NR 603 ADVANCED NURSING
PRACTICE COMPREHENSIVE FINAL
EXAM QUESTIONS AND ANSWERS
WITH VERIFIED SOLUTIONS 2026/2027
UPDATE
1. A 68-year-old patient with a history of heart failure and a reduced ejection fraction (HFrEF)
of 35% presents for a follow-up. Which medication class is now considered a ‘pillar’ of
therapy to improve survival and reduce hospitalizations, regardless of diabetic status?
A. Loop Diuretics
B. SGLT2 Inhibitors
C. Calcium Channel Blockers
D. Alpha-1 Blockers
Answer: B
Conceptual Explanation: Recent clinical trials and guidelines (AHA/ACC) have established
SGLT2 inhibitors as one of the four pillars of HFrEF management, alongside
ARNI/ACEi/ARB, Beta-blockers, and MRAs, due to their significant impact on mortality and
rehospitalization.
,2. When interpreting a pulmonary function test (PFT) for a patient suspected of having COPD,
which of the following findings is diagnostic for persistent airflow limitation?
A. Post-bronchodilator FEV1/FVC ratio < 0.70
B. Pre-bronchodilator FEV1/FVC ratio < 0.80
C. Increase in FEV1 > 12% after albuterol administration
D. Total Lung Capacity (TLC) < 80% of predicted
Answer: A
Conceptual Explanation: According to GOLD guidelines, a post-bronchodilator FEV1/FVC
ratio of less than 0.70 is the requisite finding to confirm persistent airflow limitation,
characterizing COPD.
3. A 52-year-old female presents with a T-score of -2.6 on her DXA scan. She has no history of
fractures. According to the WHO criteria, how is this result classified?
A. Normal bone density
B. Osteopenia
C. Severe osteoporosis
D. Osteoporosis
Answer: D
Conceptual Explanation: Osteoporosis is defined by a T-score of -2.5 or lower. Osteopenia
ranges from -1.0 to -2.4. A T-score of -2.6 meets the threshold for osteoporosis.
, 4. In the management of Type 2 Diabetes, which medication should be prioritized for a
patient with established Atherosclerotic Cardiovascular Disease (ASCVD)?
A. DPP-4 Inhibitors
B. Sulfonylureas
C. Thiazolidinediones
D. GLP-1 Receptor Agonists
Answer: D
Conceptual Explanation: ADA Standards of Care recommend GLP-1 receptor agonists
with proven CVD benefit or SGLT2 inhibitors for patients with established ASCVD to reduce
major adverse cardiovascular events (MACE).
5. A patient presents with a TSH of 12.4 mIU/L and a low Free T4. Which of the following is
the most appropriate initial management step?
A. Initiate Methimazole 10 mg daily
B. Observe and recheck in 6 months
C. Initiate Levothyroxine at 1.6 mcg/kg/day
D. Order a radioactive iodine uptake scan
Answer: C
PRACTICE COMPREHENSIVE FINAL
EXAM QUESTIONS AND ANSWERS
WITH VERIFIED SOLUTIONS 2026/2027
UPDATE
1. A 68-year-old patient with a history of heart failure and a reduced ejection fraction (HFrEF)
of 35% presents for a follow-up. Which medication class is now considered a ‘pillar’ of
therapy to improve survival and reduce hospitalizations, regardless of diabetic status?
A. Loop Diuretics
B. SGLT2 Inhibitors
C. Calcium Channel Blockers
D. Alpha-1 Blockers
Answer: B
Conceptual Explanation: Recent clinical trials and guidelines (AHA/ACC) have established
SGLT2 inhibitors as one of the four pillars of HFrEF management, alongside
ARNI/ACEi/ARB, Beta-blockers, and MRAs, due to their significant impact on mortality and
rehospitalization.
,2. When interpreting a pulmonary function test (PFT) for a patient suspected of having COPD,
which of the following findings is diagnostic for persistent airflow limitation?
A. Post-bronchodilator FEV1/FVC ratio < 0.70
B. Pre-bronchodilator FEV1/FVC ratio < 0.80
C. Increase in FEV1 > 12% after albuterol administration
D. Total Lung Capacity (TLC) < 80% of predicted
Answer: A
Conceptual Explanation: According to GOLD guidelines, a post-bronchodilator FEV1/FVC
ratio of less than 0.70 is the requisite finding to confirm persistent airflow limitation,
characterizing COPD.
3. A 52-year-old female presents with a T-score of -2.6 on her DXA scan. She has no history of
fractures. According to the WHO criteria, how is this result classified?
A. Normal bone density
B. Osteopenia
C. Severe osteoporosis
D. Osteoporosis
Answer: D
Conceptual Explanation: Osteoporosis is defined by a T-score of -2.5 or lower. Osteopenia
ranges from -1.0 to -2.4. A T-score of -2.6 meets the threshold for osteoporosis.
, 4. In the management of Type 2 Diabetes, which medication should be prioritized for a
patient with established Atherosclerotic Cardiovascular Disease (ASCVD)?
A. DPP-4 Inhibitors
B. Sulfonylureas
C. Thiazolidinediones
D. GLP-1 Receptor Agonists
Answer: D
Conceptual Explanation: ADA Standards of Care recommend GLP-1 receptor agonists
with proven CVD benefit or SGLT2 inhibitors for patients with established ASCVD to reduce
major adverse cardiovascular events (MACE).
5. A patient presents with a TSH of 12.4 mIU/L and a low Free T4. Which of the following is
the most appropriate initial management step?
A. Initiate Methimazole 10 mg daily
B. Observe and recheck in 6 months
C. Initiate Levothyroxine at 1.6 mcg/kg/day
D. Order a radioactive iodine uptake scan
Answer: C
