NSG 554 EXAM 3 STUDY GUIDE | TESTBANK | PRACTICE
QUESTIONS & ANSWERS | EXAM PREPARATION | ADVANCED
REVIEW | COMPREHENSIVE PRACTICE EXAM | LATEST UPDATE
2026/2027
Examiner:
Course Faculty/School of Nursing (NSG 554 Graduate Nursing Program)
TABLE OF CONTENTS
1. Advanced Cardiovascular Disorders
2. Advanced Pulmonary Disorders
3. Endocrine Disorders
4. Gastrointestinal Disorders
5. Renal and Genitourinary Disorders
6. Infectious Diseases
7. Neurological Disorders
8. Hematologic Disorders
9. Evidence-Based Clinical Decision Making
10.Advanced Pharmacologic Management
ADVANCED ASSESSMENT || DIFFERENTIAL DIAGNOSIS ||
EVIDENCE-BASED PRACTICE || PHARMACOLOGY || PRIMARY
CARE || CARDIOLOGY || PULMONOLOGY || ENDOCRINOLOGY ||
GASTROENTEROLOGY || NEPHROLOGY || INFECTIOUS DISEASES
|| NEUROLOGY || HEMATOLOGY || CLINICAL GUIDELINES ||
PATIENT SAFETY || DIAGNOSTIC INTERPRETATION || CHRONIC
DISEASE MANAGEMENT || PREVENTIVE CARE || HEALTH
PROMOTION || PROFESSIONAL JUDGMENT
QUESTION 1.
A 67-year-old man with hypertension, type 2 diabetes, and chronic kidney
disease presents with worsening exertional dyspnea, orthopnea, and bilateral
lower-extremity edema. Echocardiography demonstrates a left ventricular
ejection fraction of 32%. Which medication regimen provides the greatest
evidence-based reduction in mortality when no contraindications exist?
,A. Hydrochlorothiazide and amlodipine
B. ACE inhibitor, evidence-based beta blocker, mineralocorticoid receptor
antagonist, and SGLT2 inhibitor
C. Digoxin and loop diuretic alone
D. Nitrate therapy alone
🔴 Correct Answer: B. ACE inhibitor, evidence-based beta blocker,
mineralocorticoid receptor antagonist, and SGLT2 inhibitor
🔵 Explanation: Contemporary heart failure guidelines support quadruple
guideline-directed medical therapy consisting of an ACE inhibitor (or ARNI
when appropriate), an evidence-based beta blocker, a mineralocorticoid
receptor antagonist, and an SGLT2 inhibitor to substantially reduce mortality
and hospitalization in patients with heart failure with reduced ejection fraction.
Diuretics primarily relieve congestion without improving survival, while the
remaining options omit therapies with proven mortality benefit.
────────────────────────────────────────
QUESTION 2.
A 58-year-old woman with long-standing type 2 diabetes has persistent
albuminuria despite acceptable glycemic control. Her estimated glomerular
filtration rate is 58 mL/min/1.73 m². Which intervention is most appropriate to
slow progression of diabetic kidney disease?
A. Initiate an ACE inhibitor or ARB unless contraindicated
B. Discontinue all antihypertensive therapy
C. Restrict protein intake to near zero
D. Begin chronic NSAID therapy for renal protection
🔴 Correct Answer: A. Initiate an ACE inhibitor or ARB unless
contraindicated
🔵 Explanation: ACE inhibitors and ARBs reduce intraglomerular pressure,
decrease albuminuria, and slow progression of diabetic kidney disease.
Eliminating antihypertensive therapy worsens renal outcomes, extreme protein
restriction is not recommended, and NSAIDs may accelerate kidney injury
rather than prevent it.
,────────────────────────────────────────
QUESTION 3.
A 72-year-old patient presents with fever, productive cough, pleuritic chest pain,
tachypnea, and oxygen saturation of 88% on room air. Which finding most
strongly supports the diagnosis of community-acquired bacterial pneumonia?
A. Bilateral ankle edema
B. Diffuse hyperresonance without infiltrates
C. New focal infiltrate on chest radiograph with compatible clinical findings
D. Isolated elevation of serum creatinine
🔴 Correct Answer: C. New focal infiltrate on chest radiograph with
compatible clinical findings
🔵 Explanation: Community-acquired pneumonia is diagnosed through
compatible clinical symptoms combined with radiographic evidence of a new
pulmonary infiltrate. The remaining findings are nonspecific or suggest
alternative disease processes rather than bacterial pneumonia.
────────────────────────────────────────
QUESTION 4.
A patient with poorly controlled Graves disease develops fever, agitation,
tachycardia of 160 beats/minute, vomiting, and altered mental status after
surgery. Which intervention should occur first after initial stabilization?
A. Immediate radioactive iodine therapy
B. Begin levothyroxine replacement
C. Delay treatment until thyroid laboratory results return
D. Administer a beta blocker while initiating therapy for thyroid storm
🔴 Correct Answer: D. Administer a beta blocker while initiating therapy
for thyroid storm
🔵 Explanation: Thyroid storm is a medical emergency requiring immediate
treatment. Beta blockade rapidly controls adrenergic manifestations while
additional therapies such as thionamides, iodine, corticosteroids, and
, supportive care are initiated. Waiting for laboratory confirmation or
administering thyroid hormone would be inappropriate.
────────────────────────────────────────
QUESTION 5.
A 46-year-old patient reports episodic epigastric burning relieved temporarily
by meals but recurring several hours later. Which diagnostic test provides the
preferred noninvasive confirmation of active Helicobacter pylori infection when
the patient has not recently taken antibiotics or proton pump inhibitors?
A. Fecal occult blood test
B. Serum amylase
C. Urea breath test
D. Abdominal ultrasound
🔴 Correct Answer: C. Urea breath test
🔵 Explanation: The urea breath test has excellent sensitivity and specificity for
active Helicobacter pylori infection and is useful for both diagnosis and
confirmation of eradication. Fecal occult blood testing, serum amylase, and
ultrasound do not establish active H. pylori infection.
────────────────────────────────────────
QUESTION 6.
A patient with atrial fibrillation receiving warfarin develops sudden severe
headache and confusion. Computed tomography confirms intracranial
hemorrhage, and the INR is 4.8. Which treatment is most appropriate?
A. Continue warfarin and observe
B. Administer vitamin K and four-factor prothrombin complex concentrate
C. Increase the warfarin dose
D. Begin aspirin therapy
🔴 Correct Answer: B. Administer vitamin K and four-factor prothrombin
complex concentrate
QUESTIONS & ANSWERS | EXAM PREPARATION | ADVANCED
REVIEW | COMPREHENSIVE PRACTICE EXAM | LATEST UPDATE
2026/2027
Examiner:
Course Faculty/School of Nursing (NSG 554 Graduate Nursing Program)
TABLE OF CONTENTS
1. Advanced Cardiovascular Disorders
2. Advanced Pulmonary Disorders
3. Endocrine Disorders
4. Gastrointestinal Disorders
5. Renal and Genitourinary Disorders
6. Infectious Diseases
7. Neurological Disorders
8. Hematologic Disorders
9. Evidence-Based Clinical Decision Making
10.Advanced Pharmacologic Management
ADVANCED ASSESSMENT || DIFFERENTIAL DIAGNOSIS ||
EVIDENCE-BASED PRACTICE || PHARMACOLOGY || PRIMARY
CARE || CARDIOLOGY || PULMONOLOGY || ENDOCRINOLOGY ||
GASTROENTEROLOGY || NEPHROLOGY || INFECTIOUS DISEASES
|| NEUROLOGY || HEMATOLOGY || CLINICAL GUIDELINES ||
PATIENT SAFETY || DIAGNOSTIC INTERPRETATION || CHRONIC
DISEASE MANAGEMENT || PREVENTIVE CARE || HEALTH
PROMOTION || PROFESSIONAL JUDGMENT
QUESTION 1.
A 67-year-old man with hypertension, type 2 diabetes, and chronic kidney
disease presents with worsening exertional dyspnea, orthopnea, and bilateral
lower-extremity edema. Echocardiography demonstrates a left ventricular
ejection fraction of 32%. Which medication regimen provides the greatest
evidence-based reduction in mortality when no contraindications exist?
,A. Hydrochlorothiazide and amlodipine
B. ACE inhibitor, evidence-based beta blocker, mineralocorticoid receptor
antagonist, and SGLT2 inhibitor
C. Digoxin and loop diuretic alone
D. Nitrate therapy alone
🔴 Correct Answer: B. ACE inhibitor, evidence-based beta blocker,
mineralocorticoid receptor antagonist, and SGLT2 inhibitor
🔵 Explanation: Contemporary heart failure guidelines support quadruple
guideline-directed medical therapy consisting of an ACE inhibitor (or ARNI
when appropriate), an evidence-based beta blocker, a mineralocorticoid
receptor antagonist, and an SGLT2 inhibitor to substantially reduce mortality
and hospitalization in patients with heart failure with reduced ejection fraction.
Diuretics primarily relieve congestion without improving survival, while the
remaining options omit therapies with proven mortality benefit.
────────────────────────────────────────
QUESTION 2.
A 58-year-old woman with long-standing type 2 diabetes has persistent
albuminuria despite acceptable glycemic control. Her estimated glomerular
filtration rate is 58 mL/min/1.73 m². Which intervention is most appropriate to
slow progression of diabetic kidney disease?
A. Initiate an ACE inhibitor or ARB unless contraindicated
B. Discontinue all antihypertensive therapy
C. Restrict protein intake to near zero
D. Begin chronic NSAID therapy for renal protection
🔴 Correct Answer: A. Initiate an ACE inhibitor or ARB unless
contraindicated
🔵 Explanation: ACE inhibitors and ARBs reduce intraglomerular pressure,
decrease albuminuria, and slow progression of diabetic kidney disease.
Eliminating antihypertensive therapy worsens renal outcomes, extreme protein
restriction is not recommended, and NSAIDs may accelerate kidney injury
rather than prevent it.
,────────────────────────────────────────
QUESTION 3.
A 72-year-old patient presents with fever, productive cough, pleuritic chest pain,
tachypnea, and oxygen saturation of 88% on room air. Which finding most
strongly supports the diagnosis of community-acquired bacterial pneumonia?
A. Bilateral ankle edema
B. Diffuse hyperresonance without infiltrates
C. New focal infiltrate on chest radiograph with compatible clinical findings
D. Isolated elevation of serum creatinine
🔴 Correct Answer: C. New focal infiltrate on chest radiograph with
compatible clinical findings
🔵 Explanation: Community-acquired pneumonia is diagnosed through
compatible clinical symptoms combined with radiographic evidence of a new
pulmonary infiltrate. The remaining findings are nonspecific or suggest
alternative disease processes rather than bacterial pneumonia.
────────────────────────────────────────
QUESTION 4.
A patient with poorly controlled Graves disease develops fever, agitation,
tachycardia of 160 beats/minute, vomiting, and altered mental status after
surgery. Which intervention should occur first after initial stabilization?
A. Immediate radioactive iodine therapy
B. Begin levothyroxine replacement
C. Delay treatment until thyroid laboratory results return
D. Administer a beta blocker while initiating therapy for thyroid storm
🔴 Correct Answer: D. Administer a beta blocker while initiating therapy
for thyroid storm
🔵 Explanation: Thyroid storm is a medical emergency requiring immediate
treatment. Beta blockade rapidly controls adrenergic manifestations while
additional therapies such as thionamides, iodine, corticosteroids, and
, supportive care are initiated. Waiting for laboratory confirmation or
administering thyroid hormone would be inappropriate.
────────────────────────────────────────
QUESTION 5.
A 46-year-old patient reports episodic epigastric burning relieved temporarily
by meals but recurring several hours later. Which diagnostic test provides the
preferred noninvasive confirmation of active Helicobacter pylori infection when
the patient has not recently taken antibiotics or proton pump inhibitors?
A. Fecal occult blood test
B. Serum amylase
C. Urea breath test
D. Abdominal ultrasound
🔴 Correct Answer: C. Urea breath test
🔵 Explanation: The urea breath test has excellent sensitivity and specificity for
active Helicobacter pylori infection and is useful for both diagnosis and
confirmation of eradication. Fecal occult blood testing, serum amylase, and
ultrasound do not establish active H. pylori infection.
────────────────────────────────────────
QUESTION 6.
A patient with atrial fibrillation receiving warfarin develops sudden severe
headache and confusion. Computed tomography confirms intracranial
hemorrhage, and the INR is 4.8. Which treatment is most appropriate?
A. Continue warfarin and observe
B. Administer vitamin K and four-factor prothrombin complex concentrate
C. Increase the warfarin dose
D. Begin aspirin therapy
🔴 Correct Answer: B. Administer vitamin K and four-factor prothrombin
complex concentrate
