NUR 676 Final Exam Advanced Practice Nursing
Comprehensive Review Official Practice Exam
Actual Exam 2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass Guaranteed
– A+ Graded
══════════════════════════════════════
SECTION 1: ADVANCED HEALTH ASSESSMENT & DIAGNOSTIC REASONING Q1 –
Q15
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Question 1 of 90
A 62-year-old male presents with progressive dyspnea on exertion and a nonproductive cough
for three months. On physical exam, you note digital clubbing, fine bibasilar inspiratory
crackles, and a split S2 with a loud P2. Spirometry shows a restrictive pattern with normal
FEV1/FVC ratio and reduced DLCO. Chest X-ray reveals bilateral reticular opacities
predominantly in the lower lobes. As the APRN, which diagnostic test is most appropriate to
confirm the suspected diagnosis?
A. High-resolution CT of the chest without contrast
B. Bronchoalveolar lavage with differential cell count
C. Transbronchial lung biopsy via bronchoscopy
D. Open lung biopsy via video-assisted thoracoscopic surgery ✓ CORRECT
Correct Answer: D
Rationale: Open lung biopsy via VATS remains the gold standard for definitive diagnosis of
idiopathic pulmonary fibrosis when the clinical-radiologic presentation is characteristic but
not pathognomonic, as histopathologic UIP pattern confirmation guides antifibrotic therapy
and prognosis. High-resolution CT is highly suggestive but insufficient alone for definitive IPF
diagnosis per ATS/ERS/JRS/ALAT guidelines. Bronchoalveolar lavage and transbronchial
biopsy lack adequate tissue sampling for honeycombing and fibroblastic foci assessment.
Question 2 of 90
A 28-year-old female presents with a six-month history of episodic palpitations, heat
intolerance, and a 12-pound unintentional weight loss despite increased appetite. On exam,
you observe a fine tremor of the outstretched hands, warm moist skin, lid lag, and a diffusely
,enlarged, nontender thyroid without nodules. Her TSH is 0.01 mIU/L (low), and free T4 is
elevated. Which physical exam finding best supports Graves disease over other causes of
thyrotoxicosis?
A. Brisk deep tendon reflexes with clonus
B. Diffuse thyroid enlargement with a thyroid bruit ✓ CORRECT
C. Pretibial myxedema with nonpitting edema
D. Exophthalmos with periorbital edema
Correct Answer: B
Rationale: A thyroid bruit over a diffusely enlarged gland reflects increased vascularity
characteristic of Graves disease autoimmune hyperstimulation, distinguishing it from toxic
multinodular goiter or thyroiditis. While exophthalmos and pretibial myxedema are specific to
Graves, they are not present in all cases and are less sensitive than vascular bruit. Brisk
reflexes occur in any thyrotoxic state.
Question 3 of 90
A 45-year-old African American male with a 20-pack-year smoking history presents for a
routine physical. He has no respiratory symptoms. You are considering lung cancer screening
per USPSTF guidelines. Which combination of criteria makes this patient eligible for annual
low-dose CT screening?
A. Age 50–80, 20 pack-years, current smoker or quit within 15 years ✓ CORRECT
B. Age 55–80, 30 pack-years, current smoker only
C. Age 50–77, 15 pack-years, quit within 10 years
D. Age 55–74, 20 pack-years, current smoker or quit within 20 years
Correct Answer: A
Rationale: The 2021 USPSTF recommendation expanded lung cancer screening eligibility to
adults aged 50–80 with a 20 pack-year history who currently smoke or quit within the past 15
years, broadening access to younger patients with less cumulative exposure. The 55–80/30
pack-year criteria represent outdated 2013 guidelines. Options C and D contain incorrect age
ranges and pack-year thresholds.
Question 4 of 90
A 19-year-old college athlete presents with acute anterior knee pain after pivoting during
basketball practice. She reports a popping sensation and immediate swelling. On exam, you
note a positive Lachman test with a firm endpoint and a positive anterior drawer test. Which
additional finding on physical exam most strongly suggests an associated meniscal tear?
A. Joint line tenderness over the medial tibial plateau
B. Pain with passive hyperextension of the knee
,C. A positive McMurray test with a palpable click ✓ CORRECT
D. Inability to fully straighten the knee due to a locked fragment
Correct Answer: C
Rationale: The McMurray test, when performed with flexion and rotation producing a palpable
or audible click at the joint line, has the highest specificity for meniscal tear in the acute
ACL-injured knee. Joint line tenderness alone lacks specificity, and a true locked knee is
more indicative of a bucket-handle tear rather than a simple meniscal injury. Hyperextension
pain suggests extensor mechanism involvement.
Question 5 of 90
A 58-year-old female with type 2 diabetes presents for a routine foot exam. She has no
current foot complaints. On monofilament testing, she fails to detect the 10-g
Semmes-Weinstein filament at three of ten sites on the plantar surface. Which additional
screening test is most appropriate to complete her peripheral neuropathy assessment?
A. 128-Hz tuning fork vibration sense at the great toe ✓ CORRECT
B. Ankle-brachial index measurement bilaterally
C. Pinprick sensation testing over the dorsal foot
D. Two-point discrimination testing on the plantar surface
Correct Answer: A
Rationale: The 128-Hz tuning fork for vibration sense at the first metatarsal head is a
validated, reproducible component of the comprehensive diabetic foot exam alongside
monofilament testing, as it assesses large-fiber nerve function. Pinprick and two-point
discrimination are less reliable screening tools. ABI measures macrovascular perfusion, not
neuropathy.
Question 6 of 90
A 34-year-old female presents with a six-week history of progressive fatigue, arthralgias, and
a malar rash that worsens with sun exposure. Laboratory studies reveal a positive ANA at
1:640 titer, anti-dsDNA antibodies, leukopenia, and low complement levels. Which clinical
finding on physical examination would most strongly support active lupus nephritis?
A. Pericardial friction rub on cardiac auscultation
B. Active urinary sediment with cellular casts ✓ CORRECT
C. Nonscarring alopecia with broken hair shafts
D. Painless oral ulcers on the hard palate
Correct Answer: B
Rationale: Active urinary sediment containing red cell casts or granular casts is the hallmark
of proliferative lupus nephritis and indicates glomerular inflammation requiring urgent
, nephrology referral and likely renal biopsy. Pericarditis, alopecia, and oral ulcers are common
in SLE but do not specifically indicate renal involvement. Cast formation reflects glomerular
basement membrane damage.
Question 7 of 90
A 71-year-old male with atrial fibrillation on warfarin presents after a fall from standing height.
He struck his head but did not lose consciousness. On exam, he is alert and oriented, with a
small frontal scalp laceration. His INR is 3.8. Which is the most appropriate next step in
management?
A. Immediate head CT without contrast ✓ CORRECT
B. Observation for 24 hours with serial neuro checks
C. Administration of vitamin K 10 mg IV and fresh frozen plasma
D. Discharge with instructions to hold warfarin for two days
Correct Answer: A
Rationale: Any anticoagulated patient with head trauma requires immediate noncontrast head
CT to rule out intracranial hemorrhage, as subdural or epidural hematomas may be delayed
and clinically silent initially. Vitamin K and FFP are reserved for confirmed bleeding with
hemodynamic instability. Observation without imaging is unsafe given the elevated INR and
mechanism.
Question 8 of 90
A 26-year-old female presents with a two-day history of dysuria, frequency, and suprapubic
pain. She is afebrile with no flank pain or costovertebral angle tenderness. Urinalysis shows
positive nitrites, leukocyte esterase, and 50–100 WBCs per high-power field. Which empiric
antibiotic regimen is most appropriate for uncomplicated cystitis?
A. Ciprofloxacin 250 mg twice daily for three days
B. Nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for five days ✓ CORRECT
C. Amoxicillin-clavulanate 875/125 mg twice daily for seven days
D. Trimethoprim-sulfamethoxazole DS twice daily for three days
Correct Answer: B
Rationale: Nitrofurantoin is a first-line agent for uncomplicated cystitis with excellent efficacy
against common uropathogens and minimal resistance, while avoiding fluoroquinolone
adverse effects and TMP-SMX resistance concerns. Ciprofloxacin is reserved for
complicated infections due to safety warnings. Amoxicillin-clavulanate is not first-line due to
higher side effect profiles and resistance.
Question 9 of 90
Comprehensive Review Official Practice Exam
Actual Exam 2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass Guaranteed
– A+ Graded
══════════════════════════════════════
SECTION 1: ADVANCED HEALTH ASSESSMENT & DIAGNOSTIC REASONING Q1 –
Q15
══════════════════════════════════════
Question 1 of 90
A 62-year-old male presents with progressive dyspnea on exertion and a nonproductive cough
for three months. On physical exam, you note digital clubbing, fine bibasilar inspiratory
crackles, and a split S2 with a loud P2. Spirometry shows a restrictive pattern with normal
FEV1/FVC ratio and reduced DLCO. Chest X-ray reveals bilateral reticular opacities
predominantly in the lower lobes. As the APRN, which diagnostic test is most appropriate to
confirm the suspected diagnosis?
A. High-resolution CT of the chest without contrast
B. Bronchoalveolar lavage with differential cell count
C. Transbronchial lung biopsy via bronchoscopy
D. Open lung biopsy via video-assisted thoracoscopic surgery ✓ CORRECT
Correct Answer: D
Rationale: Open lung biopsy via VATS remains the gold standard for definitive diagnosis of
idiopathic pulmonary fibrosis when the clinical-radiologic presentation is characteristic but
not pathognomonic, as histopathologic UIP pattern confirmation guides antifibrotic therapy
and prognosis. High-resolution CT is highly suggestive but insufficient alone for definitive IPF
diagnosis per ATS/ERS/JRS/ALAT guidelines. Bronchoalveolar lavage and transbronchial
biopsy lack adequate tissue sampling for honeycombing and fibroblastic foci assessment.
Question 2 of 90
A 28-year-old female presents with a six-month history of episodic palpitations, heat
intolerance, and a 12-pound unintentional weight loss despite increased appetite. On exam,
you observe a fine tremor of the outstretched hands, warm moist skin, lid lag, and a diffusely
,enlarged, nontender thyroid without nodules. Her TSH is 0.01 mIU/L (low), and free T4 is
elevated. Which physical exam finding best supports Graves disease over other causes of
thyrotoxicosis?
A. Brisk deep tendon reflexes with clonus
B. Diffuse thyroid enlargement with a thyroid bruit ✓ CORRECT
C. Pretibial myxedema with nonpitting edema
D. Exophthalmos with periorbital edema
Correct Answer: B
Rationale: A thyroid bruit over a diffusely enlarged gland reflects increased vascularity
characteristic of Graves disease autoimmune hyperstimulation, distinguishing it from toxic
multinodular goiter or thyroiditis. While exophthalmos and pretibial myxedema are specific to
Graves, they are not present in all cases and are less sensitive than vascular bruit. Brisk
reflexes occur in any thyrotoxic state.
Question 3 of 90
A 45-year-old African American male with a 20-pack-year smoking history presents for a
routine physical. He has no respiratory symptoms. You are considering lung cancer screening
per USPSTF guidelines. Which combination of criteria makes this patient eligible for annual
low-dose CT screening?
A. Age 50–80, 20 pack-years, current smoker or quit within 15 years ✓ CORRECT
B. Age 55–80, 30 pack-years, current smoker only
C. Age 50–77, 15 pack-years, quit within 10 years
D. Age 55–74, 20 pack-years, current smoker or quit within 20 years
Correct Answer: A
Rationale: The 2021 USPSTF recommendation expanded lung cancer screening eligibility to
adults aged 50–80 with a 20 pack-year history who currently smoke or quit within the past 15
years, broadening access to younger patients with less cumulative exposure. The 55–80/30
pack-year criteria represent outdated 2013 guidelines. Options C and D contain incorrect age
ranges and pack-year thresholds.
Question 4 of 90
A 19-year-old college athlete presents with acute anterior knee pain after pivoting during
basketball practice. She reports a popping sensation and immediate swelling. On exam, you
note a positive Lachman test with a firm endpoint and a positive anterior drawer test. Which
additional finding on physical exam most strongly suggests an associated meniscal tear?
A. Joint line tenderness over the medial tibial plateau
B. Pain with passive hyperextension of the knee
,C. A positive McMurray test with a palpable click ✓ CORRECT
D. Inability to fully straighten the knee due to a locked fragment
Correct Answer: C
Rationale: The McMurray test, when performed with flexion and rotation producing a palpable
or audible click at the joint line, has the highest specificity for meniscal tear in the acute
ACL-injured knee. Joint line tenderness alone lacks specificity, and a true locked knee is
more indicative of a bucket-handle tear rather than a simple meniscal injury. Hyperextension
pain suggests extensor mechanism involvement.
Question 5 of 90
A 58-year-old female with type 2 diabetes presents for a routine foot exam. She has no
current foot complaints. On monofilament testing, she fails to detect the 10-g
Semmes-Weinstein filament at three of ten sites on the plantar surface. Which additional
screening test is most appropriate to complete her peripheral neuropathy assessment?
A. 128-Hz tuning fork vibration sense at the great toe ✓ CORRECT
B. Ankle-brachial index measurement bilaterally
C. Pinprick sensation testing over the dorsal foot
D. Two-point discrimination testing on the plantar surface
Correct Answer: A
Rationale: The 128-Hz tuning fork for vibration sense at the first metatarsal head is a
validated, reproducible component of the comprehensive diabetic foot exam alongside
monofilament testing, as it assesses large-fiber nerve function. Pinprick and two-point
discrimination are less reliable screening tools. ABI measures macrovascular perfusion, not
neuropathy.
Question 6 of 90
A 34-year-old female presents with a six-week history of progressive fatigue, arthralgias, and
a malar rash that worsens with sun exposure. Laboratory studies reveal a positive ANA at
1:640 titer, anti-dsDNA antibodies, leukopenia, and low complement levels. Which clinical
finding on physical examination would most strongly support active lupus nephritis?
A. Pericardial friction rub on cardiac auscultation
B. Active urinary sediment with cellular casts ✓ CORRECT
C. Nonscarring alopecia with broken hair shafts
D. Painless oral ulcers on the hard palate
Correct Answer: B
Rationale: Active urinary sediment containing red cell casts or granular casts is the hallmark
of proliferative lupus nephritis and indicates glomerular inflammation requiring urgent
, nephrology referral and likely renal biopsy. Pericarditis, alopecia, and oral ulcers are common
in SLE but do not specifically indicate renal involvement. Cast formation reflects glomerular
basement membrane damage.
Question 7 of 90
A 71-year-old male with atrial fibrillation on warfarin presents after a fall from standing height.
He struck his head but did not lose consciousness. On exam, he is alert and oriented, with a
small frontal scalp laceration. His INR is 3.8. Which is the most appropriate next step in
management?
A. Immediate head CT without contrast ✓ CORRECT
B. Observation for 24 hours with serial neuro checks
C. Administration of vitamin K 10 mg IV and fresh frozen plasma
D. Discharge with instructions to hold warfarin for two days
Correct Answer: A
Rationale: Any anticoagulated patient with head trauma requires immediate noncontrast head
CT to rule out intracranial hemorrhage, as subdural or epidural hematomas may be delayed
and clinically silent initially. Vitamin K and FFP are reserved for confirmed bleeding with
hemodynamic instability. Observation without imaging is unsafe given the elevated INR and
mechanism.
Question 8 of 90
A 26-year-old female presents with a two-day history of dysuria, frequency, and suprapubic
pain. She is afebrile with no flank pain or costovertebral angle tenderness. Urinalysis shows
positive nitrites, leukocyte esterase, and 50–100 WBCs per high-power field. Which empiric
antibiotic regimen is most appropriate for uncomplicated cystitis?
A. Ciprofloxacin 250 mg twice daily for three days
B. Nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for five days ✓ CORRECT
C. Amoxicillin-clavulanate 875/125 mg twice daily for seven days
D. Trimethoprim-sulfamethoxazole DS twice daily for three days
Correct Answer: B
Rationale: Nitrofurantoin is a first-line agent for uncomplicated cystitis with excellent efficacy
against common uropathogens and minimal resistance, while avoiding fluoroquinolone
adverse effects and TMP-SMX resistance concerns. Ciprofloxacin is reserved for
complicated infections due to safety warnings. Amoxicillin-clavulanate is not first-line due to
higher side effect profiles and resistance.
Question 9 of 90
