NU 673 Comprehensive Exam Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales
Assessment & Clinical Reasoning
1. A patient presents with sudden onset dyspnea, pleuritic chest pain,
tachycardia, and oxygen saturation of 88%. Which diagnosis should the
clinician prioritize?
A. Pneumonia
B. Pulmonary embolism
C. Acute bronchitis
D. Stable COPD
Answer: B. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and
hypoxemia are classic warning signs of pulmonary embolism.
Immediate evaluation is required.
2. Which finding most strongly suggests left-sided heart failure?
A. Peripheral edema
B. Jugular venous distention
C. Pulmonary crackles
D. Ascites
Answer: C. Pulmonary crackles
Rationale: Left ventricular failure causes pulmonary congestion,
producing crackles, dyspnea, and orthopnea. Peripheral edema and JVD
are more characteristic of systemic venous congestion.
3. A patient with diabetes reports sweating, tremor, and confusion.
What should be assessed first?
A. Hemoglobin A1c
B. Serum creatinine
,C. Blood glucose
D. Urine ketones
Answer: C. Blood glucose
Rationale: Sweating, tremor, and confusion strongly suggest
hypoglycemia. Point-of-care glucose should be obtained immediately.
4. Which assessment finding is most concerning in a patient with an
acute headache?
A. Photophobia
B. Mild nausea
C. Sudden “worst headache of my life”
D. History of tension headaches
Answer: C. Sudden “worst headache of my life”
Rationale: Thunderclap headache may indicate subarachnoid
hemorrhage and requires urgent evaluation.
5. Which laboratory test is most useful for assessing long-term glycemic
control?
A. Fasting glucose
B. Random glucose
C. HbA1c
D. Urine glucose
Answer: C. HbA1c
Rationale: HbA1c reflects average blood glucose over approximately
the preceding 2–3 months.
6. A patient has a blood pressure of 184/122 mmHg and new neurologic
deficits. What is the priority?
A. Recheck the pressure in one month
B. Diagnose essential hypertension
,C. Evaluate for hypertensive emergency
D. Recommend dietary sodium restriction only
Answer: C. Evaluate for hypertensive emergency
Rationale: Severe hypertension accompanied by acute target-organ
dysfunction constitutes a hypertensive emergency.
7. Which finding is most consistent with dehydration?
A. Bounding pulse
B. Moist mucous membranes
C. Orthostatic hypotension
D. Bradycardia
Answer: C. Orthostatic hypotension
Rationale: Volume depletion can cause tachycardia, dry mucous
membranes, decreased urine output, and orthostatic hypotension.
8. Which symptom is most characteristic of hyperthyroidism?
A. Cold intolerance
B. Weight gain
C. Bradycardia
D. Heat intolerance
Answer: D. Heat intolerance
Rationale: Excess thyroid hormone increases metabolic activity,
commonly causing heat intolerance, weight loss, tremor, anxiety, and
tachycardia.
9. Which finding is most concerning for bacterial meningitis?
A. Mild rhinorrhea
B. Nuchal rigidity with altered mental status
C. Chronic fatigue
D. Isolated low-grade fever
, Answer: B. Nuchal rigidity with altered mental status
Rationale: Fever, neck stiffness, altered mental status, and severe
headache are concerning for meningitis and warrant urgent evaluation.
10. Which symptom is typical of iron-deficiency anemia?
A. Polycythemia
B. Fatigue
C. Hyperactivity
D. Hypertension
Answer: B. Fatigue
Rationale: Reduced oxygen-carrying capacity commonly produces
fatigue, weakness, pallor, and exertional dyspnea.
11. A patient reports unilateral calf swelling and tenderness after
prolonged immobilization. What condition is most likely?
A. Cellulitis
B. Deep vein thrombosis
C. Osteoarthritis
D. Peripheral neuropathy
Answer: B. Deep vein thrombosis
Rationale: Unilateral swelling and tenderness following immobilization
are classic features of DVT.
12. Which physical finding is most characteristic of peripheral arterial
disease?
A. Warm, edematous legs
B. Dependent rubor
C. Brown ankle pigmentation
D. Pulses increased with elevation
Exam-Style Questions with Detailed Rationales
Assessment & Clinical Reasoning
1. A patient presents with sudden onset dyspnea, pleuritic chest pain,
tachycardia, and oxygen saturation of 88%. Which diagnosis should the
clinician prioritize?
A. Pneumonia
B. Pulmonary embolism
C. Acute bronchitis
D. Stable COPD
Answer: B. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and
hypoxemia are classic warning signs of pulmonary embolism.
Immediate evaluation is required.
2. Which finding most strongly suggests left-sided heart failure?
A. Peripheral edema
B. Jugular venous distention
C. Pulmonary crackles
D. Ascites
Answer: C. Pulmonary crackles
Rationale: Left ventricular failure causes pulmonary congestion,
producing crackles, dyspnea, and orthopnea. Peripheral edema and JVD
are more characteristic of systemic venous congestion.
3. A patient with diabetes reports sweating, tremor, and confusion.
What should be assessed first?
A. Hemoglobin A1c
B. Serum creatinine
,C. Blood glucose
D. Urine ketones
Answer: C. Blood glucose
Rationale: Sweating, tremor, and confusion strongly suggest
hypoglycemia. Point-of-care glucose should be obtained immediately.
4. Which assessment finding is most concerning in a patient with an
acute headache?
A. Photophobia
B. Mild nausea
C. Sudden “worst headache of my life”
D. History of tension headaches
Answer: C. Sudden “worst headache of my life”
Rationale: Thunderclap headache may indicate subarachnoid
hemorrhage and requires urgent evaluation.
5. Which laboratory test is most useful for assessing long-term glycemic
control?
A. Fasting glucose
B. Random glucose
C. HbA1c
D. Urine glucose
Answer: C. HbA1c
Rationale: HbA1c reflects average blood glucose over approximately
the preceding 2–3 months.
6. A patient has a blood pressure of 184/122 mmHg and new neurologic
deficits. What is the priority?
A. Recheck the pressure in one month
B. Diagnose essential hypertension
,C. Evaluate for hypertensive emergency
D. Recommend dietary sodium restriction only
Answer: C. Evaluate for hypertensive emergency
Rationale: Severe hypertension accompanied by acute target-organ
dysfunction constitutes a hypertensive emergency.
7. Which finding is most consistent with dehydration?
A. Bounding pulse
B. Moist mucous membranes
C. Orthostatic hypotension
D. Bradycardia
Answer: C. Orthostatic hypotension
Rationale: Volume depletion can cause tachycardia, dry mucous
membranes, decreased urine output, and orthostatic hypotension.
8. Which symptom is most characteristic of hyperthyroidism?
A. Cold intolerance
B. Weight gain
C. Bradycardia
D. Heat intolerance
Answer: D. Heat intolerance
Rationale: Excess thyroid hormone increases metabolic activity,
commonly causing heat intolerance, weight loss, tremor, anxiety, and
tachycardia.
9. Which finding is most concerning for bacterial meningitis?
A. Mild rhinorrhea
B. Nuchal rigidity with altered mental status
C. Chronic fatigue
D. Isolated low-grade fever
, Answer: B. Nuchal rigidity with altered mental status
Rationale: Fever, neck stiffness, altered mental status, and severe
headache are concerning for meningitis and warrant urgent evaluation.
10. Which symptom is typical of iron-deficiency anemia?
A. Polycythemia
B. Fatigue
C. Hyperactivity
D. Hypertension
Answer: B. Fatigue
Rationale: Reduced oxygen-carrying capacity commonly produces
fatigue, weakness, pallor, and exertional dyspnea.
11. A patient reports unilateral calf swelling and tenderness after
prolonged immobilization. What condition is most likely?
A. Cellulitis
B. Deep vein thrombosis
C. Osteoarthritis
D. Peripheral neuropathy
Answer: B. Deep vein thrombosis
Rationale: Unilateral swelling and tenderness following immobilization
are classic features of DVT.
12. Which physical finding is most characteristic of peripheral arterial
disease?
A. Warm, edematous legs
B. Dependent rubor
C. Brown ankle pigmentation
D. Pulses increased with elevation
