NU 578 FINAL EXAM /ACTUAL NU 578 EXAM 5 COMPREHENSIVE
FINAL EXAM LATEST 2026/2027 TESTBANK PRACTICE QUESTIONS
AND A NEW UPDATED STUDY GUIDE COMPLETE ACCURATE EXAM
REAL QUESTIONS WITH WELL ELABORATED ANSWERS AND
RATIONALES (100% CORRECT VERIFIED SOLUTIONS) NEWEST
UPDATED VERSION 2026 EDITION |GUARANTEED PASS A+ (BRAND
NEW!) FULL REVISED NU 578 APPROVED EXAM 5 FINAL TEST
|GUARANTEED PASS A+ |JUST RELEASED
1. A 72-year-old male with a history of hypertension and type 2 diabetes presents
with a 2-day history of severe, sharp chest pain that radiates to his back. His blood
pressure is 180/100 mmHg in the right arm and 110/70 mmHg in the left arm.
Which of the following is the most appropriate initial diagnostic test?
A. 12-lead electrocardiogram (ECG)
B. Transthoracic echocardiogram
C. Contrast-enhanced computed tomography (CT) angiography of the chest
D. Cardiac troponin I level
Correct Answer: C. Contrast-enhanced CT angiography
Rationale: The presentation of acute onset severe chest pain radiating to the back
with a significant blood pressure differential between arms is classic for an acute
aortic dissection. Contrast-enhanced CT angiography of the chest is the gold
standard for diagnosing aortic dissection due to its high sensitivity and specificity,
and it is readily available in most emergency settings. An ECG and troponin are
useful to rule out acute coronary syndrome but do not rule out dissection. An
echocardiogram may visualize the ascending aorta but is not as definitive as a CT
for the entire thoracic aorta.
2. A 45-year-old female with a history of systemic lupus erythematosus (SLE)
presents with a chief complaint of progressive dyspnea on exertion and a dry cough
,for three months. A high-resolution CT (HRCT) of the chest reveals bilateral
reticular opacities with honeycombing in the basilar regions. Which of the
following is the most likely diagnosis?
A. Sarcoidosis
B. Hypersensitivity pneumonitis
C. Idiopathic pulmonary fibrosis (IPF)
D. Lymphangioleiomyomatosis (LAM)
Correct Answer: C. Idiopathic pulmonary fibrosis (IPF)
Rationale: The HRCT findings of bilateral basilar reticular opacities with
honeycombing in a patient with a chronic, progressive interstitial lung disease is
characteristic of IPF. While SLE can cause interstitial lung disease, the classic
"usual interstitial pneumonia" (UIP) pattern on HRCT points strongly toward IPF.
Sarcoidosis typically involves upper and middle lung zones with hilar
lymphadenopathy. Hypersensitivity pneumonitis often has upper/mid-zone
involvement with ground-glass opacities and air trapping. LAM is a rare cystic
lung disease, predominantly in women of childbearing age.
3. A 65-year-old male with a 50-pack-year smoking history and COPD presents
with worsening dyspnea and a new cough with purulent sputum. He is febrile. A
chest X-ray reveals a cavitary lesion in the right upper lobe. Which of the
following is the most common causative pathogen for this patient's community-
acquired pneumonia (CAP) given this presentation?
A. Mycoplasma pneumoniae
B. Legionella pneumophila
C. ** Streptococcus pneumoniae **
D. Klebsiella pneumoniae
Correct Answer: C. Streptococcus pneumoniae
,Rationale: While the presence of a cavitary lesion in a patient with COPD and a
smoking history raises concern for Klebsiella or tuberculosis, the most common
cause of CAP overall, and in patients with COPD, remains Streptococcus
pneumoniae. Klebsiella is more classically seen in alcoholics and causes upper
lobe cavitation, but it is less common overall than S. pneumoniae. Mycoplasma
and Legionella are atypical pathogens and are less likely to cause cavitation in this
demographic.
4. A 55-year-old female who is 2 days post-operative from a total knee
replacement becomes acutely short of breath. She is tachypneic and tachycardic.
Her oxygen saturation is 88% on room air. An ECG shows sinus tachycardia and
an S1Q3T3 pattern. Which of the following is the most appropriate immediate next
step in management?
A. Obtain a stat echocardiogram
B. Administer a 5000-unit heparin bolus and start a heparin drip
C. Obtain a CT pulmonary angiography (CTPA)
D. Administer tissue plasminogen activator (tPA)
Correct Answer: C. Obtain a CT pulmonary angiography (CTPA)
Rationale: The patient's acute dyspnea, hypoxia, tachycardia, and S1Q3T3 pattern
on ECG in the setting of recent surgery are suggestive of a pulmonary embolism
(PE). The most appropriate immediate step is to confirm the diagnosis with a
CTPA, which is the gold standard imaging test. While anticoagulation should be
initiated if the clinical suspicion is high, the standard of care is to obtain a
confirmatory diagnostic test (CTPA) before starting treatment. tPA is reserved for
massive PE with hemodynamic instability.
5. A 34-year-old male with a history of asthma presents with acute wheezing and
shortness of breath. He is using accessory muscles and his peak expiratory flow
rate (PEFR) is 50% of his personal best. The initial treatment includes albuterol
and ipratropium nebulizers. Despite this, he remains tachypneic and his PEFR falls
to 45%. Which of the following is the most appropriate next step in management?
, A. Administer oral prednisone
B. Re-administer the albuterol/ipratropium nebulizer
C. Administer intravenous magnesium sulfate
D. Prepare for intubation and mechanical ventilation
Correct Answer: C. Administer intravenous magnesium sulfate
Rationale: This patient is having a severe acute asthma exacerbation, as evidenced
by accessory muscle use and PEFR <50% of predicted. Since he did not respond to
initial bronchodilator therapy, the next step is to consider IV magnesium sulfate,
which is a bronchodilator with smooth muscle relaxant properties. Inhaled steroids
should have been given simultaneously, and systemic corticosteroids (oral or IV
prednisone) should be started early, but in this scenario, the best next step after
failure of inhaled bronchodilators is magnesium. Intubation is reserved for severe
respiratory failure, PEFR <30%, or altered mental status.
6. A 62-year-old male with a history of coronary artery disease presents with
progressive dyspnea and lower extremity edema. A physical exam reveals jugular
venous distension, hepatomegaly, and a loud S3 gallop. A 2D echocardiogram
reveals an ejection fraction of 25%. Which of the following medications is
associated with the greatest long-term mortality benefit?
A. Furosemide
B. Carvedilol
C. Sacubitril/valsartan
D. Hydralazine/isosorbide dinitrate
Correct Answer: C. Sacubitril/valsartan
Rationale: The patient has heart failure with reduced ejection fraction (HFrEF).
The PARADIGM-HF trial demonstrated that sacubitril/valsartan (an ARNI) is
superior to enalapril in reducing mortality and hospitalizations for heart failure.
Carvedilol (a beta-blocker) also provides a mortality benefit, but the ARNI has
FINAL EXAM LATEST 2026/2027 TESTBANK PRACTICE QUESTIONS
AND A NEW UPDATED STUDY GUIDE COMPLETE ACCURATE EXAM
REAL QUESTIONS WITH WELL ELABORATED ANSWERS AND
RATIONALES (100% CORRECT VERIFIED SOLUTIONS) NEWEST
UPDATED VERSION 2026 EDITION |GUARANTEED PASS A+ (BRAND
NEW!) FULL REVISED NU 578 APPROVED EXAM 5 FINAL TEST
|GUARANTEED PASS A+ |JUST RELEASED
1. A 72-year-old male with a history of hypertension and type 2 diabetes presents
with a 2-day history of severe, sharp chest pain that radiates to his back. His blood
pressure is 180/100 mmHg in the right arm and 110/70 mmHg in the left arm.
Which of the following is the most appropriate initial diagnostic test?
A. 12-lead electrocardiogram (ECG)
B. Transthoracic echocardiogram
C. Contrast-enhanced computed tomography (CT) angiography of the chest
D. Cardiac troponin I level
Correct Answer: C. Contrast-enhanced CT angiography
Rationale: The presentation of acute onset severe chest pain radiating to the back
with a significant blood pressure differential between arms is classic for an acute
aortic dissection. Contrast-enhanced CT angiography of the chest is the gold
standard for diagnosing aortic dissection due to its high sensitivity and specificity,
and it is readily available in most emergency settings. An ECG and troponin are
useful to rule out acute coronary syndrome but do not rule out dissection. An
echocardiogram may visualize the ascending aorta but is not as definitive as a CT
for the entire thoracic aorta.
2. A 45-year-old female with a history of systemic lupus erythematosus (SLE)
presents with a chief complaint of progressive dyspnea on exertion and a dry cough
,for three months. A high-resolution CT (HRCT) of the chest reveals bilateral
reticular opacities with honeycombing in the basilar regions. Which of the
following is the most likely diagnosis?
A. Sarcoidosis
B. Hypersensitivity pneumonitis
C. Idiopathic pulmonary fibrosis (IPF)
D. Lymphangioleiomyomatosis (LAM)
Correct Answer: C. Idiopathic pulmonary fibrosis (IPF)
Rationale: The HRCT findings of bilateral basilar reticular opacities with
honeycombing in a patient with a chronic, progressive interstitial lung disease is
characteristic of IPF. While SLE can cause interstitial lung disease, the classic
"usual interstitial pneumonia" (UIP) pattern on HRCT points strongly toward IPF.
Sarcoidosis typically involves upper and middle lung zones with hilar
lymphadenopathy. Hypersensitivity pneumonitis often has upper/mid-zone
involvement with ground-glass opacities and air trapping. LAM is a rare cystic
lung disease, predominantly in women of childbearing age.
3. A 65-year-old male with a 50-pack-year smoking history and COPD presents
with worsening dyspnea and a new cough with purulent sputum. He is febrile. A
chest X-ray reveals a cavitary lesion in the right upper lobe. Which of the
following is the most common causative pathogen for this patient's community-
acquired pneumonia (CAP) given this presentation?
A. Mycoplasma pneumoniae
B. Legionella pneumophila
C. ** Streptococcus pneumoniae **
D. Klebsiella pneumoniae
Correct Answer: C. Streptococcus pneumoniae
,Rationale: While the presence of a cavitary lesion in a patient with COPD and a
smoking history raises concern for Klebsiella or tuberculosis, the most common
cause of CAP overall, and in patients with COPD, remains Streptococcus
pneumoniae. Klebsiella is more classically seen in alcoholics and causes upper
lobe cavitation, but it is less common overall than S. pneumoniae. Mycoplasma
and Legionella are atypical pathogens and are less likely to cause cavitation in this
demographic.
4. A 55-year-old female who is 2 days post-operative from a total knee
replacement becomes acutely short of breath. She is tachypneic and tachycardic.
Her oxygen saturation is 88% on room air. An ECG shows sinus tachycardia and
an S1Q3T3 pattern. Which of the following is the most appropriate immediate next
step in management?
A. Obtain a stat echocardiogram
B. Administer a 5000-unit heparin bolus and start a heparin drip
C. Obtain a CT pulmonary angiography (CTPA)
D. Administer tissue plasminogen activator (tPA)
Correct Answer: C. Obtain a CT pulmonary angiography (CTPA)
Rationale: The patient's acute dyspnea, hypoxia, tachycardia, and S1Q3T3 pattern
on ECG in the setting of recent surgery are suggestive of a pulmonary embolism
(PE). The most appropriate immediate step is to confirm the diagnosis with a
CTPA, which is the gold standard imaging test. While anticoagulation should be
initiated if the clinical suspicion is high, the standard of care is to obtain a
confirmatory diagnostic test (CTPA) before starting treatment. tPA is reserved for
massive PE with hemodynamic instability.
5. A 34-year-old male with a history of asthma presents with acute wheezing and
shortness of breath. He is using accessory muscles and his peak expiratory flow
rate (PEFR) is 50% of his personal best. The initial treatment includes albuterol
and ipratropium nebulizers. Despite this, he remains tachypneic and his PEFR falls
to 45%. Which of the following is the most appropriate next step in management?
, A. Administer oral prednisone
B. Re-administer the albuterol/ipratropium nebulizer
C. Administer intravenous magnesium sulfate
D. Prepare for intubation and mechanical ventilation
Correct Answer: C. Administer intravenous magnesium sulfate
Rationale: This patient is having a severe acute asthma exacerbation, as evidenced
by accessory muscle use and PEFR <50% of predicted. Since he did not respond to
initial bronchodilator therapy, the next step is to consider IV magnesium sulfate,
which is a bronchodilator with smooth muscle relaxant properties. Inhaled steroids
should have been given simultaneously, and systemic corticosteroids (oral or IV
prednisone) should be started early, but in this scenario, the best next step after
failure of inhaled bronchodilators is magnesium. Intubation is reserved for severe
respiratory failure, PEFR <30%, or altered mental status.
6. A 62-year-old male with a history of coronary artery disease presents with
progressive dyspnea and lower extremity edema. A physical exam reveals jugular
venous distension, hepatomegaly, and a loud S3 gallop. A 2D echocardiogram
reveals an ejection fraction of 25%. Which of the following medications is
associated with the greatest long-term mortality benefit?
A. Furosemide
B. Carvedilol
C. Sacubitril/valsartan
D. Hydralazine/isosorbide dinitrate
Correct Answer: C. Sacubitril/valsartan
Rationale: The patient has heart failure with reduced ejection fraction (HFrEF).
The PARADIGM-HF trial demonstrated that sacubitril/valsartan (an ARNI) is
superior to enalapril in reducing mortality and hospitalizations for heart failure.
Carvedilol (a beta-blocker) also provides a mortality benefit, but the ARNI has
