NR 603 COMPREHENSIVE ADVANCED
PRACTICE NURSING FINAL EXAM
PREP QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE
1. A 65-year-old male with a history of Type 2 Diabetes and Hypertension presents with a
new finding of albuminuria (UACR 45 mg/g). Which antihypertensive class is the most
appropriate first-line choice for this patient?
A. ACE Inhibitors
B. Thiazide Diuretics
C. Calcium Channel Blockers
D. Beta-Blockers
Answer: A
Conceptual Explanation: ACE inhibitors or ARBs are the first-line treatment for patients
with diabetes and albuminuria because they provide renoprotective effects by reducing
intraglomerular pressure.
2. According to the GOLD 2024 guidelines, what is the required FEV1/FVC ratio post-
bronchodilator to confirm the diagnosis of COPD?
A. Less than 0.70
,B. Less than 0.80
C. Greater than 0.75
D. Less than 0.60
Answer: A
Conceptual Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms
the presence of persistent airflow limitation, which is diagnostic for COPD.
3. A patient presents with a TSH of 12.5 mIU/L and a low Free T4. Which of the following is
the most likely diagnosis?
A. Subclinical Hypothyroidism
B. Primary Hyperthyroidism
C. Secondary Hypothyroidism
D. Primary Hypothyroidism
Answer: D
Conceptual Explanation: Primary hypothyroidism is characterized by an elevated TSH
(indicating the pituitary is working) and a low T4 (indicating the thyroid gland is failing).
4. In the management of Heart Failure with Reduced Ejection Fraction (HFrEF), which
medication class is now recommended as part of the ‘Four Pillars’ of therapy regardless of
diabetic status?
A. SGLT2 Inhibitors
, B. Sulfonylureas
C. GLP-1 Receptor Agonists
D. DPP-4 Inhibitors
Answer: A
Conceptual Explanation: SGLT2 inhibitors (like Dapagliflozin or Empagliflozin) have
shown significant benefits in reducing HF hospitalizations and mortality in HFrEF patients,
even without diabetes.
5. A 45-year-old female presents with a ‘curtain-like’ loss of vision in her right eye. This is a
medical emergency most likely associated with:
A. Acute Angle Closure Glaucoma
B. Retinal Detachment
C. Macular Degeneration
D. Cataracts
Answer: B
Conceptual Explanation: A ‘curtain falling’ over the field of vision is a classic symptom of
retinal detachment, which requires immediate ophthalmologic referral.
6. Which physical examination finding is most characteristic of Osteoarthritis (OA) rather than
Rheumatoid Arthritis (RA)?
A. Heberden’s nodes at the DIP joints
PRACTICE NURSING FINAL EXAM
PREP QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE
1. A 65-year-old male with a history of Type 2 Diabetes and Hypertension presents with a
new finding of albuminuria (UACR 45 mg/g). Which antihypertensive class is the most
appropriate first-line choice for this patient?
A. ACE Inhibitors
B. Thiazide Diuretics
C. Calcium Channel Blockers
D. Beta-Blockers
Answer: A
Conceptual Explanation: ACE inhibitors or ARBs are the first-line treatment for patients
with diabetes and albuminuria because they provide renoprotective effects by reducing
intraglomerular pressure.
2. According to the GOLD 2024 guidelines, what is the required FEV1/FVC ratio post-
bronchodilator to confirm the diagnosis of COPD?
A. Less than 0.70
,B. Less than 0.80
C. Greater than 0.75
D. Less than 0.60
Answer: A
Conceptual Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms
the presence of persistent airflow limitation, which is diagnostic for COPD.
3. A patient presents with a TSH of 12.5 mIU/L and a low Free T4. Which of the following is
the most likely diagnosis?
A. Subclinical Hypothyroidism
B. Primary Hyperthyroidism
C. Secondary Hypothyroidism
D. Primary Hypothyroidism
Answer: D
Conceptual Explanation: Primary hypothyroidism is characterized by an elevated TSH
(indicating the pituitary is working) and a low T4 (indicating the thyroid gland is failing).
4. In the management of Heart Failure with Reduced Ejection Fraction (HFrEF), which
medication class is now recommended as part of the ‘Four Pillars’ of therapy regardless of
diabetic status?
A. SGLT2 Inhibitors
, B. Sulfonylureas
C. GLP-1 Receptor Agonists
D. DPP-4 Inhibitors
Answer: A
Conceptual Explanation: SGLT2 inhibitors (like Dapagliflozin or Empagliflozin) have
shown significant benefits in reducing HF hospitalizations and mortality in HFrEF patients,
even without diabetes.
5. A 45-year-old female presents with a ‘curtain-like’ loss of vision in her right eye. This is a
medical emergency most likely associated with:
A. Acute Angle Closure Glaucoma
B. Retinal Detachment
C. Macular Degeneration
D. Cataracts
Answer: B
Conceptual Explanation: A ‘curtain falling’ over the field of vision is a classic symptom of
retinal detachment, which requires immediate ophthalmologic referral.
6. Which physical examination finding is most characteristic of Osteoarthritis (OA) rather than
Rheumatoid Arthritis (RA)?
A. Heberden’s nodes at the DIP joints
