NURS 6531 FINAL EXAM 2026
Moussa Class - Summer Quarter - Week 11
Walden University - Version 3
Advanced Health Assessment and Diagnostic Reasoning
100 Questions - Multiple Choice (A-D) - One Correct Answer Each
Section 1: Advanced Health Assessment and Diagnostic Reasoning (Q1-Q18)
Q1: A 52-year-old African American male presents for a routine physical examination. During
inspection of the precordium, the nurse practitioner observes a visible pulsation at the left sternal
border in the 4th intercostal space. Which of the following best explains this finding?
A. Normal finding of the apical impulse in a thin-chested individual
B. Right ventricular heave suggestive of right ventricular hypertrophy **[CORRECT]**
C. Left ventricular aneurysm causing abnormal outward displacement
D. Pectus excavatum creating an illusion of cardiac pulsation
Correct Answer: B
Rationale: A visible pulsation at the left sternal border (parasternal heave) is indicative of right ventricular hypertrophy,
commonly caused by pulmonary hypertension or left-sided heart failure. The apical impulse is normally located at the 5th
intercostal space at the midclavicular line, not the left sternal border. A left ventricular aneurysm would produce a sustained
diffuse apical impulse rather than a parasternal heave. Pectus excavatum is a structural deformity that does not generate true
pulsatile movement. This clinical finding warrants further evaluation with echocardiography per the Walden University
clinical reasoning framework.
Q2: A 68-year-old female with chronic obstructive pulmonary disease (COPD) presents with increased
dyspnea. On auscultation, the nurse practitioner notes distant breath sounds with prolonged
expiratory phase and scattered wheezes. Which percussion finding would most likely accompany these
auscultatory findings?
A. Dullness to percussion at both lung bases bilaterally
B. Hyperresonance over the bilateral lung fields **[CORRECT]**
C. Tympanic percussion note over the left upper lobe
D. Normal resonance throughout all lung fields
Correct Answer: B
Rationale: Hyperresonance on percussion is the expected finding in COPD due to air trapping and hyperinflation of the lungs,
which reduces lung tissue density. Dullness would suggest consolidation, pleural effusion, or atelectasis rather than air
trapping. Tympany would suggest a pneumothorax or large bulla, not diffuse COPD. Normal resonance would be
inconsistent with the clinical picture of COPD with increased dyspnea. The combination of distant breath sounds, prolonged
expiratory phase, wheezing, and hyperresonance forms the classic clinical triad for COPD assessment taught in the Walden
curriculum.
Q3: A 45-year-old female presents with a 2-week history of progressive weakness, fatigue, and
paresthesias in both feet. On examination, the nurse practitioner notes glossitis, angular cheilitis, and
a positive Romberg sign. Laboratory studies reveal hemoglobin of 9.2 g/dL and MCV of 112 fL. Which
diagnostic test is most appropriate to confirm the suspected diagnosis?
A. Serum iron studies including ferritin and TIBC
Page 1 NURS 6531 Final Exam 2026
, B. Serum methylmalonic acid and homocysteine levels **[CORRECT]**
C. Bone marrow aspiration with Prussian blue staining
D. Direct Coombs test for autoimmune hemolysis
Correct Answer: B
Rationale: The clinical presentation of macrocytic anemia (MCV 112 fL) with neurological symptoms (paresthesias, positive
Romberg sign) and glossitis strongly suggests vitamin B12 deficiency. Serum methylmalonic acid (MMA) and homocysteine
are the most sensitive and specific confirmatory tests because MMA is elevated only in B12 deficiency while homocysteine is
elevated in both B12 and folate deficiency. Serum iron studies evaluate for iron deficiency anemia, which is microcytic. Bone
marrow aspiration is invasive and not a first-line test. The Direct Coombs test evaluates for immune-mediated hemolysis,
which is not suggested by this presentation.
Q4: When performing a comprehensive geriatric assessment on an 82-year-old patient, the nurse
practitioner uses the CAGE questionnaire as part of the screening process. Which of the following
accurately describes a component of the CAGE assessment as taught in the Walden University FNP
curriculum?
A. Have you ever felt the need to Cut down on your drinking? **[CORRECT]**
B. Have you ever experienced Chest pain after consuming alcohol?
C. Do you ever Consume more than three drinks per occasion?
D. Have you ever been told by a doctor to Curtail your alcohol intake?
Correct Answer: A
Rationale: The CAGE questionnaire is a validated four-item screening tool for alcohol use disorder. The acronym stands for:
Cut down (felt the need to cut down), Annoyed (people annoyed you by criticizing your drinking), Guilty (felt guilty about
drinking), and Eye-opener (had a drink first thing in the morning). A positive response to two or more items warrants further
assessment. Options B, C, and D are not components of the validated CAGE instrument and represent common distractors
that reflect inadequate knowledge of this screening framework as emphasized in the Walden curriculum.
Q5: A 35-year-old male presents with sharp, tearing chest pain radiating to his back between the
shoulder blades. He has a history of poorly controlled hypertension. On examination, blood pressure is
190/110 mmHg in the right arm and 160/90 mmHg in the left arm, and a diastolic murmur is heard at
the left sternal border. What is the most likely diagnosis?
A. Acute myocardial infarction of the anterior wall
B. Acute aortic dissection **[CORRECT]**
C. Pulmonary embolism with right heart strain
D. Acute pericarditis with pericardial effusion
Correct Answer: B
Rationale: The classic presentation of acute aortic dissection includes sudden-onset tearing chest pain radiating to the back, a
significant blood pressure differential between arms (greater than 20 mmHg), and a history of hypertension. The diastolic
murmur at the left sternal border suggests aortic regurgitation from aortic root involvement in Type A dissection. Myocardial
infarction typically presents with pressure-like pain and ECG changes. Pulmonary embolism presents with dyspnea and
pleuritic pain. Pericarditis presents with positional chest pain and a friction rub. Immediate imaging with CT angiography is
required as this is a life-threatening emergency.
Q6: A 28-year-old female presents with a 3-day history of vaginal discharge, dysuria, and lower
abdominal pain. On speculum examination, the nurse practitioner notes mucopurulent cervical
discharge and cervical motion tenderness. Which finding would most support a diagnosis of pelvic
inflammatory disease (PID) rather than uncomplicated cervicitis?
A. Positive whiff test with potassium hydroxide preparation
B. Adnexal tenderness on bimanual examination **[CORRECT]**
C. Strawberry appearance of the cervix on colposcopy
D. Presence of clue cells on saline microscopy
Page 2 NURS 6531 Final Exam 2026
,Correct Answer: B
Rationale: Adnexal tenderness on bimanual examination, along with cervical motion tenderness and mucopurulent discharge,
constitutes the clinical triad supporting a diagnosis of pelvic inflammatory disease (PID). The positive whiff test and clue cells
suggest bacterial vaginosis. The strawberry cervix appearance is characteristic of Trichomonas vaginalis infection. PID
requires prompt treatment with broad-spectrum antibiotic regimens covering Chlamydia trachomatis and Neisseria
gonorrhoeae to prevent long-term complications including infertility and chronic pelvic pain.
Q7: A nurse practitioner is performing a focused neurological assessment on a patient who presents
with sudden-onset right-sided weakness and slurred speech. Using the pretest probability framework
taught in the Walden curriculum, which assessment tool is most appropriate for rapid initial stroke
screening in this clinical setting?
A. Mini-Mental State Examination (MMSE)
B. Cincinnati Prehospital Stroke Scale (CPSS) **[CORRECT]**
C. Montreal Cognitive Assessment (MoCA)
D. Glasgow Coma Scale (GCS)
Correct Answer: B
Rationale: The Cincinnati Prehospital Stroke Scale is the most appropriate rapid screening tool for acute stroke assessment,
evaluating three domains: facial droop, arm drift, and abnormal speech. It is designed for rapid administration within
minutes and has high sensitivity for detecting stroke. The MMSE and MoCA are cognitive screening tools used for dementia
evaluation, not acute stroke. The GCS assesses level of consciousness and is used in trauma settings rather than focused stroke
screening. Rapid recognition using CPSS enables timely activation of stroke protocols and thrombolytic eligibility assessment.
Q8: A 72-year-old male presents for follow-up of heart failure with reduced ejection fraction (HFrEF).
On examination, the nurse practitioner identifies pitting edema (2+), jugular venous distension at 8
cm above the sternal angle, and bilateral crackles at the lung bases. Which finding represents a
contraindication to initiating an ACE inhibitor at this visit?
A. Serum potassium of 5.6 mEq/L **[CORRECT]**
B. Bilateral crackles at the lung bases
C. Blood pressure of 110/70 mmHg
D. Estimated GFR of 45 mL/min/1.73 m2
Correct Answer: A
Rationale: A serum potassium level of 5.6 mEq/L (hyperkalemia) is a contraindication to initiating ACE inhibitor therapy
because ACE inhibitors reduce aldosterone production, which further increases potassium levels and risks life-threatening
hyperkalemia. Bilateral crackles indicate pulmonary congestion, which is actually an indication for ACE inhibitor therapy in
HFrEF. Blood pressure of 110/70 mmHg is acceptable for initiating an ACE inhibitor. An eGFR of 45 mL/min is not an
absolute contraindication but requires monitoring. This distinction is critical for safe prescribing in the Walden pharmacology
curriculum.
Q9: During a well-child visit for a 4-year-old, the nurse practitioner observes that the child can hop on
one foot, speaks in complete sentences of 4-5 words, and can draw a circle. The parent reports the child
engages in parallel play with other children. Which developmental assessment tool would be most
appropriate for formal documentation of this child's developmental status?
A. Edinburgh Postnatal Depression Scale (EPDS)
B. Ages and Stages Questionnaire (ASQ-3) **[CORRECT]**
C. PHQ-9 Patient Health Questionnaire
D. CAGE questionnaire for substance use
Correct Answer: B
Rationale: The Ages and Stages Questionnaire, Third Edition (ASQ-3) is a standardized developmental screening tool
designed for children from 1 month to 5.5 years. It assesses five domains: communication, gross motor, fine motor,
problem-solving, and personal-social, making it ideal for documenting the developmental milestones described. The EPDS
Page 3 NURS 6531 Final Exam 2026
, screens for postpartum depression in mothers. The PHQ-9 screens for depression in adults. The CAGE is an alcohol screening
tool for adults. Selecting the appropriate screening tool based on patient age and purpose is a core competency in the Walden
FNP program.
Q10: A 58-year-old male presents with a 6-month history of progressively worsening heartburn,
regurgitation, and dysphagia. He has a 20-pack-year smoking history and drinks alcohol daily. On
examination, he appears cachectic with decreased breath sounds in the left lower lung field. An upper
endoscopy reveals a mass in the distal esophagus. Which risk factor in this patient's history is most
strongly associated with the suspected diagnosis?
A. Chronic NSAID use for joint pain
B. Family history of colon cancer
C. Long-standing gastroesophageal reflux disease (GERD) with smoking and alcohol use
**[CORRECT]**
D. Recent travel to an endemic area for parasitic infection
Correct Answer: C
Rationale: Long-standing GERD combined with smoking and alcohol use constitutes the strongest risk factor profile for
esophageal adenocarcinoma. Chronic GERD can lead to Barrett esophagus, which is a premalignant condition that
predisposes to adenocarcinoma of the distal esophagus. Smoking and alcohol act synergistically as independent risk factors.
Chronic NSAID use is associated with peptic ulcer disease and gastric pathology, not esophageal cancer. Family history of
colon cancer is not directly linked to esophageal malignancy. Travel history for parasitic infection is irrelevant to this clinical
presentation.
Q11: A 40-year-old female presents with intermittent episodes of palpitations, sweating, tremors, and
anxiety that occur primarily in the early morning hours. Her fasting blood glucose is 52 mg/dL during
one of these episodes. Which diagnostic strategy is most appropriate for evaluating the cause of her
hypoglycemia?
A. 72-hour supervised fast with measurement of plasma glucose, insulin, C-peptide, and proinsulin
levels **[CORRECT]**
B. Oral glucose tolerance test with serial glucose measurements
C. Hemoglobin A1c measurement with fasting lipid panel
D. Random cortisol level with ACTH stimulation test
Correct Answer: A
Rationale: The 72-hour supervised fast is the gold standard diagnostic test for evaluating hypoglycemia of uncertain etiology.
During the fast, plasma glucose, insulin, C-peptide, and proinsulin levels are measured simultaneously. A low glucose level
with inappropriately elevated insulin and C-peptide suggests endogenous hyperinsulinism (insulinoma), while low C-peptide
with low insulin suggests exogenous insulin administration. The oral glucose tolerance test is used for diagnosing diabetes
mellitus. Hemoglobin A1c reflects long-term glycemic control. Cortisol testing evaluates for adrenal insufficiency, which
typically does not cause episodic hypoglycemia.
Q12: A nurse practitioner is performing a cardiac auscultation on a 32-year-old pregnant patient at 28
weeks gestation. A soft systolic ejection murmur is heard along the left sternal border. The murmur
does not radiate and diminishes when the patient is placed in the left lateral decubitus position. What
is the most appropriate interpretation of this finding?
A. This is a pathological murmur indicating mitral valve prolapse requiring echocardiography
B. This is a physiological flow murmur expected during pregnancy due to increased blood volume
**[CORRECT]**
C. This murmur suggests congenital aortic stenosis that was previously undiagnosed
D. This finding indicates peripartum cardiomyopathy and requires immediate cardiology referral
Correct Answer: B
Page 4 NURS 6531 Final Exam 2026
Moussa Class - Summer Quarter - Week 11
Walden University - Version 3
Advanced Health Assessment and Diagnostic Reasoning
100 Questions - Multiple Choice (A-D) - One Correct Answer Each
Section 1: Advanced Health Assessment and Diagnostic Reasoning (Q1-Q18)
Q1: A 52-year-old African American male presents for a routine physical examination. During
inspection of the precordium, the nurse practitioner observes a visible pulsation at the left sternal
border in the 4th intercostal space. Which of the following best explains this finding?
A. Normal finding of the apical impulse in a thin-chested individual
B. Right ventricular heave suggestive of right ventricular hypertrophy **[CORRECT]**
C. Left ventricular aneurysm causing abnormal outward displacement
D. Pectus excavatum creating an illusion of cardiac pulsation
Correct Answer: B
Rationale: A visible pulsation at the left sternal border (parasternal heave) is indicative of right ventricular hypertrophy,
commonly caused by pulmonary hypertension or left-sided heart failure. The apical impulse is normally located at the 5th
intercostal space at the midclavicular line, not the left sternal border. A left ventricular aneurysm would produce a sustained
diffuse apical impulse rather than a parasternal heave. Pectus excavatum is a structural deformity that does not generate true
pulsatile movement. This clinical finding warrants further evaluation with echocardiography per the Walden University
clinical reasoning framework.
Q2: A 68-year-old female with chronic obstructive pulmonary disease (COPD) presents with increased
dyspnea. On auscultation, the nurse practitioner notes distant breath sounds with prolonged
expiratory phase and scattered wheezes. Which percussion finding would most likely accompany these
auscultatory findings?
A. Dullness to percussion at both lung bases bilaterally
B. Hyperresonance over the bilateral lung fields **[CORRECT]**
C. Tympanic percussion note over the left upper lobe
D. Normal resonance throughout all lung fields
Correct Answer: B
Rationale: Hyperresonance on percussion is the expected finding in COPD due to air trapping and hyperinflation of the lungs,
which reduces lung tissue density. Dullness would suggest consolidation, pleural effusion, or atelectasis rather than air
trapping. Tympany would suggest a pneumothorax or large bulla, not diffuse COPD. Normal resonance would be
inconsistent with the clinical picture of COPD with increased dyspnea. The combination of distant breath sounds, prolonged
expiratory phase, wheezing, and hyperresonance forms the classic clinical triad for COPD assessment taught in the Walden
curriculum.
Q3: A 45-year-old female presents with a 2-week history of progressive weakness, fatigue, and
paresthesias in both feet. On examination, the nurse practitioner notes glossitis, angular cheilitis, and
a positive Romberg sign. Laboratory studies reveal hemoglobin of 9.2 g/dL and MCV of 112 fL. Which
diagnostic test is most appropriate to confirm the suspected diagnosis?
A. Serum iron studies including ferritin and TIBC
Page 1 NURS 6531 Final Exam 2026
, B. Serum methylmalonic acid and homocysteine levels **[CORRECT]**
C. Bone marrow aspiration with Prussian blue staining
D. Direct Coombs test for autoimmune hemolysis
Correct Answer: B
Rationale: The clinical presentation of macrocytic anemia (MCV 112 fL) with neurological symptoms (paresthesias, positive
Romberg sign) and glossitis strongly suggests vitamin B12 deficiency. Serum methylmalonic acid (MMA) and homocysteine
are the most sensitive and specific confirmatory tests because MMA is elevated only in B12 deficiency while homocysteine is
elevated in both B12 and folate deficiency. Serum iron studies evaluate for iron deficiency anemia, which is microcytic. Bone
marrow aspiration is invasive and not a first-line test. The Direct Coombs test evaluates for immune-mediated hemolysis,
which is not suggested by this presentation.
Q4: When performing a comprehensive geriatric assessment on an 82-year-old patient, the nurse
practitioner uses the CAGE questionnaire as part of the screening process. Which of the following
accurately describes a component of the CAGE assessment as taught in the Walden University FNP
curriculum?
A. Have you ever felt the need to Cut down on your drinking? **[CORRECT]**
B. Have you ever experienced Chest pain after consuming alcohol?
C. Do you ever Consume more than three drinks per occasion?
D. Have you ever been told by a doctor to Curtail your alcohol intake?
Correct Answer: A
Rationale: The CAGE questionnaire is a validated four-item screening tool for alcohol use disorder. The acronym stands for:
Cut down (felt the need to cut down), Annoyed (people annoyed you by criticizing your drinking), Guilty (felt guilty about
drinking), and Eye-opener (had a drink first thing in the morning). A positive response to two or more items warrants further
assessment. Options B, C, and D are not components of the validated CAGE instrument and represent common distractors
that reflect inadequate knowledge of this screening framework as emphasized in the Walden curriculum.
Q5: A 35-year-old male presents with sharp, tearing chest pain radiating to his back between the
shoulder blades. He has a history of poorly controlled hypertension. On examination, blood pressure is
190/110 mmHg in the right arm and 160/90 mmHg in the left arm, and a diastolic murmur is heard at
the left sternal border. What is the most likely diagnosis?
A. Acute myocardial infarction of the anterior wall
B. Acute aortic dissection **[CORRECT]**
C. Pulmonary embolism with right heart strain
D. Acute pericarditis with pericardial effusion
Correct Answer: B
Rationale: The classic presentation of acute aortic dissection includes sudden-onset tearing chest pain radiating to the back, a
significant blood pressure differential between arms (greater than 20 mmHg), and a history of hypertension. The diastolic
murmur at the left sternal border suggests aortic regurgitation from aortic root involvement in Type A dissection. Myocardial
infarction typically presents with pressure-like pain and ECG changes. Pulmonary embolism presents with dyspnea and
pleuritic pain. Pericarditis presents with positional chest pain and a friction rub. Immediate imaging with CT angiography is
required as this is a life-threatening emergency.
Q6: A 28-year-old female presents with a 3-day history of vaginal discharge, dysuria, and lower
abdominal pain. On speculum examination, the nurse practitioner notes mucopurulent cervical
discharge and cervical motion tenderness. Which finding would most support a diagnosis of pelvic
inflammatory disease (PID) rather than uncomplicated cervicitis?
A. Positive whiff test with potassium hydroxide preparation
B. Adnexal tenderness on bimanual examination **[CORRECT]**
C. Strawberry appearance of the cervix on colposcopy
D. Presence of clue cells on saline microscopy
Page 2 NURS 6531 Final Exam 2026
,Correct Answer: B
Rationale: Adnexal tenderness on bimanual examination, along with cervical motion tenderness and mucopurulent discharge,
constitutes the clinical triad supporting a diagnosis of pelvic inflammatory disease (PID). The positive whiff test and clue cells
suggest bacterial vaginosis. The strawberry cervix appearance is characteristic of Trichomonas vaginalis infection. PID
requires prompt treatment with broad-spectrum antibiotic regimens covering Chlamydia trachomatis and Neisseria
gonorrhoeae to prevent long-term complications including infertility and chronic pelvic pain.
Q7: A nurse practitioner is performing a focused neurological assessment on a patient who presents
with sudden-onset right-sided weakness and slurred speech. Using the pretest probability framework
taught in the Walden curriculum, which assessment tool is most appropriate for rapid initial stroke
screening in this clinical setting?
A. Mini-Mental State Examination (MMSE)
B. Cincinnati Prehospital Stroke Scale (CPSS) **[CORRECT]**
C. Montreal Cognitive Assessment (MoCA)
D. Glasgow Coma Scale (GCS)
Correct Answer: B
Rationale: The Cincinnati Prehospital Stroke Scale is the most appropriate rapid screening tool for acute stroke assessment,
evaluating three domains: facial droop, arm drift, and abnormal speech. It is designed for rapid administration within
minutes and has high sensitivity for detecting stroke. The MMSE and MoCA are cognitive screening tools used for dementia
evaluation, not acute stroke. The GCS assesses level of consciousness and is used in trauma settings rather than focused stroke
screening. Rapid recognition using CPSS enables timely activation of stroke protocols and thrombolytic eligibility assessment.
Q8: A 72-year-old male presents for follow-up of heart failure with reduced ejection fraction (HFrEF).
On examination, the nurse practitioner identifies pitting edema (2+), jugular venous distension at 8
cm above the sternal angle, and bilateral crackles at the lung bases. Which finding represents a
contraindication to initiating an ACE inhibitor at this visit?
A. Serum potassium of 5.6 mEq/L **[CORRECT]**
B. Bilateral crackles at the lung bases
C. Blood pressure of 110/70 mmHg
D. Estimated GFR of 45 mL/min/1.73 m2
Correct Answer: A
Rationale: A serum potassium level of 5.6 mEq/L (hyperkalemia) is a contraindication to initiating ACE inhibitor therapy
because ACE inhibitors reduce aldosterone production, which further increases potassium levels and risks life-threatening
hyperkalemia. Bilateral crackles indicate pulmonary congestion, which is actually an indication for ACE inhibitor therapy in
HFrEF. Blood pressure of 110/70 mmHg is acceptable for initiating an ACE inhibitor. An eGFR of 45 mL/min is not an
absolute contraindication but requires monitoring. This distinction is critical for safe prescribing in the Walden pharmacology
curriculum.
Q9: During a well-child visit for a 4-year-old, the nurse practitioner observes that the child can hop on
one foot, speaks in complete sentences of 4-5 words, and can draw a circle. The parent reports the child
engages in parallel play with other children. Which developmental assessment tool would be most
appropriate for formal documentation of this child's developmental status?
A. Edinburgh Postnatal Depression Scale (EPDS)
B. Ages and Stages Questionnaire (ASQ-3) **[CORRECT]**
C. PHQ-9 Patient Health Questionnaire
D. CAGE questionnaire for substance use
Correct Answer: B
Rationale: The Ages and Stages Questionnaire, Third Edition (ASQ-3) is a standardized developmental screening tool
designed for children from 1 month to 5.5 years. It assesses five domains: communication, gross motor, fine motor,
problem-solving, and personal-social, making it ideal for documenting the developmental milestones described. The EPDS
Page 3 NURS 6531 Final Exam 2026
, screens for postpartum depression in mothers. The PHQ-9 screens for depression in adults. The CAGE is an alcohol screening
tool for adults. Selecting the appropriate screening tool based on patient age and purpose is a core competency in the Walden
FNP program.
Q10: A 58-year-old male presents with a 6-month history of progressively worsening heartburn,
regurgitation, and dysphagia. He has a 20-pack-year smoking history and drinks alcohol daily. On
examination, he appears cachectic with decreased breath sounds in the left lower lung field. An upper
endoscopy reveals a mass in the distal esophagus. Which risk factor in this patient's history is most
strongly associated with the suspected diagnosis?
A. Chronic NSAID use for joint pain
B. Family history of colon cancer
C. Long-standing gastroesophageal reflux disease (GERD) with smoking and alcohol use
**[CORRECT]**
D. Recent travel to an endemic area for parasitic infection
Correct Answer: C
Rationale: Long-standing GERD combined with smoking and alcohol use constitutes the strongest risk factor profile for
esophageal adenocarcinoma. Chronic GERD can lead to Barrett esophagus, which is a premalignant condition that
predisposes to adenocarcinoma of the distal esophagus. Smoking and alcohol act synergistically as independent risk factors.
Chronic NSAID use is associated with peptic ulcer disease and gastric pathology, not esophageal cancer. Family history of
colon cancer is not directly linked to esophageal malignancy. Travel history for parasitic infection is irrelevant to this clinical
presentation.
Q11: A 40-year-old female presents with intermittent episodes of palpitations, sweating, tremors, and
anxiety that occur primarily in the early morning hours. Her fasting blood glucose is 52 mg/dL during
one of these episodes. Which diagnostic strategy is most appropriate for evaluating the cause of her
hypoglycemia?
A. 72-hour supervised fast with measurement of plasma glucose, insulin, C-peptide, and proinsulin
levels **[CORRECT]**
B. Oral glucose tolerance test with serial glucose measurements
C. Hemoglobin A1c measurement with fasting lipid panel
D. Random cortisol level with ACTH stimulation test
Correct Answer: A
Rationale: The 72-hour supervised fast is the gold standard diagnostic test for evaluating hypoglycemia of uncertain etiology.
During the fast, plasma glucose, insulin, C-peptide, and proinsulin levels are measured simultaneously. A low glucose level
with inappropriately elevated insulin and C-peptide suggests endogenous hyperinsulinism (insulinoma), while low C-peptide
with low insulin suggests exogenous insulin administration. The oral glucose tolerance test is used for diagnosing diabetes
mellitus. Hemoglobin A1c reflects long-term glycemic control. Cortisol testing evaluates for adrenal insufficiency, which
typically does not cause episodic hypoglycemia.
Q12: A nurse practitioner is performing a cardiac auscultation on a 32-year-old pregnant patient at 28
weeks gestation. A soft systolic ejection murmur is heard along the left sternal border. The murmur
does not radiate and diminishes when the patient is placed in the left lateral decubitus position. What
is the most appropriate interpretation of this finding?
A. This is a pathological murmur indicating mitral valve prolapse requiring echocardiography
B. This is a physiological flow murmur expected during pregnancy due to increased blood volume
**[CORRECT]**
C. This murmur suggests congenital aortic stenosis that was previously undiagnosed
D. This finding indicates peripartum cardiomyopathy and requires immediate cardiology referral
Correct Answer: B
Page 4 NURS 6531 Final Exam 2026
