facial bones.
D. Plain chest CT without contrast.
CORRECT ANSWER: B
RATIONALE: To evaluate for a cardiac source of an embolic stroke, such as
valvular vegetations or mural thrombi, a transthoracic or transesophageal
echocardiogram must be performed. A TTE provides an initial non-invasive
look, while a TEE provides high-resolution images of the heart valves to identify
small vegetations. A 12-lead ECG checks for rhythm disturbances like atrial
fibrillation but cannot visually detect structural vegetations. Facial and plain chest
CT scans provide no information regarding intracardiac structures.
Question 7
System Practice Prep with Detailed Rationales
Course Code: NURS-4426
Course Name: Advanced Clinical Judgment and Licensure Readiness,
CEA_Practice_Exam_2026_2027
Topic: Adult-Gerontology, Advanced Cardiology, Endocrine Crises, and
Jurisprudence
Academic Year: 2026/2027
Question 1
An African American adult male client presents to the primary care clinic for a
follow-up blood pressure evaluation. Despite strict compliance with a low-sodium
lifestyle, a rigid DASH diet, and an optimized 60-minute daily moderate-to-high
intensity exercise program, his blood pressure remains chronically elevated at
158/94 mm Hg. Following JNC8 Hypertension Guidelines, which of the following
pharmacological agents represents the best choice for this client?
A. Lisinopril (Zestril)
B. Amlodipine (Norvasc)
C. Metformin (Glucophage)
D. Propranolol (Inderal)
CORRECT ANSWER: B
RATIONALE: According to the JNC8 Hypertension Guidelines, African
American clients with hypertension should be initiated on a dihydropyridine
calcium channel blocker (such as amlodipine/Norvasc) or a thiazide diuretic
as first-line therapy. Clinical trials demonstrate that this population has a more
robust blood pressure reduction with calcium channel blockers compared to ACE
inhibitors or beta-blockers when lifestyle modifications are not at goal. Lisinopril
is less effective as a first-line monotherapy in this demographic, metformin is an
anti-diabetic biguanide, and propranolol is a non-selective beta-blocker primarily
used for migraine prophylaxis or arrhythmia control rather than initial hypertension
monotherapy.
,Question 2
A 50-year-old woman with a chronic history of hypertension and Type 2 diabetes
mellitus presents with worsening dyspnea on exertion, paroxysmal nocturnal
dyspnea, and orthopnea. Upon physical examination, the nurse notes jugular
venous distention (JVD) and bilateral pulmonary crackles during lung
auscultation. The nurse should recognize that this specific clinical clustering is
diagnostic of which of the following conditions?
A. Acute localized lobar pneumonia.
B. Congestive heart failure (CHF).
C. Uncomplicated acute myocardial infarction.
D. Primary vasomotor rhinitis.
CORRECT ANSWER: B
RATIONALE: This client's presentation reflects volume overload secondary to
congestive heart failure (CHF). The presence of bilateral pulmonary crackles
reflects a left ventricular backup causing pulmonary edema, while the presence
of jugular venous distention (JVD) reflects a right ventricular volume backup
into the systemic venous circuit. Dyspnea on exertion and orthopnea are classic
symptoms of fluid overload. While an acute myocardial infarction can precipitate
heart failure, an isolated MI does not inherently define this multi-axis state of
systemic fluid backup without cardiac dysfunction. Pneumonia presents with fever
and localized consolidations rather than bilateral heart failure symptoms.
Question 3
A nurse is reviewing the diagnostic workup for a client who has a confirmed 4.5
cm ascending aortic aneurysm. Which of the following medical imaging
modalities represents the standard of care for serial surveillance and precise multi-
axis measurement of this vascular lesion?
A. Transesophageal echocardiogram (TEE) under deep procedural sedation.
B. CT Angiography (CTA) of the chest.
C. Standard CT pulmonary embolism (PE) protocol.
D. Plain anteroposterior (PA) view chest X-ray.
CORRECT ANSWER: B
RATIONALE: CT Angiography (CTA) of the chest is the absolute clinical
,gold standard for the serial surveillance of an ascending aortic aneurysm, as it
provides the multi-axis cross-sectional reconstruction needed to measure the
dimensions of the vascular lumen. A standard CT PE protocol is timed for the
pulmonary artery, not the aorta, making it inappropriate for tracking aneurysm
expansion. Plain chest X-rays can detect a wide mediastinum but lack the precision
to measure subtle growth. A TEE is invasive and requires unnecessary procedural
sedation.
Question 4
A nurse is reviewing the provider's choices for a client who requires immediate
vasoconstrictive therapy but must avoid any direct chronotropic or inotropic
cardiac stimulation. Which of the following adrenergic medications does not cause
any beta-1 receptor stimulation?
A. Epinephrine.
B. Isoproterenol.
C. Phenylephrine.
D. Albuterol.
CORRECT ANSWER: C
RATIONALE: Phenylephrine is a pure, selective alpha-1 adrenergic agonist
that does not cause any beta-1 or beta-2 stimulation. It increases blood pressure
strictly by inducing intense systemic vasoconstriction without direct cardiac
chronotropic or inotropic effects. Epinephrine and isoproterenol stimulate both
alpha and beta receptors, causing significant cardiac overstimulation. Albuterol is a
beta-2 agonist that can cross-react and cause mild beta-1 cardiac stimulation at
high doses.
Question 5
A nurse is performing a physical assessment on a client who has a history of an
untreated perioral abscess noted on a maxillofacial CT scan. The client suddenly
develops a high fever, severe tachycardia, and is diagnosed with a Streptococcus
viridans endocarditis. The nurse should understand that the primary source of this
systemic infection was introduced through which route?
A. A new intravenous catheter placed in the operating room today.
, B. The oral mucosa and gumline tissues adjacent to the dental abscess.
C. Infestation of scabies across the webs of the lower extremities.
D. A viral infection pathognomonic for a common cold.
CORRECT ANSWER: B
RATIONALE: Streptococcus viridans is a primary resident of the normal
oral flora. In the presence of a perioral dental abscess or gumline infection,
these bacteria can easily gain entry into the bloodstream, resulting in bacteremia
and subsequent seeding of the heart valves, which leads to infective endocarditis.
Scabies infestations do not carry a risk for S. viridans bacterial sepsis, common
colds are viral, and a newly placed IV catheter is an unlikely source for an
infection that has already manifested.
Question 6
A nurse is caring for an adult client who was admitted with an acute embolic
stroke. A comprehensive workup is ordered to fully evaluate and rule out a
cardiac source of the embolus, such as valvular vegetation from infective
endocarditis. Which of the following diagnostic procedures should the nurse
prepare the client for?
A. 12-Lead Electrocardiogram (ECG) tracking.
B. Transthoracic (TTE) or Transesophageal Echocardiogram (TEE).
C. High-resolution CT scan of the facial bones.
D. Plain chest CT without contrast.
CORRECT ANSWER: B
RATIONALE: To evaluate for a cardiac source of an embolic stroke, such as
valvular vegetations or mural thrombi, a transthoracic or transesophageal
echocardiogram must be performed. A TTE provides an initial non-invasive
look, while a TEE provides high-resolution images of the heart valves to identify
small vegetations. A 12-lead ECG checks for rhythm disturbances like atrial
fibrillation but cannot visually detect structural vegetations. Facial and plain chest
CT scans provide no information regarding intracardiac structures.
Question 7
