NURS 5350 • M3 Lesson 3 Practice Exam Advanced Nursing Concepts | Complete Solutions with Rationales
NURS 5350 M3 Lesson 3
Practice Questions With Complete Solutions
Advanced Nursing Concepts • Course Examination Preparation
Cognitive Levels: 25% Recall / 50%
Total Questions: 50 Sections: 5 Format: Multiple Choice (A–D)
Application / 25% Analysis
Instructions: This practice examination consists of 50 multiple-choice questions across five content domains
aligned with NURS 5350 Module 3 Lesson 3 objectives. Each question presents a clinical scenario, knowledge
application, or analysis prompt with four response options (A–D). The correct response is identified inline with the
[CORRECT] marker, followed by a 'Correct Answer' line and a comprehensive rationale integrating diagnostic
reasoning, pathophysiology, pharmacology, clinical management, and evidence-based practice. Recommended
time: 75 minutes. Cognitive distribution: 25% recall, 50% application, 25% analysis.
Section 1: Advanced Health Assessment and Diagnostic Reasoning
Comprehensive Health History, Physical Examination Techniques, Differential Diagnosis, and Clinical Decision-Making
Q1 - Q12
Q1: A 68-year-old male with a history of hypertension and hyperlipidemia presents to the clinic complaining of
substernal chest pressure that began 45 minutes ago while shoveling snow, radiating to his left arm, with
associated diaphoresis and dyspnea. Vital signs: BP 152/94, HR 102, RR 22, SpO2 95% on room air. Which
element of the focused history is MOST critical to obtain before initiating the 12-lead ECG and troponin
pathway?
A. Family history of premature coronary artery disease in first-degree relatives
B. Exact character, radiation, provoking/palliating factors, and time course (OPQRST) of the pain [CORRECT]
C. Detailed social history including employment stress and pack-years of tobacco use
D. Review of prior outpatient lipid panels and antihypertensive medication adherence
Correct Answer: B. Exact character, radiation, provoking/palliating factors, and time course (OPQRST) of the pain
**[CORRECT]**
Rationale:
While all history elements inform long-term cardiac risk stratification, the OPQRST characterization of present-pain
quality, radiation, and temporal pattern is the highest-yield data set because it differentiates STEMI/NSTEMI, aortic
dissection, pneumothorax, and GERD — diagnoses that change disposition within minutes. Per ACS guidelines, a
12-lead ECG must be obtained within 10 minutes of arrival; the focused pain history runs concurrently, not sequentially.
Family history (A), social history (C), and outpatient records (D) are secondary data that refine risk stratification after
the acute pathway is initiated, but none of them triage the patient in the next 10 minutes.
NURS 5350 • Module 3 • Lesson 3 — Practice Questions with Complete Solutions Page 1
,NURS 5350 • M3 Lesson 3 Practice Exam Advanced Nursing Concepts | Complete Solutions with Rationales
Q2: When performing a comprehensive geriatric assessment on an 82-year-old female with new-onset
confusion, which validated screening tool provides the MOST sensitive bedside evaluation for cognitive
impairment and should be administered before completing the medication review?
A. Confusion Assessment Method (CAM) [CORRECT]
B. Mini-Cog (three-item recall plus clock-drawing test)
C. Patient Health Questionnaire-9 (PHQ-9)
D. Functional Independence Measure (FIM)
Correct Answer: A. Confusion Assessment Method (CAM) **[CORRECT]**
Rationale:
The CAM is specifically validated for delirium detection in hospitalized and older adults, evaluating four features: acute
onset/fluctuating course, inattention, disorganized thinking, and altered level of consciousness — diagnosis requires
features 1 and 2 plus either 3 or 4. New-onset confusion in an 82-year-old is delirium until proven otherwise, and CAM
distinguishes this from chronic dementia. The Mini-Cog (A) screens for chronic dementia but is less sensitive for
delirium. PHQ-9 (C) evaluates depression, and FIM (D) measures functional disability — neither addresses acute
cognitive change. Identifying delirium first redirects the medication review toward anticholinergic, opioid, and
benzodiazepine contributors.
Q3: A 54-year-old female presents with acute onset of severe, tearing chest pain radiating to her back between
the scapulae. BP is 180/110 in the right arm and 148/92 in the left arm. Which physical examination finding, if
present, MOST strongly increases the pretest probability of acute aortic dissection and should prompt
immediate CTA of the chest and abdomen?
A. Bilateral basilar crackles on lung auscultation
B. Dullness to percussion at the left lung base
C. A new diastolic decrescendo murmur at the left sternal border [CORRECT]
D. Expiratory wheezing bilaterally with prolonged expiratory phase
Correct Answer: C. A new diastolic decrescendo murmur at the left sternal border **[CORRECT]**
Rationale:
A new aortic regurgitation murmur (diastolic decrescendo at the left sternal border) occurs in approximately 32% of
proximal dissections because the dissection flap undermines the aortic valve apparatus, causing acute valvular
incompetence. Combined with the blood pressure differential (>20 mmHg between arms) and tearing pain radiating to
the back, the pretest probability of Stanford type A dissection is high enough that CTA is mandatory before any
anticoagulation or fibrinolysis. Bilateral crackles (A) suggest heart failure, dullness at the base (C) suggests effusion, and
wheezing (D) suggests COPD/asthma exacerbation — none of these are specific for dissection and each would misdirect
the workup.
NURS 5350 • Module 3 • Lesson 3 — Practice Questions with Complete Solutions Page 2
,NURS 5350 • M3 Lesson 3 Practice Exam Advanced Nursing Concepts | Complete Solutions with Rationales
Q4: A 72-year-old male with chronic kidney disease stage 4 (eGFR 22 mL/min/1.73m²) presents with
progressive dyspnea, orthopnea, and bilateral lower extremity edema. BNP returns at 1,840 pg/mL. Which
interpretation of this laboratory value is MOST accurate for clinical decision-making?
A. BNP is renally cleared and is chronically elevated in CKD; a single value cannot distinguish HF from reduced
clearance, so a comparison to the patient's baseline BNP and clinical exam is required [CORRECT]
B. The markedly elevated BNP confirms acute decompensated heart failure and rules out a renal contribution to volume
overload
C. BNP above 1,000 pg/mL is diagnostic of pulmonary embolism and warrants immediate CTPA
D. The BNP value is falsely low due to CKD and should be repeated after hemodialysis before interpretation
Correct Answer: A. BNP is renally cleared and is chronically elevated in CKD; a single value cannot distinguish HF
from reduced clearance, so a comparison to the patient's baseline BNP and clinical exam is required
**[CORRECT]**
Rationale:
BNP is primarily cleared by neutprilysin and renal tubular secretion; in advanced CKD, baseline BNP is chronically
elevated independent of cardiac status, often exceeding 400 pg/mL without heart failure. A single value of 1,840 pg/mL
in a stage 4 CKD patient cannot reliably distinguish cardiac from renal volume overload — the clinician must compare to
the patient's prior baseline BNP, assess jugular venous pressure, look for S3 gallop and crackles, and consider
NT-proBNP thresholds adjusted for eGFR. The value does not rule out renal contribution (A), is not diagnostic of PE
(C, D-dimer would be appropriate), and is not falsely low in CKD (D) — it is falsely elevated.
Q5: A 56-year-old male is admitted with community-acquired pneumonia. On hospital day 2, he develops a
temperature of 38.9°C, HR 124, RR 28, BP 88/52 after 30 mL/kg of crystalloid, and confusion. Lactate is 3.8
mmol/L. Using the qSOFA and SOFA frameworks, what is the MOST appropriate next step?
A. Continue current management with scheduled acetaminophen and reassess in 4 hours
B. Administer a single dose of oral azithromycin and discharge home with close follow-up
C. Order a head CT to evaluate the new confusion before treating presumed infection
D. Initiate the Surviving Sepsis Campaign 1-hour bundle: broad-spectrum antibiotics, repeat fluid bolus,
vasopressors for MAP < 65, and lactate re-measurement [CORRECT]
Correct Answer: D. Initiate the Surviving Sepsis Campaign 1-hour bundle: broad-spectrum antibiotics, repeat fluid
bolus, vasopressors for MAP < 65, and lactate re-measurement **[CORRECT]**
Rationale:
The patient meets qSOFA criteria (RR ≥ 22, altered mentation, SBP < 100) and has septic shock physiology
(hypotension after fluids, lactate > 2 mmol/L) per Sepsis-3 definitions. The Surviving Sepsis 1-hour bundle recommends
immediate broad-spectrum IV antibiotics within 1 hour, repeat crystalloid 30 mL/kg if hypoperfusion persists,
norepinephrine for MAP < 65 after fluids, and lactate re-measurement at 2-4 hours. Delaying antibiotics for imaging (C)
increases mortality approximately 7.6% per hour of delay in septic shock. Oral azithromycin and discharge (D) is
inappropriate for a septic patient, and reassessment without intervention (A) ignores organ dysfunction.
NURS 5350 • Module 3 • Lesson 3 — Practice Questions with Complete Solutions Page 3
, NURS 5350 • M3 Lesson 3 Practice Exam Advanced Nursing Concepts | Complete Solutions with Rationales
Q6: An advanced practice nurse is preparing to hand off a critically ill patient to the intensivist using the SBAR
communication framework. Which statement BEST represents the 'Assessment' component of SBAR?
A. Mr. Lee is a 72-year-old male admitted for community-acquired pneumonia
B. I believe he is developing septic shock with worsening volume depletion [CORRECT]
C. Over the past hour, his systolic BP has dropped from 110 to 84 and his HR has risen to 124
D. I would like you to come evaluate him immediately and consider central line placement
Correct Answer: B. I believe he is developing septic shock with worsening volume depletion **[CORRECT]**
Rationale:
SBAR stands for Situation, Background, Assessment, Recommendation. The Assessment component (C) is the APN's
professional interpretation of the data — what the clinician thinks is happening. Option A is the Situation (current
relevant problem), B is the Background (objective data trends), and D is the Recommendation (specific action
requested). Clear separation of these four components reduces communication errors during handoff, and the
Assessment in particular forces the APN to commit to a clinical hypothesis that the receiving clinician can then validate
or refute.
Q7: A 47-year-old female presents with a 2-week history of progressive fatigue, low-grade fever, and a new
systolic murmur. Three blood cultures are drawn and grow Streptococcus viridans. Which physical
examination finding, if newly documented, represents a classic peripheral manifestation of subacute infective
endocarditis and supports the diagnosis?
A. Erythema marginatum with raised serpiginous borders on the trunk
B. Painful, tender nodules on the pads of the fingers and toes (Osler nodes) [CORRECT]
C. Target-shaped erythematous lesions on the extensor surfaces (erythema multiforme)
D. Silvery, scaly plaques on the extensor surfaces of elbows and knees
Correct Answer: B. Painful, tender nodules on the pads of the fingers and toes (Osler nodes) **[CORRECT]**
Rationale:
Osler nodes are painful, pea-sized nodules on the pads of fingers and toes caused by immune complex deposition and
represent a classic peripheral manifestation of infective endocarditis, along with Janeway lesions (painless macules on
palms/soles), splinter hemorrhages, and Roth spots. Erythema marginatum (A) is a major Jones criterion for rheumatic
fever, not endocarditis. Erythema multiforme (C) is associated with drug reactions or HSV infection, and silvery plaques
(D) describe psoriasis. The combination of bacteremia, new murmur, and Osler nodes strongly supports the Duke criteria
diagnosis of infective endocarditis.
NURS 5350 • Module 3 • Lesson 3 — Practice Questions with Complete Solutions Page 4
NURS 5350 M3 Lesson 3
Practice Questions With Complete Solutions
Advanced Nursing Concepts • Course Examination Preparation
Cognitive Levels: 25% Recall / 50%
Total Questions: 50 Sections: 5 Format: Multiple Choice (A–D)
Application / 25% Analysis
Instructions: This practice examination consists of 50 multiple-choice questions across five content domains
aligned with NURS 5350 Module 3 Lesson 3 objectives. Each question presents a clinical scenario, knowledge
application, or analysis prompt with four response options (A–D). The correct response is identified inline with the
[CORRECT] marker, followed by a 'Correct Answer' line and a comprehensive rationale integrating diagnostic
reasoning, pathophysiology, pharmacology, clinical management, and evidence-based practice. Recommended
time: 75 minutes. Cognitive distribution: 25% recall, 50% application, 25% analysis.
Section 1: Advanced Health Assessment and Diagnostic Reasoning
Comprehensive Health History, Physical Examination Techniques, Differential Diagnosis, and Clinical Decision-Making
Q1 - Q12
Q1: A 68-year-old male with a history of hypertension and hyperlipidemia presents to the clinic complaining of
substernal chest pressure that began 45 minutes ago while shoveling snow, radiating to his left arm, with
associated diaphoresis and dyspnea. Vital signs: BP 152/94, HR 102, RR 22, SpO2 95% on room air. Which
element of the focused history is MOST critical to obtain before initiating the 12-lead ECG and troponin
pathway?
A. Family history of premature coronary artery disease in first-degree relatives
B. Exact character, radiation, provoking/palliating factors, and time course (OPQRST) of the pain [CORRECT]
C. Detailed social history including employment stress and pack-years of tobacco use
D. Review of prior outpatient lipid panels and antihypertensive medication adherence
Correct Answer: B. Exact character, radiation, provoking/palliating factors, and time course (OPQRST) of the pain
**[CORRECT]**
Rationale:
While all history elements inform long-term cardiac risk stratification, the OPQRST characterization of present-pain
quality, radiation, and temporal pattern is the highest-yield data set because it differentiates STEMI/NSTEMI, aortic
dissection, pneumothorax, and GERD — diagnoses that change disposition within minutes. Per ACS guidelines, a
12-lead ECG must be obtained within 10 minutes of arrival; the focused pain history runs concurrently, not sequentially.
Family history (A), social history (C), and outpatient records (D) are secondary data that refine risk stratification after
the acute pathway is initiated, but none of them triage the patient in the next 10 minutes.
NURS 5350 • Module 3 • Lesson 3 — Practice Questions with Complete Solutions Page 1
,NURS 5350 • M3 Lesson 3 Practice Exam Advanced Nursing Concepts | Complete Solutions with Rationales
Q2: When performing a comprehensive geriatric assessment on an 82-year-old female with new-onset
confusion, which validated screening tool provides the MOST sensitive bedside evaluation for cognitive
impairment and should be administered before completing the medication review?
A. Confusion Assessment Method (CAM) [CORRECT]
B. Mini-Cog (three-item recall plus clock-drawing test)
C. Patient Health Questionnaire-9 (PHQ-9)
D. Functional Independence Measure (FIM)
Correct Answer: A. Confusion Assessment Method (CAM) **[CORRECT]**
Rationale:
The CAM is specifically validated for delirium detection in hospitalized and older adults, evaluating four features: acute
onset/fluctuating course, inattention, disorganized thinking, and altered level of consciousness — diagnosis requires
features 1 and 2 plus either 3 or 4. New-onset confusion in an 82-year-old is delirium until proven otherwise, and CAM
distinguishes this from chronic dementia. The Mini-Cog (A) screens for chronic dementia but is less sensitive for
delirium. PHQ-9 (C) evaluates depression, and FIM (D) measures functional disability — neither addresses acute
cognitive change. Identifying delirium first redirects the medication review toward anticholinergic, opioid, and
benzodiazepine contributors.
Q3: A 54-year-old female presents with acute onset of severe, tearing chest pain radiating to her back between
the scapulae. BP is 180/110 in the right arm and 148/92 in the left arm. Which physical examination finding, if
present, MOST strongly increases the pretest probability of acute aortic dissection and should prompt
immediate CTA of the chest and abdomen?
A. Bilateral basilar crackles on lung auscultation
B. Dullness to percussion at the left lung base
C. A new diastolic decrescendo murmur at the left sternal border [CORRECT]
D. Expiratory wheezing bilaterally with prolonged expiratory phase
Correct Answer: C. A new diastolic decrescendo murmur at the left sternal border **[CORRECT]**
Rationale:
A new aortic regurgitation murmur (diastolic decrescendo at the left sternal border) occurs in approximately 32% of
proximal dissections because the dissection flap undermines the aortic valve apparatus, causing acute valvular
incompetence. Combined with the blood pressure differential (>20 mmHg between arms) and tearing pain radiating to
the back, the pretest probability of Stanford type A dissection is high enough that CTA is mandatory before any
anticoagulation or fibrinolysis. Bilateral crackles (A) suggest heart failure, dullness at the base (C) suggests effusion, and
wheezing (D) suggests COPD/asthma exacerbation — none of these are specific for dissection and each would misdirect
the workup.
NURS 5350 • Module 3 • Lesson 3 — Practice Questions with Complete Solutions Page 2
,NURS 5350 • M3 Lesson 3 Practice Exam Advanced Nursing Concepts | Complete Solutions with Rationales
Q4: A 72-year-old male with chronic kidney disease stage 4 (eGFR 22 mL/min/1.73m²) presents with
progressive dyspnea, orthopnea, and bilateral lower extremity edema. BNP returns at 1,840 pg/mL. Which
interpretation of this laboratory value is MOST accurate for clinical decision-making?
A. BNP is renally cleared and is chronically elevated in CKD; a single value cannot distinguish HF from reduced
clearance, so a comparison to the patient's baseline BNP and clinical exam is required [CORRECT]
B. The markedly elevated BNP confirms acute decompensated heart failure and rules out a renal contribution to volume
overload
C. BNP above 1,000 pg/mL is diagnostic of pulmonary embolism and warrants immediate CTPA
D. The BNP value is falsely low due to CKD and should be repeated after hemodialysis before interpretation
Correct Answer: A. BNP is renally cleared and is chronically elevated in CKD; a single value cannot distinguish HF
from reduced clearance, so a comparison to the patient's baseline BNP and clinical exam is required
**[CORRECT]**
Rationale:
BNP is primarily cleared by neutprilysin and renal tubular secretion; in advanced CKD, baseline BNP is chronically
elevated independent of cardiac status, often exceeding 400 pg/mL without heart failure. A single value of 1,840 pg/mL
in a stage 4 CKD patient cannot reliably distinguish cardiac from renal volume overload — the clinician must compare to
the patient's prior baseline BNP, assess jugular venous pressure, look for S3 gallop and crackles, and consider
NT-proBNP thresholds adjusted for eGFR. The value does not rule out renal contribution (A), is not diagnostic of PE
(C, D-dimer would be appropriate), and is not falsely low in CKD (D) — it is falsely elevated.
Q5: A 56-year-old male is admitted with community-acquired pneumonia. On hospital day 2, he develops a
temperature of 38.9°C, HR 124, RR 28, BP 88/52 after 30 mL/kg of crystalloid, and confusion. Lactate is 3.8
mmol/L. Using the qSOFA and SOFA frameworks, what is the MOST appropriate next step?
A. Continue current management with scheduled acetaminophen and reassess in 4 hours
B. Administer a single dose of oral azithromycin and discharge home with close follow-up
C. Order a head CT to evaluate the new confusion before treating presumed infection
D. Initiate the Surviving Sepsis Campaign 1-hour bundle: broad-spectrum antibiotics, repeat fluid bolus,
vasopressors for MAP < 65, and lactate re-measurement [CORRECT]
Correct Answer: D. Initiate the Surviving Sepsis Campaign 1-hour bundle: broad-spectrum antibiotics, repeat fluid
bolus, vasopressors for MAP < 65, and lactate re-measurement **[CORRECT]**
Rationale:
The patient meets qSOFA criteria (RR ≥ 22, altered mentation, SBP < 100) and has septic shock physiology
(hypotension after fluids, lactate > 2 mmol/L) per Sepsis-3 definitions. The Surviving Sepsis 1-hour bundle recommends
immediate broad-spectrum IV antibiotics within 1 hour, repeat crystalloid 30 mL/kg if hypoperfusion persists,
norepinephrine for MAP < 65 after fluids, and lactate re-measurement at 2-4 hours. Delaying antibiotics for imaging (C)
increases mortality approximately 7.6% per hour of delay in septic shock. Oral azithromycin and discharge (D) is
inappropriate for a septic patient, and reassessment without intervention (A) ignores organ dysfunction.
NURS 5350 • Module 3 • Lesson 3 — Practice Questions with Complete Solutions Page 3
, NURS 5350 • M3 Lesson 3 Practice Exam Advanced Nursing Concepts | Complete Solutions with Rationales
Q6: An advanced practice nurse is preparing to hand off a critically ill patient to the intensivist using the SBAR
communication framework. Which statement BEST represents the 'Assessment' component of SBAR?
A. Mr. Lee is a 72-year-old male admitted for community-acquired pneumonia
B. I believe he is developing septic shock with worsening volume depletion [CORRECT]
C. Over the past hour, his systolic BP has dropped from 110 to 84 and his HR has risen to 124
D. I would like you to come evaluate him immediately and consider central line placement
Correct Answer: B. I believe he is developing septic shock with worsening volume depletion **[CORRECT]**
Rationale:
SBAR stands for Situation, Background, Assessment, Recommendation. The Assessment component (C) is the APN's
professional interpretation of the data — what the clinician thinks is happening. Option A is the Situation (current
relevant problem), B is the Background (objective data trends), and D is the Recommendation (specific action
requested). Clear separation of these four components reduces communication errors during handoff, and the
Assessment in particular forces the APN to commit to a clinical hypothesis that the receiving clinician can then validate
or refute.
Q7: A 47-year-old female presents with a 2-week history of progressive fatigue, low-grade fever, and a new
systolic murmur. Three blood cultures are drawn and grow Streptococcus viridans. Which physical
examination finding, if newly documented, represents a classic peripheral manifestation of subacute infective
endocarditis and supports the diagnosis?
A. Erythema marginatum with raised serpiginous borders on the trunk
B. Painful, tender nodules on the pads of the fingers and toes (Osler nodes) [CORRECT]
C. Target-shaped erythematous lesions on the extensor surfaces (erythema multiforme)
D. Silvery, scaly plaques on the extensor surfaces of elbows and knees
Correct Answer: B. Painful, tender nodules on the pads of the fingers and toes (Osler nodes) **[CORRECT]**
Rationale:
Osler nodes are painful, pea-sized nodules on the pads of fingers and toes caused by immune complex deposition and
represent a classic peripheral manifestation of infective endocarditis, along with Janeway lesions (painless macules on
palms/soles), splinter hemorrhages, and Roth spots. Erythema marginatum (A) is a major Jones criterion for rheumatic
fever, not endocarditis. Erythema multiforme (C) is associated with drug reactions or HSV infection, and silvery plaques
(D) describe psoriasis. The combination of bacteremia, new murmur, and Osler nodes strongly supports the Duke criteria
diagnosis of infective endocarditis.
NURS 5350 • Module 3 • Lesson 3 — Practice Questions with Complete Solutions Page 4
