NUR 6130 ADVANCED PRACTICE NURSING
III EXAMS 1–3 BUNDLE
ORIGINAL PRACTICE QUESTIONS WITH COMPLETE
SOLUTIONS
QUESTIONS 1–100
EXAM 1–3 COMPREHENSIVE PRACTICE REVIEW
QUESTION 1
A 67-year-old patient with hypertension presents for follow-up. The patient reports
dizziness when standing from a chair. Current medications include lisinopril,
hydrochlorothiazide, and an alpha-1 blocker. Supine blood pressure is 142/78 mm Hg,
and standing blood pressure after 3 minutes is 112/64 mm Hg. Which finding is most
important for the nurse practitioner to address?
A) Supine systolic blood pressure
B) Mild reduction in diastolic pressure
C) Orthostatic blood pressure decrease associated with symptoms
D) Long-term use of hydrochlorothiazide
Rationale: C is correct because a substantial blood-pressure decline with standing
accompanied by dizziness indicates symptomatic orthostatic hypotension and creates
a fall/syncope risk. A is incorrect because the supine pressure is not the immediate
safety concern. B is incorrect because the diastolic reduction alone does not explain
the patient's symptoms. D is incorrect because hydrochlorothiazide may contribute to
volume depletion, but the clinically urgent finding is the symptomatic orthostatic
change itself.
QUESTION 2
A patient with newly diagnosed heart failure with reduced ejection fraction has an
ejection fraction of 30%. Which medication strategy provides the strongest evidence
for reducing morbidity and mortality when tolerated?
A) Loop diuretic alone
B) Digoxin alone
C) Guideline-directed combination therapy targeting neurohormonal and
1
,cardiometabolic pathways
D) Nitrate monotherapy
Rationale: C is correct because contemporary heart-failure management uses
multiple evidence-based medication classes that improve outcomes, including an
angiotensin-pathway agent/ARNI, evidence-based beta blocker, mineralocorticoid
receptor antagonist, and SGLT2 inhibitor when appropriate. A is incorrect because
loop diuretics primarily relieve congestion and do not provide the same mortality
benefit as foundational therapy. B is incorrect because digoxin may reduce
hospitalization in selected patients but is not foundational mortality-reducing therapy.
D is incorrect because nitrate monotherapy is insufficient for comprehensive HFrEF
management.
QUESTION 3
A 58-year-old patient with type 2 diabetes reports burning pain in both feet that is
worse at night. Examination reveals decreased vibration and monofilament sensation
bilaterally. Which intervention is most appropriate?
A) Begin chronic opioid therapy
B) Assess foot-protection behaviors and initiate evidence-based neuropathic pain
management
C) Recommend walking barefoot to stimulate sensory receptors
D) Reassure the patient that the symptoms will resolve spontaneously
Rationale: B is correct because diabetic distal symmetric polyneuropathy requires
both symptom management and prevention of injury through foot care and regular
inspection. A is incorrect because opioids are generally not preferred first-line
therapy for chronic diabetic neuropathic pain. C is incorrect because loss of
protective sensation makes barefoot walking dangerous. D is incorrect because
neuropathy may progress and can result in ulceration, infection, and amputation if
not addressed.
QUESTION 4
A 72-year-old patient with atrial fibrillation is prescribed an anticoagulant. Which
assessment should receive priority before treatment decisions are finalized?
A) Preferred medication color
B) Stroke risk, bleeding risk, renal function, and medication interactions
C) Patient's preferred time of day for exercise
D) Serum sodium alone
Rationale: B is correct because anticoagulation decisions require balancing
thromboembolic risk against bleeding risk while considering renal function and
interacting medications. A is irrelevant to clinical decision-making. C may matter for
2
,general health but does not determine anticoagulation safety. D is insufficient
because sodium alone does not establish whether anticoagulation is appropriate or
safe.
QUESTION 5
A patient taking warfarin for thromboembolic prevention reports starting
trimethoprim-sulfamethoxazole for a urinary tract infection. What is the most
appropriate response?
A) Tell the patient there is no interaction
B) Increase the warfarin dose automatically
C) Review the interaction and arrange appropriate anticoagulation monitoring
or an alternative antimicrobial
D) Tell the patient to stop all medications
Rationale: C is correct because trimethoprim-sulfamethoxazole can substantially
increase anticoagulant effect and bleeding risk in patients receiving warfarin. A is
incorrect because clinically important interaction potential exists. B is incorrect
because increasing warfarin would potentially worsen anticoagulation. D is unsafe
because discontinuing all medications without clinical direction is inappropriate.
QUESTION 6
A 45-year-old patient presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea. The initial ECG demonstrates ST-segment elevation in
contiguous leads. What is the priority?
A) Schedule outpatient stress testing
B) Administer an antacid and reassess tomorrow
C) Activate an emergency reperfusion pathway for suspected acute myocardial
infarction
D) Obtain a fasting lipid panel before treatment
Rationale: C is correct because ST-elevation myocardial infarction is a time-critical
emergency requiring immediate reperfusion evaluation and appropriate acute
coronary syndrome management. A is incorrect because outpatient testing delays
definitive treatment. B is unsafe because the presentation is highly concerning for
myocardial infarction. D is not the immediate priority in a patient with an acute
coronary syndrome.
QUESTION 7
3
, A patient with asthma uses a short-acting bronchodilator several times each day and
awakens at night with wheezing twice weekly. Which interpretation is most
appropriate?
A) Asthma is well controlled
B) The patient should simply increase caffeine intake
C) The frequency of symptoms suggests inadequate control and need for
reassessment of controller therapy and adherence
D) Short-acting bronchodilator use proves that the diagnosis is incorrect
Rationale: C is correct because frequent rescue medication use and nocturnal
symptoms indicate inadequate asthma control and warrant assessment of adherence,
technique, triggers, and controller therapy. A is incorrect because frequent symptoms
are inconsistent with good control. B has no therapeutic basis. D is incorrect because
bronchodilator responsiveness is compatible with asthma.
QUESTION 8
A patient with COPD has worsening dyspnea and increased sputum purulence and
volume. Which finding most strongly supports an acute exacerbation?
A) Stable baseline cough
B) Acute worsening of respiratory symptoms beyond normal day-to-day
variation
C) Long-standing smoking history alone
D) Stable oxygen saturation at baseline
Rationale: B is correct because COPD exacerbation is characterized by acute
worsening of respiratory symptoms requiring additional treatment. A is incorrect
because stable symptoms reflect baseline disease. C is a risk factor but does not
establish an exacerbation. D does not demonstrate acute clinical deterioration.
QUESTION 9
A patient with suspected bacterial pneumonia has fever, tachypnea, productive cough,
and focal crackles. Which finding should prompt the greatest concern for severe
disease?
A) Mild pleuritic discomfort
B) Productive cough
C) Hypotension with altered mental status
D) Low-grade fever
Rationale: C is correct because hypotension and altered mental status can indicate
severe systemic illness, sepsis, and impaired organ perfusion. A and B may occur with
uncomplicated pneumonia. D is nonspecific and does not by itself indicate severity.
4
III EXAMS 1–3 BUNDLE
ORIGINAL PRACTICE QUESTIONS WITH COMPLETE
SOLUTIONS
QUESTIONS 1–100
EXAM 1–3 COMPREHENSIVE PRACTICE REVIEW
QUESTION 1
A 67-year-old patient with hypertension presents for follow-up. The patient reports
dizziness when standing from a chair. Current medications include lisinopril,
hydrochlorothiazide, and an alpha-1 blocker. Supine blood pressure is 142/78 mm Hg,
and standing blood pressure after 3 minutes is 112/64 mm Hg. Which finding is most
important for the nurse practitioner to address?
A) Supine systolic blood pressure
B) Mild reduction in diastolic pressure
C) Orthostatic blood pressure decrease associated with symptoms
D) Long-term use of hydrochlorothiazide
Rationale: C is correct because a substantial blood-pressure decline with standing
accompanied by dizziness indicates symptomatic orthostatic hypotension and creates
a fall/syncope risk. A is incorrect because the supine pressure is not the immediate
safety concern. B is incorrect because the diastolic reduction alone does not explain
the patient's symptoms. D is incorrect because hydrochlorothiazide may contribute to
volume depletion, but the clinically urgent finding is the symptomatic orthostatic
change itself.
QUESTION 2
A patient with newly diagnosed heart failure with reduced ejection fraction has an
ejection fraction of 30%. Which medication strategy provides the strongest evidence
for reducing morbidity and mortality when tolerated?
A) Loop diuretic alone
B) Digoxin alone
C) Guideline-directed combination therapy targeting neurohormonal and
1
,cardiometabolic pathways
D) Nitrate monotherapy
Rationale: C is correct because contemporary heart-failure management uses
multiple evidence-based medication classes that improve outcomes, including an
angiotensin-pathway agent/ARNI, evidence-based beta blocker, mineralocorticoid
receptor antagonist, and SGLT2 inhibitor when appropriate. A is incorrect because
loop diuretics primarily relieve congestion and do not provide the same mortality
benefit as foundational therapy. B is incorrect because digoxin may reduce
hospitalization in selected patients but is not foundational mortality-reducing therapy.
D is incorrect because nitrate monotherapy is insufficient for comprehensive HFrEF
management.
QUESTION 3
A 58-year-old patient with type 2 diabetes reports burning pain in both feet that is
worse at night. Examination reveals decreased vibration and monofilament sensation
bilaterally. Which intervention is most appropriate?
A) Begin chronic opioid therapy
B) Assess foot-protection behaviors and initiate evidence-based neuropathic pain
management
C) Recommend walking barefoot to stimulate sensory receptors
D) Reassure the patient that the symptoms will resolve spontaneously
Rationale: B is correct because diabetic distal symmetric polyneuropathy requires
both symptom management and prevention of injury through foot care and regular
inspection. A is incorrect because opioids are generally not preferred first-line
therapy for chronic diabetic neuropathic pain. C is incorrect because loss of
protective sensation makes barefoot walking dangerous. D is incorrect because
neuropathy may progress and can result in ulceration, infection, and amputation if
not addressed.
QUESTION 4
A 72-year-old patient with atrial fibrillation is prescribed an anticoagulant. Which
assessment should receive priority before treatment decisions are finalized?
A) Preferred medication color
B) Stroke risk, bleeding risk, renal function, and medication interactions
C) Patient's preferred time of day for exercise
D) Serum sodium alone
Rationale: B is correct because anticoagulation decisions require balancing
thromboembolic risk against bleeding risk while considering renal function and
interacting medications. A is irrelevant to clinical decision-making. C may matter for
2
,general health but does not determine anticoagulation safety. D is insufficient
because sodium alone does not establish whether anticoagulation is appropriate or
safe.
QUESTION 5
A patient taking warfarin for thromboembolic prevention reports starting
trimethoprim-sulfamethoxazole for a urinary tract infection. What is the most
appropriate response?
A) Tell the patient there is no interaction
B) Increase the warfarin dose automatically
C) Review the interaction and arrange appropriate anticoagulation monitoring
or an alternative antimicrobial
D) Tell the patient to stop all medications
Rationale: C is correct because trimethoprim-sulfamethoxazole can substantially
increase anticoagulant effect and bleeding risk in patients receiving warfarin. A is
incorrect because clinically important interaction potential exists. B is incorrect
because increasing warfarin would potentially worsen anticoagulation. D is unsafe
because discontinuing all medications without clinical direction is inappropriate.
QUESTION 6
A 45-year-old patient presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea. The initial ECG demonstrates ST-segment elevation in
contiguous leads. What is the priority?
A) Schedule outpatient stress testing
B) Administer an antacid and reassess tomorrow
C) Activate an emergency reperfusion pathway for suspected acute myocardial
infarction
D) Obtain a fasting lipid panel before treatment
Rationale: C is correct because ST-elevation myocardial infarction is a time-critical
emergency requiring immediate reperfusion evaluation and appropriate acute
coronary syndrome management. A is incorrect because outpatient testing delays
definitive treatment. B is unsafe because the presentation is highly concerning for
myocardial infarction. D is not the immediate priority in a patient with an acute
coronary syndrome.
QUESTION 7
3
, A patient with asthma uses a short-acting bronchodilator several times each day and
awakens at night with wheezing twice weekly. Which interpretation is most
appropriate?
A) Asthma is well controlled
B) The patient should simply increase caffeine intake
C) The frequency of symptoms suggests inadequate control and need for
reassessment of controller therapy and adherence
D) Short-acting bronchodilator use proves that the diagnosis is incorrect
Rationale: C is correct because frequent rescue medication use and nocturnal
symptoms indicate inadequate asthma control and warrant assessment of adherence,
technique, triggers, and controller therapy. A is incorrect because frequent symptoms
are inconsistent with good control. B has no therapeutic basis. D is incorrect because
bronchodilator responsiveness is compatible with asthma.
QUESTION 8
A patient with COPD has worsening dyspnea and increased sputum purulence and
volume. Which finding most strongly supports an acute exacerbation?
A) Stable baseline cough
B) Acute worsening of respiratory symptoms beyond normal day-to-day
variation
C) Long-standing smoking history alone
D) Stable oxygen saturation at baseline
Rationale: B is correct because COPD exacerbation is characterized by acute
worsening of respiratory symptoms requiring additional treatment. A is incorrect
because stable symptoms reflect baseline disease. C is a risk factor but does not
establish an exacerbation. D does not demonstrate acute clinical deterioration.
QUESTION 9
A patient with suspected bacterial pneumonia has fever, tachypnea, productive cough,
and focal crackles. Which finding should prompt the greatest concern for severe
disease?
A) Mild pleuritic discomfort
B) Productive cough
C) Hypotension with altered mental status
D) Low-grade fever
Rationale: C is correct because hypotension and altered mental status can indicate
severe systemic illness, sepsis, and impaired organ perfusion. A and B may occur with
uncomplicated pneumonia. D is nonspecific and does not by itself indicate severity.
4
