NR 667 ADVANCED PRACTICE NURSING III FINAL EXAM AND STUDY
GUIDE COMPLETE ACCURATE QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (100% CORRECT VERIFIED SOLUTIONS)
1. A 58-year-old man with hypertension, type 2 diabetes, and chronic kidney
disease returns for follow-up after three months of lifestyle modification
and medication therapy. His blood pressure remains 152/94 mmHg, and
laboratory testing shows persistent albuminuria with an estimated GFR of
48 mL/min/1.73 m². Which medication class would provide blood-pressure
control while also offering renal protection in this patient?
A. Dihydropyridine calcium channel blocker
B. ACE inhibitor
C. Loop diuretic
D. Alpha-1 adrenergic blocker
Answer: B
2. A 72-year-old woman reports several months of exertional substernal chest
pressure that consistently occurs when walking two blocks and resolves
within several minutes of rest. Her ECG at rest is normal, and she has no
pain at the time of evaluation. Which diagnosis best explains this
presentation?
A. Acute pericarditis
B. Unstable angina
C. Stable angina
D. Pulmonary embolism
Answer: C
3. A 67-year-old patient with systolic heart failure presents with increasing
dyspnea, orthopnea, bilateral lower-extremity edema, and a three-pound
weight gain over four days. Examination reveals bibasilar crackles and
elevated jugular venous pressure. Which medication is most appropriate for
rapid relief of the patient's current volume overload?
pg. 1
,A. Furosemide
B. Metoprolol
C. Lisinopril
D. Spironolactone
Answer: A
4. A 45-year-old woman presents with episodic palpitations, tremulousness,
heat intolerance, anxiety, and unexplained weight loss despite increased
appetite. Examination reveals a fine tremor and a diffusely enlarged thyroid.
Which laboratory pattern is most consistent with primary hyperthyroidism?
A. High TSH and high free T4
B. Low TSH and low free T4
C. Normal TSH and low free T4
D. Low TSH and high free T4
Answer: D
5. A 29-year-old woman presents with dysuria, urinary frequency, and
suprapubic discomfort for two days. She denies fever, flank pain, vomiting,
pregnancy, or vaginal discharge. Urinalysis demonstrates leukocyte esterase
and nitrites. Which diagnosis is most likely?
A. Acute uncomplicated cystitis
B. Acute pyelonephritis
C. Nephrolithiasis
D. Pelvic inflammatory disease
Answer: A
6. A 64-year-old man with a history of smoking presents with progressive
exertional dyspnea and chronic productive cough. Spirometry demonstrates
a post-bronchodilator FEV1/FVC ratio below the diagnostic threshold for
persistent airflow obstruction. Which diagnosis is most consistent with
these findings?
pg. 2
,A. Restrictive lung disease
B. Chronic obstructive pulmonary disease
C. Pulmonary edema
D. Interstitial pulmonary fibrosis
Answer: B
7. A 24-year-old woman presents with recurrent episodes of wheezing, chest
tightness, and cough that occur after exposure to cats and improve with a
short-acting bronchodilator. Between episodes, her examination is normal.
Which underlying condition best explains her symptoms?
A. Bronchiectasis
B. Pulmonary embolism
C. Asthma
D. Chronic bronchitis
Answer: C
8. A 61-year-old man with diabetes reports burning pain and numbness in
both feet that is worse at night. Examination reveals decreased vibration
sensation and diminished ankle reflexes bilaterally. Which complication is
most likely responsible?
A. Peripheral arterial disease
B. Lumbar radiculopathy
C. Myopathy
D. Diabetic peripheral neuropathy
Answer: D
9. A 53-year-old woman presents with persistent fatigue, constipation, dry
skin, cold intolerance, and an unexplained 7-kg weight gain. Which
laboratory finding would most strongly support primary hypothyroidism?
A. Elevated TSH with decreased free T4
B. Decreased TSH with elevated free T4
pg. 3
, C. Elevated TSH with elevated free T4
D. Normal TSH with decreased T3 only
Answer: A
10. A 38-year-old man presents with severe unilateral headache associated with
tearing and nasal congestion on the same side. Episodes occur at
approximately the same time each night and last about 60 minutes. Which
headache disorder is most likely?
A. Migraine without aura
B. Tension-type headache
C. Cluster headache
D. Medication-overuse headache
Answer: C
11. A 70-year-old woman presents with sudden-onset right-sided weakness and
expressive aphasia that began 45 minutes ago. She is awake and has no
history of recent surgery or active bleeding. What is the priority diagnostic
study for rapidly determining whether she may be a candidate for acute
reperfusion therapy?
A. Carotid ultrasound
B. Noncontrast CT of the head
C. MRI of the cervical spine
D. EEG
Answer: B
12. A 59-year-old man develops sudden severe chest pain described as tearing
and radiating to his back. Blood pressure is significantly higher in one arm
than the other, and a new diastolic murmur is present. Which condition
should be suspected?
A. Acute aortic dissection
B. Stable angina
pg. 4
GUIDE COMPLETE ACCURATE QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (100% CORRECT VERIFIED SOLUTIONS)
1. A 58-year-old man with hypertension, type 2 diabetes, and chronic kidney
disease returns for follow-up after three months of lifestyle modification
and medication therapy. His blood pressure remains 152/94 mmHg, and
laboratory testing shows persistent albuminuria with an estimated GFR of
48 mL/min/1.73 m². Which medication class would provide blood-pressure
control while also offering renal protection in this patient?
A. Dihydropyridine calcium channel blocker
B. ACE inhibitor
C. Loop diuretic
D. Alpha-1 adrenergic blocker
Answer: B
2. A 72-year-old woman reports several months of exertional substernal chest
pressure that consistently occurs when walking two blocks and resolves
within several minutes of rest. Her ECG at rest is normal, and she has no
pain at the time of evaluation. Which diagnosis best explains this
presentation?
A. Acute pericarditis
B. Unstable angina
C. Stable angina
D. Pulmonary embolism
Answer: C
3. A 67-year-old patient with systolic heart failure presents with increasing
dyspnea, orthopnea, bilateral lower-extremity edema, and a three-pound
weight gain over four days. Examination reveals bibasilar crackles and
elevated jugular venous pressure. Which medication is most appropriate for
rapid relief of the patient's current volume overload?
pg. 1
,A. Furosemide
B. Metoprolol
C. Lisinopril
D. Spironolactone
Answer: A
4. A 45-year-old woman presents with episodic palpitations, tremulousness,
heat intolerance, anxiety, and unexplained weight loss despite increased
appetite. Examination reveals a fine tremor and a diffusely enlarged thyroid.
Which laboratory pattern is most consistent with primary hyperthyroidism?
A. High TSH and high free T4
B. Low TSH and low free T4
C. Normal TSH and low free T4
D. Low TSH and high free T4
Answer: D
5. A 29-year-old woman presents with dysuria, urinary frequency, and
suprapubic discomfort for two days. She denies fever, flank pain, vomiting,
pregnancy, or vaginal discharge. Urinalysis demonstrates leukocyte esterase
and nitrites. Which diagnosis is most likely?
A. Acute uncomplicated cystitis
B. Acute pyelonephritis
C. Nephrolithiasis
D. Pelvic inflammatory disease
Answer: A
6. A 64-year-old man with a history of smoking presents with progressive
exertional dyspnea and chronic productive cough. Spirometry demonstrates
a post-bronchodilator FEV1/FVC ratio below the diagnostic threshold for
persistent airflow obstruction. Which diagnosis is most consistent with
these findings?
pg. 2
,A. Restrictive lung disease
B. Chronic obstructive pulmonary disease
C. Pulmonary edema
D. Interstitial pulmonary fibrosis
Answer: B
7. A 24-year-old woman presents with recurrent episodes of wheezing, chest
tightness, and cough that occur after exposure to cats and improve with a
short-acting bronchodilator. Between episodes, her examination is normal.
Which underlying condition best explains her symptoms?
A. Bronchiectasis
B. Pulmonary embolism
C. Asthma
D. Chronic bronchitis
Answer: C
8. A 61-year-old man with diabetes reports burning pain and numbness in
both feet that is worse at night. Examination reveals decreased vibration
sensation and diminished ankle reflexes bilaterally. Which complication is
most likely responsible?
A. Peripheral arterial disease
B. Lumbar radiculopathy
C. Myopathy
D. Diabetic peripheral neuropathy
Answer: D
9. A 53-year-old woman presents with persistent fatigue, constipation, dry
skin, cold intolerance, and an unexplained 7-kg weight gain. Which
laboratory finding would most strongly support primary hypothyroidism?
A. Elevated TSH with decreased free T4
B. Decreased TSH with elevated free T4
pg. 3
, C. Elevated TSH with elevated free T4
D. Normal TSH with decreased T3 only
Answer: A
10. A 38-year-old man presents with severe unilateral headache associated with
tearing and nasal congestion on the same side. Episodes occur at
approximately the same time each night and last about 60 minutes. Which
headache disorder is most likely?
A. Migraine without aura
B. Tension-type headache
C. Cluster headache
D. Medication-overuse headache
Answer: C
11. A 70-year-old woman presents with sudden-onset right-sided weakness and
expressive aphasia that began 45 minutes ago. She is awake and has no
history of recent surgery or active bleeding. What is the priority diagnostic
study for rapidly determining whether she may be a candidate for acute
reperfusion therapy?
A. Carotid ultrasound
B. Noncontrast CT of the head
C. MRI of the cervical spine
D. EEG
Answer: B
12. A 59-year-old man develops sudden severe chest pain described as tearing
and radiating to his back. Blood pressure is significantly higher in one arm
than the other, and a new diastolic murmur is present. Which condition
should be suspected?
A. Acute aortic dissection
B. Stable angina
pg. 4
