NUR 6111 – Exam 2 (Advanced Practice Nursing I) – 2026
Actual Exam Questions and Correct Answers
Q001:
Type: NGN - Diagnostic
Scenario: 54-year-old man presents to primary care with 3-hour history of acute
midsternal chest pressure radiating to left jaw. Describes “crushing” pain while shoveling
snow. PMH: HTN, hyperlipidemia, 30-pack-year smoking. Vitals: BP 158/96 mmHg, HR
104 bpm, RR 22, SpO₂ 96% RA, T 36.8 °C. Focused exam: diaphoresis, audible S₄, no
murmurs, lungs clear, no leg edema.
Question: Which diagnostic test should be obtained next?
Options:
A. D-dimer
B. 12-lead ECG
C. Chest radiograph
D. Cardiac MRI
(Correct: B)
Rationale:
● Answer: 12-lead ECG
● Why (2026 Standard): 2023 ACC/AHA chest pain guideline states immediate
ECG within 10 min for suspected acute coronary syndrome; ECG shows ischemic
changes earliest.
, ● Errors: D-dimer delays care and is for pulmonary embolus suspicion; chest
radiograph insensitive for acute ischemia; MRI not first-line emergent test.
Q002:
Type: Complex MCQ
Scenario: 29-year-old woman presents with 2-day retrosternal burning pain after meals,
no radiation. PMH: anxiety. Vitals stable. Exam: epigastric tenderness, no rebound.
Question: Most likely diagnosis?
Options:
A. Acute myocardial infarction
B. Gastroesophageal reflux disease
C. Pulmonary embolism
D. Stable angina
(Correct: B)
Rationale:
● Answer: Gastroesophageal reflux disease
● Why (2026 Standard): Typical reflux symptoms (burning, post-prandial) without
ischemic features.
● Errors: MI/angina unlikely in young woman without risk factors; PE presents with
dyspnea/tachycardia.
Q003:
Type: NGN - Diagnostic
,Scenario: 67-year-old man with COPD GOLD stage III reports 4-day progressive
dyspnea, orthopnea, bilateral leg swelling to knees. Vitals: BP 140/88, HR 110, RR 26,
SpO₂ 89% RA. Exam: JVP 12 cm, bibasilar crackles, wheezes, 2+ pitting edema.
Question: Priority differential?
Options:
A. Acute asthma exacerbation
B. Acute decompensated heart failure
C. Spontaneous pneumothorax
D. Pulmonary embolism
(Correct: B)
Rationale:
● Answer: Acute decompensated heart failure
● Why (2026 Standard): Elevated JVP, orthopnea, bilateral edema, crackles indicate
volume overload.
● Errors: Asthma lacks edema; pneumothorax causes unilateral decreased breath
sounds; PE usually asymmetric.
Q004:
Type: Complex MCQ
Scenario: 45-year-old woman 10 days postpartum presents with acute pleuritic chest pain,
tachycardia, no fever. Vitals: HR 112, BP 100/60, RR 24, SpO₂ 93% RA. Exam: clear
lungs, left calf swelling +3 cm vs right.
Question: Next best diagnostic test?
, Options:
A. Ventilation-perfusion scan
B. D-dimer
C. Bilateral lower-extremity venous ultrasound
D. CT pulmonary angiography
(Correct: D)
Rationale:
● Answer: CT pulmonary angiography
● Why (2026 Standard): High-probability Wells score; CTPA is imaging gold
standard for PE.
● Errors: D-dimer can be false-positive postpartum; ultrasound only confirms DVT
but not PE location.
Q005:
Type: NGN - Diagnostic
Scenario: 38-year-old man with acute sharp chest pain relieved by sitting up; improved
with NSAIDs. Pain varies with inspiration. PMH: URI 1 week ago. Vitals: T 37.9 °C, HR
92, BP 118/70. Exam: friction rub at left lower sternal border.
Question: Most likely diagnosis?
Options:
A. Acute pericarditis
B. Myocardial infarction
Actual Exam Questions and Correct Answers
Q001:
Type: NGN - Diagnostic
Scenario: 54-year-old man presents to primary care with 3-hour history of acute
midsternal chest pressure radiating to left jaw. Describes “crushing” pain while shoveling
snow. PMH: HTN, hyperlipidemia, 30-pack-year smoking. Vitals: BP 158/96 mmHg, HR
104 bpm, RR 22, SpO₂ 96% RA, T 36.8 °C. Focused exam: diaphoresis, audible S₄, no
murmurs, lungs clear, no leg edema.
Question: Which diagnostic test should be obtained next?
Options:
A. D-dimer
B. 12-lead ECG
C. Chest radiograph
D. Cardiac MRI
(Correct: B)
Rationale:
● Answer: 12-lead ECG
● Why (2026 Standard): 2023 ACC/AHA chest pain guideline states immediate
ECG within 10 min for suspected acute coronary syndrome; ECG shows ischemic
changes earliest.
, ● Errors: D-dimer delays care and is for pulmonary embolus suspicion; chest
radiograph insensitive for acute ischemia; MRI not first-line emergent test.
Q002:
Type: Complex MCQ
Scenario: 29-year-old woman presents with 2-day retrosternal burning pain after meals,
no radiation. PMH: anxiety. Vitals stable. Exam: epigastric tenderness, no rebound.
Question: Most likely diagnosis?
Options:
A. Acute myocardial infarction
B. Gastroesophageal reflux disease
C. Pulmonary embolism
D. Stable angina
(Correct: B)
Rationale:
● Answer: Gastroesophageal reflux disease
● Why (2026 Standard): Typical reflux symptoms (burning, post-prandial) without
ischemic features.
● Errors: MI/angina unlikely in young woman without risk factors; PE presents with
dyspnea/tachycardia.
Q003:
Type: NGN - Diagnostic
,Scenario: 67-year-old man with COPD GOLD stage III reports 4-day progressive
dyspnea, orthopnea, bilateral leg swelling to knees. Vitals: BP 140/88, HR 110, RR 26,
SpO₂ 89% RA. Exam: JVP 12 cm, bibasilar crackles, wheezes, 2+ pitting edema.
Question: Priority differential?
Options:
A. Acute asthma exacerbation
B. Acute decompensated heart failure
C. Spontaneous pneumothorax
D. Pulmonary embolism
(Correct: B)
Rationale:
● Answer: Acute decompensated heart failure
● Why (2026 Standard): Elevated JVP, orthopnea, bilateral edema, crackles indicate
volume overload.
● Errors: Asthma lacks edema; pneumothorax causes unilateral decreased breath
sounds; PE usually asymmetric.
Q004:
Type: Complex MCQ
Scenario: 45-year-old woman 10 days postpartum presents with acute pleuritic chest pain,
tachycardia, no fever. Vitals: HR 112, BP 100/60, RR 24, SpO₂ 93% RA. Exam: clear
lungs, left calf swelling +3 cm vs right.
Question: Next best diagnostic test?
, Options:
A. Ventilation-perfusion scan
B. D-dimer
C. Bilateral lower-extremity venous ultrasound
D. CT pulmonary angiography
(Correct: D)
Rationale:
● Answer: CT pulmonary angiography
● Why (2026 Standard): High-probability Wells score; CTPA is imaging gold
standard for PE.
● Errors: D-dimer can be false-positive postpartum; ultrasound only confirms DVT
but not PE location.
Q005:
Type: NGN - Diagnostic
Scenario: 38-year-old man with acute sharp chest pain relieved by sitting up; improved
with NSAIDs. Pain varies with inspiration. PMH: URI 1 week ago. Vitals: T 37.9 °C, HR
92, BP 118/70. Exam: friction rub at left lower sternal border.
Question: Most likely diagnosis?
Options:
A. Acute pericarditis
B. Myocardial infarction
