NR 667 ADVANCED PRACTICE NURSING EXAM 2 PREP
QUESTIONS AND ANSWERS 2026/2027 UPDATE. 100%
VERIFIED
1. A 65-year-old male with a history of HTN and HFrEF (LVEF 35%)
presents for a follow-up. He is currently taking Lisinopril 20mg and
Carvedilol 6.25mg BID. His BP is 138/84 and HR is 72. Which of the
following is the most appropriate next step in managing his heart
failure?
A. Add Furosemide 20mg daily
B. Add Spironolactone 25mg daily
C. Increase Carvedilol to 12.5mg BID
D. Switch Lisinopril to Losartan
Answer: B
Rationale: In patients with HFrEF and LVEF <= 35% who are already on
an ACE inhibitor and Beta-blocker, the addition of an Aldosterone
Antagonist like Spironolactone is recommended to reduce mortality and
morbidity.
2. A 58-year-old female presents with a 3-month history of fatigue,
cold intolerance, and weight gain. Her TSH is elevated and Free T4 is
low. Which of the following is the most appropriate initial treatment?
A. Levothyroxine 1.6 mcg/kg daily
B. Methimazole 10mg daily
C. Liothyronine 25mcg daily
D. Radioactive iodine ablation
,Answer: A
Rationale: The patient has primary hypothyroidism. The standard of
care is initiation of Levothyroxine monotherapy, dosed at approximately
1.6 mcg/kg/day in otherwise healthy adults.
3. A 45-year-old male with Type 2 Diabetes presents with a morning
fasting blood glucose of 160 mg/dL. You suspect the Dawn
Phenomenon. Which of the following strategies would confirm this
diagnosis?
A. Check blood glucose at 3:00 AM; it will be elevated
B. Check blood glucose at 3:00 AM; it will be low
C. Check HbA1c levels
D. Administer a bedtime snack
Answer: A
Rationale: The Dawn Phenomenon is characterized by early morning
hyperglycemia due to the release of counter-regulatory hormones.
Checking a 3:00 AM glucose will reveal an elevated level, distinguishing
it from the Somogyi effect where the 3:00 AM glucose is low.
4. A 72-year-old male with a history of COPD presents with increased
dyspnea, sputum production, and wheezing. He is currently taking
Tiotropium. Which of the following is the most appropriate addition
to his maintenance therapy?
A. Fluticasone/Salmeterol inhaler
B. Albuterol rescue inhaler PRN
C. Oral prednisone taper
D. Montelukast daily
Answer: A
Rationale: For patients with COPD who remain symptomatic on a long-
acting muscarinic antagonist (LAMA) like Tiotropium, the addition of a
,long-acting beta-agonist (LABA) combined with an inhaled
corticosteroid (ICS) is recommended to improve lung function and
reduce exacerbations.
5. A 30-year-old female presents with dysuria, frequency, and urgency.
She has no fever or flank pain. Which of the following is the most
appropriate first-line treatment?
A. Nitrofurantoin 100mg BID for 5 days
B. Ciprofloxacin 500mg BID for 7 days
C. Amoxicillin 500mg TID for 10 days
D. Doxycycline 100mg BID for 7 days
Answer: A
Rationale: Uncomplicated cystitis is typically treated empirically with
Nitrofurantoin, Trimethoprim-Sulfamethoxazole, or Fosfomycin.
Nitrofurantoin is highly effective for uncomplicated lower UTIs.
Fluoroquinolones are reserved for complicated infections due to
collateral damage and resistance concerns.
6. A 50-year-old male presents with sudden onset of severe pain in his
right great toe. The joint is erythematous, swollen, and exquisitely
tender. Which of the following is the most appropriate treatment for
an acute gout flare?
A. Allopurinol 300mg daily
B. Colchicine 1.2mg then 0.6mg 1 hour later
C. Probenecid 500mg BID
D. Febuxostat 40mg daily
Answer: B
Rationale: Colchicine, NSAIDs, or corticosteroids are first-line
treatments for acute gout flares. Allopurinol and Febuxostat are urate-
, lowering therapies indicated for chronic management, not acute flares,
as they can worsen the flare initially.
7. A 68-year-old female presents with a new diagnosis of
hypertension. Her BP is 155/92. She has no other comorbidities.
According to JNC 8 guidelines, which of the following is the most
appropriate initial antihypertensive?
A. Lisinopril 10mg daily
B. Amlodipine 5mg daily
C. Hydrochlorothiazide 25mg daily
D. Metoprolol 25mg BID
Answer: C
Rationale: For African American patients or those over 60 with
uncomplicated hypertension, thiazide diuretics or calcium channel
blockers are recommended as first-line therapy. This patient is over 60,
making a thiazide (like HCTZ) or CCB appropriate.
8. A 24-year-old female presents with a 2-day history of severe
unilateral headache, nausea, and photophobia. She reports similar
episodes in the past. Which of the following is the most appropriate
acute treatment?
A. Sumatriptan 50mg PO
B. Propranolol 40mg PO
C. Amitriptyline 25mg PO
D. Topiramate 50mg PO
Answer: A
Rationale: Triptans (like Sumatriptan) are first-line acute treatments for
moderate to severe migraine attacks. Propranolol, Amitriptyline, and
Topiramate are used for migraine prophylaxis.
QUESTIONS AND ANSWERS 2026/2027 UPDATE. 100%
VERIFIED
1. A 65-year-old male with a history of HTN and HFrEF (LVEF 35%)
presents for a follow-up. He is currently taking Lisinopril 20mg and
Carvedilol 6.25mg BID. His BP is 138/84 and HR is 72. Which of the
following is the most appropriate next step in managing his heart
failure?
A. Add Furosemide 20mg daily
B. Add Spironolactone 25mg daily
C. Increase Carvedilol to 12.5mg BID
D. Switch Lisinopril to Losartan
Answer: B
Rationale: In patients with HFrEF and LVEF <= 35% who are already on
an ACE inhibitor and Beta-blocker, the addition of an Aldosterone
Antagonist like Spironolactone is recommended to reduce mortality and
morbidity.
2. A 58-year-old female presents with a 3-month history of fatigue,
cold intolerance, and weight gain. Her TSH is elevated and Free T4 is
low. Which of the following is the most appropriate initial treatment?
A. Levothyroxine 1.6 mcg/kg daily
B. Methimazole 10mg daily
C. Liothyronine 25mcg daily
D. Radioactive iodine ablation
,Answer: A
Rationale: The patient has primary hypothyroidism. The standard of
care is initiation of Levothyroxine monotherapy, dosed at approximately
1.6 mcg/kg/day in otherwise healthy adults.
3. A 45-year-old male with Type 2 Diabetes presents with a morning
fasting blood glucose of 160 mg/dL. You suspect the Dawn
Phenomenon. Which of the following strategies would confirm this
diagnosis?
A. Check blood glucose at 3:00 AM; it will be elevated
B. Check blood glucose at 3:00 AM; it will be low
C. Check HbA1c levels
D. Administer a bedtime snack
Answer: A
Rationale: The Dawn Phenomenon is characterized by early morning
hyperglycemia due to the release of counter-regulatory hormones.
Checking a 3:00 AM glucose will reveal an elevated level, distinguishing
it from the Somogyi effect where the 3:00 AM glucose is low.
4. A 72-year-old male with a history of COPD presents with increased
dyspnea, sputum production, and wheezing. He is currently taking
Tiotropium. Which of the following is the most appropriate addition
to his maintenance therapy?
A. Fluticasone/Salmeterol inhaler
B. Albuterol rescue inhaler PRN
C. Oral prednisone taper
D. Montelukast daily
Answer: A
Rationale: For patients with COPD who remain symptomatic on a long-
acting muscarinic antagonist (LAMA) like Tiotropium, the addition of a
,long-acting beta-agonist (LABA) combined with an inhaled
corticosteroid (ICS) is recommended to improve lung function and
reduce exacerbations.
5. A 30-year-old female presents with dysuria, frequency, and urgency.
She has no fever or flank pain. Which of the following is the most
appropriate first-line treatment?
A. Nitrofurantoin 100mg BID for 5 days
B. Ciprofloxacin 500mg BID for 7 days
C. Amoxicillin 500mg TID for 10 days
D. Doxycycline 100mg BID for 7 days
Answer: A
Rationale: Uncomplicated cystitis is typically treated empirically with
Nitrofurantoin, Trimethoprim-Sulfamethoxazole, or Fosfomycin.
Nitrofurantoin is highly effective for uncomplicated lower UTIs.
Fluoroquinolones are reserved for complicated infections due to
collateral damage and resistance concerns.
6. A 50-year-old male presents with sudden onset of severe pain in his
right great toe. The joint is erythematous, swollen, and exquisitely
tender. Which of the following is the most appropriate treatment for
an acute gout flare?
A. Allopurinol 300mg daily
B. Colchicine 1.2mg then 0.6mg 1 hour later
C. Probenecid 500mg BID
D. Febuxostat 40mg daily
Answer: B
Rationale: Colchicine, NSAIDs, or corticosteroids are first-line
treatments for acute gout flares. Allopurinol and Febuxostat are urate-
, lowering therapies indicated for chronic management, not acute flares,
as they can worsen the flare initially.
7. A 68-year-old female presents with a new diagnosis of
hypertension. Her BP is 155/92. She has no other comorbidities.
According to JNC 8 guidelines, which of the following is the most
appropriate initial antihypertensive?
A. Lisinopril 10mg daily
B. Amlodipine 5mg daily
C. Hydrochlorothiazide 25mg daily
D. Metoprolol 25mg BID
Answer: C
Rationale: For African American patients or those over 60 with
uncomplicated hypertension, thiazide diuretics or calcium channel
blockers are recommended as first-line therapy. This patient is over 60,
making a thiazide (like HCTZ) or CCB appropriate.
8. A 24-year-old female presents with a 2-day history of severe
unilateral headache, nausea, and photophobia. She reports similar
episodes in the past. Which of the following is the most appropriate
acute treatment?
A. Sumatriptan 50mg PO
B. Propranolol 40mg PO
C. Amitriptyline 25mg PO
D. Topiramate 50mg PO
Answer: A
Rationale: Triptans (like Sumatriptan) are first-line acute treatments for
moderate to severe migraine attacks. Propranolol, Amitriptyline, and
Topiramate are used for migraine prophylaxis.
