NR 607 Final Exam Questions and Answers
NCELX-STYLE with rationales (2025-2026)
Question 1
A 68-year-old man with a history of hypertension presents with sudden onset of left-sided weakness
and slurred speech. What is the nurse practitioner's priority action?
A. Administer aspirin immediately.
B. Obtain a finger-stick blood glucose.
C. Begin intravenous antibiotics.
D. Schedule an MRI for the following day.
Correct Answer: B
Rationale: Hypoglycemia can mimic an acute stroke and must be ruled out immediately because it is
rapidly treatable. Once hypoglycemia is excluded, urgent stroke evaluation and imaging should
follow.
Question 2
Which medication is considered first-line therapy for a patient with newly diagnosed type 2 diabetes
mellitus, assuming no contraindications?
A. Glyburide
B. Metformin
C. Regular insulin
D. Pioglitazone
Correct Answer: B
Rationale: Metformin is recommended as initial pharmacologic therapy for most adults with type 2
diabetes because it improves insulin sensitivity, has a low risk of hypoglycemia, and may promote
modest weight loss.
Question 3
A patient with chronic heart failure reports waking at night feeling short of breath. This symptom is
known as:
A. Orthopnea
B. Paroxysmal nocturnal dyspnea
C. Dyspnea on exertion
D. Hyperventilation
Correct Answer: B
Rationale: Paroxysmal nocturnal dyspnea is sudden nighttime shortness of breath that awakens the
patient from sleep and is a classic symptom of heart failure.
,Question 4
Which laboratory test is the best indicator of long-term glycemic control?
A. Fasting blood glucose
B. Random glucose
C. Hemoglobin A1c
D. Oral glucose tolerance test
Correct Answer: C
Rationale: Hemoglobin A1c reflects average blood glucose over the previous 2–3 months and is the
standard measure of long-term glycemic control.
Question 5
A patient with chronic obstructive pulmonary disease (COPD) presents with increased sputum
production, worsening dyspnea, and increased cough. These findings are most consistent with:
A. Stable COPD
B. Acute COPD exacerbation
C. Pulmonary embolism
D. Asthma remission
Correct Answer: B
Rationale: Increased dyspnea, sputum volume, and sputum purulence are classic signs of an acute
COPD exacerbation.
Question 6
Which electrolyte abnormality is most commonly associated with peaked T waves on an ECG?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypocalcemia
Correct Answer: B
Rationale: Hyperkalemia characteristically causes tall, peaked T waves and can progress to life-
threatening cardiac conduction abnormalities.
Question 7
A patient presents with chest pain radiating to the left arm that began 30 minutes ago. What is the
priority diagnostic test?
, A. Chest X-ray
B. 12-lead electrocardiogram (ECG)
C. Echocardiogram
D. Pulmonary function test
Correct Answer: B
Rationale: A 12-lead ECG should be obtained within 10 minutes of presentation in patients with
suspected acute coronary syndrome to identify myocardial ischemia or infarction.
Question 8
Which antihypertensive medication class is generally recommended as first-line therapy for patients
with diabetes and albuminuria?
A. Beta-blockers
B. ACE inhibitors
C. Calcium channel blockers
D. Alpha-blockers
Correct Answer: B
Rationale: ACE inhibitors reduce blood pressure and help protect kidney function by reducing
intraglomerular pressure and proteinuria.
Question 9
Which finding is most characteristic of iron deficiency anemia?
A. Elevated mean corpuscular volume (MCV)
B. Low ferritin level
C. Elevated vitamin B12 level
D. Hypercalcemia
Correct Answer: B
Rationale: Low ferritin is the most specific laboratory indicator of depleted iron stores and supports
the diagnosis of iron deficiency anemia.
Question 10
A 55-year-old woman presents with dysuria, urinary frequency, and urgency without fever or flank
pain. What is the most likely diagnosis?
A. Acute pyelonephritis
B. Uncomplicated cystitis
C. Nephrolithiasis
D. Glomerulonephritis
Correct Answer: B
NCELX-STYLE with rationales (2025-2026)
Question 1
A 68-year-old man with a history of hypertension presents with sudden onset of left-sided weakness
and slurred speech. What is the nurse practitioner's priority action?
A. Administer aspirin immediately.
B. Obtain a finger-stick blood glucose.
C. Begin intravenous antibiotics.
D. Schedule an MRI for the following day.
Correct Answer: B
Rationale: Hypoglycemia can mimic an acute stroke and must be ruled out immediately because it is
rapidly treatable. Once hypoglycemia is excluded, urgent stroke evaluation and imaging should
follow.
Question 2
Which medication is considered first-line therapy for a patient with newly diagnosed type 2 diabetes
mellitus, assuming no contraindications?
A. Glyburide
B. Metformin
C. Regular insulin
D. Pioglitazone
Correct Answer: B
Rationale: Metformin is recommended as initial pharmacologic therapy for most adults with type 2
diabetes because it improves insulin sensitivity, has a low risk of hypoglycemia, and may promote
modest weight loss.
Question 3
A patient with chronic heart failure reports waking at night feeling short of breath. This symptom is
known as:
A. Orthopnea
B. Paroxysmal nocturnal dyspnea
C. Dyspnea on exertion
D. Hyperventilation
Correct Answer: B
Rationale: Paroxysmal nocturnal dyspnea is sudden nighttime shortness of breath that awakens the
patient from sleep and is a classic symptom of heart failure.
,Question 4
Which laboratory test is the best indicator of long-term glycemic control?
A. Fasting blood glucose
B. Random glucose
C. Hemoglobin A1c
D. Oral glucose tolerance test
Correct Answer: C
Rationale: Hemoglobin A1c reflects average blood glucose over the previous 2–3 months and is the
standard measure of long-term glycemic control.
Question 5
A patient with chronic obstructive pulmonary disease (COPD) presents with increased sputum
production, worsening dyspnea, and increased cough. These findings are most consistent with:
A. Stable COPD
B. Acute COPD exacerbation
C. Pulmonary embolism
D. Asthma remission
Correct Answer: B
Rationale: Increased dyspnea, sputum volume, and sputum purulence are classic signs of an acute
COPD exacerbation.
Question 6
Which electrolyte abnormality is most commonly associated with peaked T waves on an ECG?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypocalcemia
Correct Answer: B
Rationale: Hyperkalemia characteristically causes tall, peaked T waves and can progress to life-
threatening cardiac conduction abnormalities.
Question 7
A patient presents with chest pain radiating to the left arm that began 30 minutes ago. What is the
priority diagnostic test?
, A. Chest X-ray
B. 12-lead electrocardiogram (ECG)
C. Echocardiogram
D. Pulmonary function test
Correct Answer: B
Rationale: A 12-lead ECG should be obtained within 10 minutes of presentation in patients with
suspected acute coronary syndrome to identify myocardial ischemia or infarction.
Question 8
Which antihypertensive medication class is generally recommended as first-line therapy for patients
with diabetes and albuminuria?
A. Beta-blockers
B. ACE inhibitors
C. Calcium channel blockers
D. Alpha-blockers
Correct Answer: B
Rationale: ACE inhibitors reduce blood pressure and help protect kidney function by reducing
intraglomerular pressure and proteinuria.
Question 9
Which finding is most characteristic of iron deficiency anemia?
A. Elevated mean corpuscular volume (MCV)
B. Low ferritin level
C. Elevated vitamin B12 level
D. Hypercalcemia
Correct Answer: B
Rationale: Low ferritin is the most specific laboratory indicator of depleted iron stores and supports
the diagnosis of iron deficiency anemia.
Question 10
A 55-year-old woman presents with dysuria, urinary frequency, and urgency without fever or flank
pain. What is the most likely diagnosis?
A. Acute pyelonephritis
B. Uncomplicated cystitis
C. Nephrolithiasis
D. Glomerulonephritis
Correct Answer: B
