NURS 676 FINAL
EXAM VERSION 3
(GENUINE EXAM
WITH ANSWERS)
Question 1: A patient reports recurrent chest pain that occurs regardless
of activity and is not relieved by rest. The provider administers one
nitroglycerin tablet which does not relieve the pain. What is the next
action?
A) Administer a second nitroglycerin tablet
B) Give the patient a beta blocker
C) Order an immediate chest x-ray
D) Discharge the patient with a follow-up appointment
Correct ,,,,answer,,,: B
Rationale: Unstable angina is characterized by chest pain that occurs at
rest or with minimal exertion and is not relieved by rest or standard
,doses of nitroglycerin. When one sublingual nitroglycerin tablet does not
relieve the pain, the next appropriate action is to administer a beta
blocker to reduce myocardial oxygen demand by decreasing heart rate
and contractility. This represents an acute coronary syndrome that
requires prompt medical management. Immediate referral to an
emergency department is also warranted in this clinical scenario .
Question 2: A patient is brought to an emergency department with
symptoms of acute ST-segment elevation myocardial infarction
(STEMI). The nearest hospital that can perform a percutaneous coronary
intervention (PCI) is three hours away. What is the initial treatment for
this patient?
A) Transport immediately for PCI
B) Initiate fibrinolytic therapy
C) Administer oral antiplatelet agents only
D) Wait for cardiology consultation
Correct ,,,,answer,,,: B
Rationale: In acute STEMI, the goal is to restore coronary perfusion as
quickly as possible. When PCI cannot be performed within 90 to 120
minutes of first medical contact, fibrinolytic therapy is indicated. The
guideline recommends fibrinolytic therapy if the time from symptom
onset to treatment is within 12 hours and PCI is not readily available.
Delaying treatment while waiting for transport to a distant PCI-capable
hospital increases myocardial damage and mortality. Fibrinolytics such
as alteplase, reteplase, or tenecteplase should be initiated promptly .
,Question 3: Black cohosh is an herb that is commonly used for:
A) Hypertension
B) Menopausal symptoms
C) Anxiety disorders
D) Gastrointestinal upset
Correct ,,,,answer,,,: B
Rationale: Black cohosh (Actaea racemosa) is an herbal supplement
that is commonly used to treat menopausal symptoms, particularly hot
flashes, night sweats, and mood disturbances. It has been studied for its
potential estrogenic effects and is widely used as an alternative to
hormone replacement therapy. While some patients may find it helpful,
evidence for its efficacy is mixed, and patients should be counseled
about potential risks, including rare hepatotoxicity. It is not indicated for
hypertension, anxiety disorders, or gastrointestinal upset .
Question 4: A 6-month-old child has developed skin irritation due to an
allergic reaction. He has been prescribed a topical skin ointment. The
nurse will consider which of the following before administering the
drug?
A) The infant's skin has greater permeability than that of an adult
B) Topical medications are not effective in infants
C) Infants require higher doses of topical medications
D) Topical medications should never be used in infants
, Correct ,,,,answer,,,: A
Rationale: Infants have greater skin permeability than adults due to a
thinner stratum corneum and a higher surface area-to-body weight ratio.
This increased permeability means that topical medications can be
absorbed more readily, potentially leading to systemic effects. When
administering topical medications to infants, nurses must use caution
and consider the potential for increased absorption, which may require
lower doses or less frequent application. The medication should be
applied sparingly to the smallest area necessary .
Question 5: A Nurse Practitioner is caring for a 10-year-old boy who
complains of chronic headaches. His mother reports that she gives him
Tylenol at least three times a day. Which of the following will the nurse
work with the physician to evaluate?
A) Renal function
B) Hepatic function
C) Cardiac function
D) Pulmonary function
Correct ,,,,answer,,,: B
Rationale: Acetaminophen (Tylenol) is primarily metabolized in the
liver through glucuronidation and sulfation pathways. Chronic use,
particularly at higher doses, can lead to hepatotoxicity due to the
accumulation of a toxic metabolite (N-acetyl-p-benzoquinone imine or
NAPQI). In a child receiving acetaminophen frequently for headaches,
hepatic function should be evaluated with liver enzyme tests. While
acetaminophen is generally safe at therapeutic doses, chronic use
EXAM VERSION 3
(GENUINE EXAM
WITH ANSWERS)
Question 1: A patient reports recurrent chest pain that occurs regardless
of activity and is not relieved by rest. The provider administers one
nitroglycerin tablet which does not relieve the pain. What is the next
action?
A) Administer a second nitroglycerin tablet
B) Give the patient a beta blocker
C) Order an immediate chest x-ray
D) Discharge the patient with a follow-up appointment
Correct ,,,,answer,,,: B
Rationale: Unstable angina is characterized by chest pain that occurs at
rest or with minimal exertion and is not relieved by rest or standard
,doses of nitroglycerin. When one sublingual nitroglycerin tablet does not
relieve the pain, the next appropriate action is to administer a beta
blocker to reduce myocardial oxygen demand by decreasing heart rate
and contractility. This represents an acute coronary syndrome that
requires prompt medical management. Immediate referral to an
emergency department is also warranted in this clinical scenario .
Question 2: A patient is brought to an emergency department with
symptoms of acute ST-segment elevation myocardial infarction
(STEMI). The nearest hospital that can perform a percutaneous coronary
intervention (PCI) is three hours away. What is the initial treatment for
this patient?
A) Transport immediately for PCI
B) Initiate fibrinolytic therapy
C) Administer oral antiplatelet agents only
D) Wait for cardiology consultation
Correct ,,,,answer,,,: B
Rationale: In acute STEMI, the goal is to restore coronary perfusion as
quickly as possible. When PCI cannot be performed within 90 to 120
minutes of first medical contact, fibrinolytic therapy is indicated. The
guideline recommends fibrinolytic therapy if the time from symptom
onset to treatment is within 12 hours and PCI is not readily available.
Delaying treatment while waiting for transport to a distant PCI-capable
hospital increases myocardial damage and mortality. Fibrinolytics such
as alteplase, reteplase, or tenecteplase should be initiated promptly .
,Question 3: Black cohosh is an herb that is commonly used for:
A) Hypertension
B) Menopausal symptoms
C) Anxiety disorders
D) Gastrointestinal upset
Correct ,,,,answer,,,: B
Rationale: Black cohosh (Actaea racemosa) is an herbal supplement
that is commonly used to treat menopausal symptoms, particularly hot
flashes, night sweats, and mood disturbances. It has been studied for its
potential estrogenic effects and is widely used as an alternative to
hormone replacement therapy. While some patients may find it helpful,
evidence for its efficacy is mixed, and patients should be counseled
about potential risks, including rare hepatotoxicity. It is not indicated for
hypertension, anxiety disorders, or gastrointestinal upset .
Question 4: A 6-month-old child has developed skin irritation due to an
allergic reaction. He has been prescribed a topical skin ointment. The
nurse will consider which of the following before administering the
drug?
A) The infant's skin has greater permeability than that of an adult
B) Topical medications are not effective in infants
C) Infants require higher doses of topical medications
D) Topical medications should never be used in infants
, Correct ,,,,answer,,,: A
Rationale: Infants have greater skin permeability than adults due to a
thinner stratum corneum and a higher surface area-to-body weight ratio.
This increased permeability means that topical medications can be
absorbed more readily, potentially leading to systemic effects. When
administering topical medications to infants, nurses must use caution
and consider the potential for increased absorption, which may require
lower doses or less frequent application. The medication should be
applied sparingly to the smallest area necessary .
Question 5: A Nurse Practitioner is caring for a 10-year-old boy who
complains of chronic headaches. His mother reports that she gives him
Tylenol at least three times a day. Which of the following will the nurse
work with the physician to evaluate?
A) Renal function
B) Hepatic function
C) Cardiac function
D) Pulmonary function
Correct ,,,,answer,,,: B
Rationale: Acetaminophen (Tylenol) is primarily metabolized in the
liver through glucuronidation and sulfation pathways. Chronic use,
particularly at higher doses, can lead to hepatotoxicity due to the
accumulation of a toxic metabolite (N-acetyl-p-benzoquinone imine or
NAPQI). In a child receiving acetaminophen frequently for headaches,
hepatic function should be evaluated with liver enzyme tests. While
acetaminophen is generally safe at therapeutic doses, chronic use
