NSG 552 Advanced Nursing Practice & Adult Health Final Exam
| Comprehensive QUESTION Bank & Detailed Explanations
2026/2027
QUESTION 1
When evaluating a patient with newly diagnosed hypertension using
the 2017 ACC/AHA guidelines, which blood pressure reading classifies
the patient as having Stage 2 Hypertension?
A. 120-129 / less than 80 mmHg
B. 130--89 mmHg
C. 140 mmHg or higher / 90 mmHg or higher
D. Greater than 180 / greater than 120 mmHg
Correct Answer: C. 140 mmHg or higher / 90 mmHg or higher
Detailed Rationale: According to the ACC/AHA guidelines, Stage 1
hypertension is defined as a systolic BP of 130-139 mmHg or diastolic
BP of 80-89 mmHg. Stage 2 hypertension is defined as a systolic BP of
140 mmHg or higher or a diastolic BP of 90 mmHg or higher.
QUESTION 2
An advanced practice nurse is reviewing medication therapy for a
patient with heart failure with reduced ejection fraction (HFrEF). The
patient is currently on an ACE inhibitor, a beta-blocker, and a loop
diuretic. Which medication class should be considered as a replacement
for the ACE inhibitor to further reduce morbidity and mortality based
on clinical trial evidence?
,A. Calcium channel blockers
B. Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)
C. Direct thrombin inhibitors
D. Alpha-1 adrenergic blockers
Correct Answer: B. Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)
Detailed Rationale: The PARADIGM-HF trial demonstrated that
replacement of an ACE inhibitor with an ARNI (sacubitril/valsartan)
significantly reduced morbidity and mortality from cardiovascular
causes in patients with HFrEF.
QUESTION 3
A 60-year-old male with chronic obstructive pulmonary disease (COPD)
experiences frequent exacerbations despite being on a long-acting
muscarinic antagonist (LAMA). According to current GOLD guidelines,
what is the preferred next step in pharmacological management?
A. Add a long-acting beta-agonist (LABA) or a LABA plus inhaled
corticosteroid (ICS) combination based on blood eosinophil counts
B. Discontinue all bronchodilators and start oral prednisone indefinitely
C. Prescribe short-acting beta-agonists as monotherapy
D. Initiate systemic intravenous antibiotics without a clinical change in
sputum
Correct Answer: A. Add a long-acting beta-agonist (LABA) or a LABA
plus inhaled corticosteroid (ICS) combination based on blood eosinophil
counts
,Detailed Rationale: For patients with COPD experiencing persistent
exacerbations on single bronchodilator therapy (LAMA), escalation to
dual bronchodilation (LAMA/LABA) or addition of an ICS (especially if
blood eosinophils are ≥ 300 cells/uL) is recommended to reduce
exacerbation frequency.
QUESTION 4
Which of the following antidiabetic medications provides proven
cardiovascular risk reduction and renal protection benefits, making it a
preferred add-on therapy for patients with Type 2 Diabetes and
established atherosclerotic cardiovascular disease or chronic kidney
disease?
A. Sulfonylureas (e.g., glipizide)
B. Sodium-glucose cotransporter-2 (SGLT2) inhibitors
C. Meglitinides
D. Alpha-glucosidase inhibitors
Correct Answer: B. Sodium-glucose cotransporter-2 (SGLT2) inhibitors
Detailed Rationale: SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin)
and GLP-1 receptor agonists have demonstrated robust cardiovascular
and renal protective effects independent of glycemic control, making
them guideline-preferred agents for high-risk patients.
QUESTION 5
According to the Beers Criteria, which of the following medication
classes should generally be avoided in older adults due to an increased
risk of cognitive impairment, delirium, and falls?
, A. Statin medications
B. Benzodiazepines and sedative-hypnotics
C. Inhaled short-acting beta-agonists
D. Proton pump inhibitors used for short-term indications
Correct Answer: B. Benzodiazepines and sedative-hypnotics
Detailed Rationale: The Beers Criteria lists potentially inappropriate
medications for older adults. Benzodiazepines, non-benzodiazepine
receptor agonist hypnotics, and other sedatives increase the risk of
cognitive decline, delirium, falls, and motor vehicle crashes in the
elderly.
QUESTION 6
A 45-year-old female presents with fatigue, cold intolerance, dry skin,
and constipation. Laboratory evaluation reveals a TSH of 9.5 mIU/L
(elevated) and a free T4 within the normal reference range. How is this
biochemical profile classified?
A. Overt hypothyroidism
B. Subclinical hypothyroidism
C. Secondary hyperthyroidism
D. Euthyroid sick syndrome
Correct Answer: B. Subclinical hypothyroidism
Detailed Rationale: Subclinical hypothyroidism is characterized by an
elevated serum TSH level paired with a normal circulating free T4 level.
Patients are often asymptomatic or have mild, non-specific symptoms.
| Comprehensive QUESTION Bank & Detailed Explanations
2026/2027
QUESTION 1
When evaluating a patient with newly diagnosed hypertension using
the 2017 ACC/AHA guidelines, which blood pressure reading classifies
the patient as having Stage 2 Hypertension?
A. 120-129 / less than 80 mmHg
B. 130--89 mmHg
C. 140 mmHg or higher / 90 mmHg or higher
D. Greater than 180 / greater than 120 mmHg
Correct Answer: C. 140 mmHg or higher / 90 mmHg or higher
Detailed Rationale: According to the ACC/AHA guidelines, Stage 1
hypertension is defined as a systolic BP of 130-139 mmHg or diastolic
BP of 80-89 mmHg. Stage 2 hypertension is defined as a systolic BP of
140 mmHg or higher or a diastolic BP of 90 mmHg or higher.
QUESTION 2
An advanced practice nurse is reviewing medication therapy for a
patient with heart failure with reduced ejection fraction (HFrEF). The
patient is currently on an ACE inhibitor, a beta-blocker, and a loop
diuretic. Which medication class should be considered as a replacement
for the ACE inhibitor to further reduce morbidity and mortality based
on clinical trial evidence?
,A. Calcium channel blockers
B. Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)
C. Direct thrombin inhibitors
D. Alpha-1 adrenergic blockers
Correct Answer: B. Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)
Detailed Rationale: The PARADIGM-HF trial demonstrated that
replacement of an ACE inhibitor with an ARNI (sacubitril/valsartan)
significantly reduced morbidity and mortality from cardiovascular
causes in patients with HFrEF.
QUESTION 3
A 60-year-old male with chronic obstructive pulmonary disease (COPD)
experiences frequent exacerbations despite being on a long-acting
muscarinic antagonist (LAMA). According to current GOLD guidelines,
what is the preferred next step in pharmacological management?
A. Add a long-acting beta-agonist (LABA) or a LABA plus inhaled
corticosteroid (ICS) combination based on blood eosinophil counts
B. Discontinue all bronchodilators and start oral prednisone indefinitely
C. Prescribe short-acting beta-agonists as monotherapy
D. Initiate systemic intravenous antibiotics without a clinical change in
sputum
Correct Answer: A. Add a long-acting beta-agonist (LABA) or a LABA
plus inhaled corticosteroid (ICS) combination based on blood eosinophil
counts
,Detailed Rationale: For patients with COPD experiencing persistent
exacerbations on single bronchodilator therapy (LAMA), escalation to
dual bronchodilation (LAMA/LABA) or addition of an ICS (especially if
blood eosinophils are ≥ 300 cells/uL) is recommended to reduce
exacerbation frequency.
QUESTION 4
Which of the following antidiabetic medications provides proven
cardiovascular risk reduction and renal protection benefits, making it a
preferred add-on therapy for patients with Type 2 Diabetes and
established atherosclerotic cardiovascular disease or chronic kidney
disease?
A. Sulfonylureas (e.g., glipizide)
B. Sodium-glucose cotransporter-2 (SGLT2) inhibitors
C. Meglitinides
D. Alpha-glucosidase inhibitors
Correct Answer: B. Sodium-glucose cotransporter-2 (SGLT2) inhibitors
Detailed Rationale: SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin)
and GLP-1 receptor agonists have demonstrated robust cardiovascular
and renal protective effects independent of glycemic control, making
them guideline-preferred agents for high-risk patients.
QUESTION 5
According to the Beers Criteria, which of the following medication
classes should generally be avoided in older adults due to an increased
risk of cognitive impairment, delirium, and falls?
, A. Statin medications
B. Benzodiazepines and sedative-hypnotics
C. Inhaled short-acting beta-agonists
D. Proton pump inhibitors used for short-term indications
Correct Answer: B. Benzodiazepines and sedative-hypnotics
Detailed Rationale: The Beers Criteria lists potentially inappropriate
medications for older adults. Benzodiazepines, non-benzodiazepine
receptor agonist hypnotics, and other sedatives increase the risk of
cognitive decline, delirium, falls, and motor vehicle crashes in the
elderly.
QUESTION 6
A 45-year-old female presents with fatigue, cold intolerance, dry skin,
and constipation. Laboratory evaluation reveals a TSH of 9.5 mIU/L
(elevated) and a free T4 within the normal reference range. How is this
biochemical profile classified?
A. Overt hypothyroidism
B. Subclinical hypothyroidism
C. Secondary hyperthyroidism
D. Euthyroid sick syndrome
Correct Answer: B. Subclinical hypothyroidism
Detailed Rationale: Subclinical hypothyroidism is characterized by an
elevated serum TSH level paired with a normal circulating free T4 level.
Patients are often asymptomatic or have mild, non-specific symptoms.
