NR 603 ADVANCED CLINICAL NURSING
COMPREHENSIVE EXAM PREP
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE
1. A 58-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents for a follow-up. He is currently taking Lisinopril 20mg daily and Carvedilol 12.5mg
twice daily. His blood pressure is 118/74 mmHg and heart rate is 62 bpm. Which of the
following is the next best step in optimizing his guideline-directed medical therapy (GDMT)?
A. Add Digoxin 0.125mg daily
B. Increase Carvedilol to 25mg twice daily
C. Add Furosemide 20mg daily
D. Switch Lisinopril to Sacubitril/Valsartan
Answer: D
Conceptual Explanation: According to the latest heart failure guidelines, an ARNI
(Sacubitril/Valsartan) is preferred over an ACE inhibitor or ARB for symptomatic HFrEF to
further reduce morbidity and mortality.
,2. A 64-year-old female smoker presents with worsening dyspnea and productive cough. Her
FEV1/FVC ratio is 0.62 and her FEV1 is 55% of predicted. Based on GOLD criteria, which
classification and initial treatment is most appropriate?
A. GOLD 2 (Moderate); LAMA or LABA
B. GOLD 1 (Mild); SABA PRN
C. GOLD 3 (Severe); ICS and LABA
D. GOLD 4 (Very Severe); Triple therapy
Answer: A
Conceptual Explanation: An FEV1/FVC < 0.70 confirms COPD. An FEV1 between 50% and
80% predicted indicates GOLD 2 (Moderate). Initial maintenance therapy for symptomatic
patients usually starts with a long-acting bronchodilator (LAMA or LABA).
3. A 45-year-old patient presents with a TSH level of 8.2 mIU/L and a normal Free T4. The
patient reports mild fatigue but no other symptoms. What is the most appropriate
management according to current guidelines?
A. Repeat TSH and Free T4 in 3–6 months
B. Start Levothyroxine 50mcg daily
C. Order a thyroid ultrasound immediately
D. Initiate Methimazole therapy
Answer: A
, Conceptual Explanation: This patient has subclinical hypothyroidism (elevated TSH,
normal T4). Treatment is generally reserved for TSH > 10, presence of antibodies, or
significant symptoms. Repeating tests in 3-6 months is standard to confirm persistence.
4. Which of the following physical exam findings is most suggestive of an ACL (Anterior
Cruciate Ligament) tear?
A. Positive McMurray test
B. Positive Lachman test
C. Positive Finkelstein test
D. Positive Phalen sign
Answer: B
Conceptual Explanation: The Lachman test is the most sensitive physical examination
maneuver for detecting an ACL tear.
5. A 72-year-old male with a history of CKD Stage 3 presents with a blood pressure of 152/92
mmHg. Which of the following antihypertensive classes is the first-line choice for this patient
to prevent disease progression?
A. Calcium Channel Blocker
B. Thiazide Diuretic
C. ACE Inhibitor
D. Beta-Blocker
COMPREHENSIVE EXAM PREP
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE
1. A 58-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents for a follow-up. He is currently taking Lisinopril 20mg daily and Carvedilol 12.5mg
twice daily. His blood pressure is 118/74 mmHg and heart rate is 62 bpm. Which of the
following is the next best step in optimizing his guideline-directed medical therapy (GDMT)?
A. Add Digoxin 0.125mg daily
B. Increase Carvedilol to 25mg twice daily
C. Add Furosemide 20mg daily
D. Switch Lisinopril to Sacubitril/Valsartan
Answer: D
Conceptual Explanation: According to the latest heart failure guidelines, an ARNI
(Sacubitril/Valsartan) is preferred over an ACE inhibitor or ARB for symptomatic HFrEF to
further reduce morbidity and mortality.
,2. A 64-year-old female smoker presents with worsening dyspnea and productive cough. Her
FEV1/FVC ratio is 0.62 and her FEV1 is 55% of predicted. Based on GOLD criteria, which
classification and initial treatment is most appropriate?
A. GOLD 2 (Moderate); LAMA or LABA
B. GOLD 1 (Mild); SABA PRN
C. GOLD 3 (Severe); ICS and LABA
D. GOLD 4 (Very Severe); Triple therapy
Answer: A
Conceptual Explanation: An FEV1/FVC < 0.70 confirms COPD. An FEV1 between 50% and
80% predicted indicates GOLD 2 (Moderate). Initial maintenance therapy for symptomatic
patients usually starts with a long-acting bronchodilator (LAMA or LABA).
3. A 45-year-old patient presents with a TSH level of 8.2 mIU/L and a normal Free T4. The
patient reports mild fatigue but no other symptoms. What is the most appropriate
management according to current guidelines?
A. Repeat TSH and Free T4 in 3–6 months
B. Start Levothyroxine 50mcg daily
C. Order a thyroid ultrasound immediately
D. Initiate Methimazole therapy
Answer: A
, Conceptual Explanation: This patient has subclinical hypothyroidism (elevated TSH,
normal T4). Treatment is generally reserved for TSH > 10, presence of antibodies, or
significant symptoms. Repeating tests in 3-6 months is standard to confirm persistence.
4. Which of the following physical exam findings is most suggestive of an ACL (Anterior
Cruciate Ligament) tear?
A. Positive McMurray test
B. Positive Lachman test
C. Positive Finkelstein test
D. Positive Phalen sign
Answer: B
Conceptual Explanation: The Lachman test is the most sensitive physical examination
maneuver for detecting an ACL tear.
5. A 72-year-old male with a history of CKD Stage 3 presents with a blood pressure of 152/92
mmHg. Which of the following antihypertensive classes is the first-line choice for this patient
to prevent disease progression?
A. Calcium Channel Blocker
B. Thiazide Diuretic
C. ACE Inhibitor
D. Beta-Blocker
