NURS 5432 FINAL EXAM UPDATED PRACTICE
QUESTIONS AND CORRECT ANSWERS
Study edition: original exam-style questions based on publicly visible NURS 5432 topic previews. They are not represented as
leaked or guaranteed copies of a live/proctored examination.
Format: A, B, C, D choices • Correct answer and rationale immediately after every question • Questions are blue, correct answers are
green, and rationales are dark red.
1. A 45-year-old has pressure-like chest pain radiating to the left arm with diaphoresis. Which finding most
strongly supports acute myocardial ischemia?
A. Pain reproduced by palpation
B. Pain worse with inspiration
C. Pressure-like pain with autonomic symptoms
D. Pain limited to the epigastrium
Correct Answer: C. Pressure-like pain with autonomic symptoms
Rationale: Pressure or squeezing chest discomfort with radiation and diaphoresis/nausea is a classic ischemic pattern.
2. Which medication class is an established first-line option for uncomplicated hypertension?
A. Thiazide-type diuretic
B. Loop diuretic
C. Class IC antiarrhythmic
D. Short-acting nitrate
Correct Answer: A. Thiazide-type diuretic
Rationale: Thiazide-type diuretics are established first-line antihypertensive agents in appropriate patients.
3. An older adult has gradual memory complaints but performs much better when given cues. Which
diagnosis is most consistent?
A. Delirium
B. Depression-related pseudodementia
C. Lewy body dementia
D. Normal aging
Correct Answer: B. Depression-related pseudodementia
Rationale: Depression-related cognitive impairment may improve substantially with prompting, whereas delirium is acute and
dementia is typically progressive.
4. Which laboratory group is useful when evaluating reversible contributors to cognitive impairment?
A. CBC, metabolic panel, TSH, vitamin B12
B. Troponin, CK-MB, BNP
C. Lipase, amylase, bilirubin
D. D-dimer, fibrinogen, ESR
Correct Answer: A. CBC, metabolic panel, TSH, vitamin B12
Rationale: Basic hematologic/metabolic testing, thyroid testing, and vitamin B12 assessment can identify important reversible
contributors.
NURS 5432 Study Edition • Page 1
,5. Fatigue, weight gain, constipation, and cold intolerance most strongly suggest:
A. Hyperthyroidism
B. Hypothyroidism
C. Pheochromocytoma
D. Primary hyperaldosteronism
Correct Answer: B. Hypothyroidism
Rationale: These symptoms are classic for reduced thyroid hormone activity.
6. Which age-related change can prolong the distribution of lipid-soluble medications?
A. Increased total body water
B. Increased body fat
C. Increased lean body mass
D. Increased renal clearance
Correct Answer: B. Increased body fat
Rationale: Older adults generally have a higher proportion of body fat, which can increase the distribution and persistence of
lipid-soluble drugs.
7. Which vaccine is routinely recommended beginning at age 50 for prevention of herpes zoster?
A. Live varicella vaccine only
B. Recombinant zoster vaccine
C. Hepatitis A vaccine
D. Pneumococcal vaccine only
Correct Answer: B. Recombinant zoster vaccine
Rationale: Recombinant zoster vaccine is routinely recommended for adults beginning at age 50.
8. How often should most adults receive seasonal influenza vaccination?
A. Every 5 years
B. Every 2 years
C. Annually
D. Only after age 65
Correct Answer: C. Annually
Rationale: Seasonal influenza vaccination is recommended annually for most people six months of age and older.
9. Epigastric pain that improves after eating but returns several hours later and at night is most typical of:
A. Duodenal ulcer
B. Acute pancreatitis
C. Acute cholecystitis
D. Gastric outlet obstruction
Correct Answer: A. Duodenal ulcer
Rationale: Duodenal ulcer pain may improve temporarily with food and recur several hours later or at night.
NURS 5432 Study Edition • Page 2
, 10. Murphy sign is most closely associated with:
A. Appendicitis
B. Cholecystitis
C. Diverticulitis
D. Cystitis
Correct Answer: B. Cholecystitis
Rationale: Right-upper-quadrant pain with inspiratory arrest during palpation is characteristic of acute cholecystitis.
11. Pain with internal rotation of a flexed right hip can indicate irritation from:
A. Pelvic appendicitis
B. Pancreatitis
C. Renal colic
D. Gastritis
Correct Answer: A. Pelvic appendicitis
Rationale: The obturator sign may occur when a pelvic appendix irritates the obturator internus muscle.
12. Which age-related change decreases the volume of distribution of water-soluble drugs?
A. Increased body fat
B. Decreased total body water
C. Increased albumin
D. Increased skeletal muscle
Correct Answer: B. Decreased total body water
Rationale: Total body water decreases with age, which can increase serum concentrations of water-soluble medications.
13. Which medication is potentially inappropriate for many older adults because of strong anticholinergic
effects?
A. Diphenhydramine
B. Acetaminophen
C. Levothyroxine
D. Topical hydrocortisone
Correct Answer: A. Diphenhydramine
Rationale: Diphenhydramine can cause confusion, urinary retention, constipation, and falls through anticholinergic effects.
14. Which medication may be used as an initial pharmacologic option for mild osteoarthritis pain when
individualized to the patient?
A. Acetaminophen
B. Methadone
C. Ketamine infusion
D. High-dose opioid therapy
Correct Answer: A. Acetaminophen
Rationale: Acetaminophen may be considered for mild osteoarthritis pain while accounting for liver risk and total daily dose.
NURS 5432 Study Edition • Page 3
QUESTIONS AND CORRECT ANSWERS
Study edition: original exam-style questions based on publicly visible NURS 5432 topic previews. They are not represented as
leaked or guaranteed copies of a live/proctored examination.
Format: A, B, C, D choices • Correct answer and rationale immediately after every question • Questions are blue, correct answers are
green, and rationales are dark red.
1. A 45-year-old has pressure-like chest pain radiating to the left arm with diaphoresis. Which finding most
strongly supports acute myocardial ischemia?
A. Pain reproduced by palpation
B. Pain worse with inspiration
C. Pressure-like pain with autonomic symptoms
D. Pain limited to the epigastrium
Correct Answer: C. Pressure-like pain with autonomic symptoms
Rationale: Pressure or squeezing chest discomfort with radiation and diaphoresis/nausea is a classic ischemic pattern.
2. Which medication class is an established first-line option for uncomplicated hypertension?
A. Thiazide-type diuretic
B. Loop diuretic
C. Class IC antiarrhythmic
D. Short-acting nitrate
Correct Answer: A. Thiazide-type diuretic
Rationale: Thiazide-type diuretics are established first-line antihypertensive agents in appropriate patients.
3. An older adult has gradual memory complaints but performs much better when given cues. Which
diagnosis is most consistent?
A. Delirium
B. Depression-related pseudodementia
C. Lewy body dementia
D. Normal aging
Correct Answer: B. Depression-related pseudodementia
Rationale: Depression-related cognitive impairment may improve substantially with prompting, whereas delirium is acute and
dementia is typically progressive.
4. Which laboratory group is useful when evaluating reversible contributors to cognitive impairment?
A. CBC, metabolic panel, TSH, vitamin B12
B. Troponin, CK-MB, BNP
C. Lipase, amylase, bilirubin
D. D-dimer, fibrinogen, ESR
Correct Answer: A. CBC, metabolic panel, TSH, vitamin B12
Rationale: Basic hematologic/metabolic testing, thyroid testing, and vitamin B12 assessment can identify important reversible
contributors.
NURS 5432 Study Edition • Page 1
,5. Fatigue, weight gain, constipation, and cold intolerance most strongly suggest:
A. Hyperthyroidism
B. Hypothyroidism
C. Pheochromocytoma
D. Primary hyperaldosteronism
Correct Answer: B. Hypothyroidism
Rationale: These symptoms are classic for reduced thyroid hormone activity.
6. Which age-related change can prolong the distribution of lipid-soluble medications?
A. Increased total body water
B. Increased body fat
C. Increased lean body mass
D. Increased renal clearance
Correct Answer: B. Increased body fat
Rationale: Older adults generally have a higher proportion of body fat, which can increase the distribution and persistence of
lipid-soluble drugs.
7. Which vaccine is routinely recommended beginning at age 50 for prevention of herpes zoster?
A. Live varicella vaccine only
B. Recombinant zoster vaccine
C. Hepatitis A vaccine
D. Pneumococcal vaccine only
Correct Answer: B. Recombinant zoster vaccine
Rationale: Recombinant zoster vaccine is routinely recommended for adults beginning at age 50.
8. How often should most adults receive seasonal influenza vaccination?
A. Every 5 years
B. Every 2 years
C. Annually
D. Only after age 65
Correct Answer: C. Annually
Rationale: Seasonal influenza vaccination is recommended annually for most people six months of age and older.
9. Epigastric pain that improves after eating but returns several hours later and at night is most typical of:
A. Duodenal ulcer
B. Acute pancreatitis
C. Acute cholecystitis
D. Gastric outlet obstruction
Correct Answer: A. Duodenal ulcer
Rationale: Duodenal ulcer pain may improve temporarily with food and recur several hours later or at night.
NURS 5432 Study Edition • Page 2
, 10. Murphy sign is most closely associated with:
A. Appendicitis
B. Cholecystitis
C. Diverticulitis
D. Cystitis
Correct Answer: B. Cholecystitis
Rationale: Right-upper-quadrant pain with inspiratory arrest during palpation is characteristic of acute cholecystitis.
11. Pain with internal rotation of a flexed right hip can indicate irritation from:
A. Pelvic appendicitis
B. Pancreatitis
C. Renal colic
D. Gastritis
Correct Answer: A. Pelvic appendicitis
Rationale: The obturator sign may occur when a pelvic appendix irritates the obturator internus muscle.
12. Which age-related change decreases the volume of distribution of water-soluble drugs?
A. Increased body fat
B. Decreased total body water
C. Increased albumin
D. Increased skeletal muscle
Correct Answer: B. Decreased total body water
Rationale: Total body water decreases with age, which can increase serum concentrations of water-soluble medications.
13. Which medication is potentially inappropriate for many older adults because of strong anticholinergic
effects?
A. Diphenhydramine
B. Acetaminophen
C. Levothyroxine
D. Topical hydrocortisone
Correct Answer: A. Diphenhydramine
Rationale: Diphenhydramine can cause confusion, urinary retention, constipation, and falls through anticholinergic effects.
14. Which medication may be used as an initial pharmacologic option for mild osteoarthritis pain when
individualized to the patient?
A. Acetaminophen
B. Methadone
C. Ketamine infusion
D. High-dose opioid therapy
Correct Answer: A. Acetaminophen
Rationale: Acetaminophen may be considered for mild osteoarthritis pain while accounting for liver risk and total daily dose.
NURS 5432 Study Edition • Page 3
