NSG 6430 EXAM-FINAL 2026/2027- CORRECTLY ANSWERED QUESTIONS.
1. A 50-year-old man with a history of osteoarthritis presents with knee pain that is interfering with
his daily activities. What is the most appropriate initial non-pharmacological management?
Correct answer:
Physical therapy and weight loss
For a patient with osteoarthritis experiencing knee pain that interferes with daily activities, the most
appropriate initial non-pharmacological management involves educating them about osteoarthritis,
recommending exercises to improve joint flexibility and strength, emphasizing weight management if
overweight.
2. Your patient with a large bump on their cheek should be evaluated and ruled out for which
cardiac complication-linked diagnosis?
Correct answer:
Perioral abscess
Perioral abscesses are linked to complications since the bloodstream access is so easy for pathogens.
The remainder do not represent any cardiac risk.
3. A grade III/VI, low-pitched, diastolic, rumbling murmur heard at the apex, and best heard in the
left lateral decubitus position, is most indicative of which of the following types of valve problem?
Correct Answer:
Mitral stenosis
4. A 70-year-old man presents with acute onset of right-sided weakness and difficulty speaking. His
symptoms started 2 hours ago. What is the most appropriate initial intervention?
Correct Answer:
Perform a CT scan of the head
A CT scan may be performed in cases of right-sided weakness and difficulty speaking (aphasia) to
assess for possible acute neurological conditions, such as stroke or intracranial hemorrhage. Stroke is a
leading cause of sudden onset right-sided weakness and aphasia. A CT scan of the brain is often the
initial imaging test used to assess for acute ischemic stroke (due to a blocked blood vessel) or
hemorrhagic stroke (due to bleeding into the brain).
5. Patients who present with SAIDH should be treated with which of the following regimens?
Correct Answer:
Free water restriction
SAIDH will have an increased expression of antidiuretic hormone (ADH) and as such free water should
be restricted to help normalize the sodium balance. In some cases, loop diuretics are used to help
promote elimination of free water.
6. The patient you are caring for has experienced a low blood pressure for a period of 2 hours
before treatment with a fluid bolus. Which type acute renal dysfunction is being described in this
scenario?
Correct answer:
Prerenal
Inability to provide driving pressure to the glomerulus of the kidney such as hypotension is an example of
prerenal source of renal dysfunction.
7. Multimodal analgesia involves the use of multiple agents to avoid reliance on which particular
class of medication?
Correct answer:
,Opioids
Multimodal analgesia is a concept of care designed to reduce the reliance and risks of overuse of opioids.
8. An adult male is seen for an initial visit. He denies tobacco, drug, or alcohol use. He has a
sedentary lifestyle and no family history of diabetes. BP = 120/80, P = 76, and BMI = 31. Which of
the following diabetes screening tests should the nurse practitioner order?
Correct answer:
Fasting plasma glucose
With a sedentary lifestyle, a BMI of 31, on an initial visit establish a baseline, a fasting glucose is an
appropriate response to specifically evaluate the diabetes screening for this patient.
9. Your patient has been noticing bilateral joint pain in the knees and feet for about 6 months and
has been started on methotrexate. Which of the following diagnoses correlate to this treatment
plan?
Correct answer:
Rheumatoid arthritis
This is a classic diagnosis and treatment of RA. OA is the same as DJD, and PMR is typically located in
the upper chest and shoulder girdle.
10. The most important diagnostic factor in evaluating angina pectoris is the patient’s:
Correct Answer:
History
When it comes to cardiac patients, it’s important to remember that history is the most important diagnostic
factor in evaluating angina pectoris. A patient’s history can easily make the diagnosis by simply providing
a history of their precipitating factors and symptoms, such as exertional dyspnea, Reproducible, cardiac
stressors such as exercise, strenuous activity, and the associated symptoms. Cardiac MRI may evaluate
the patient’s heart with find detail, but it does not show active ischemia well, rather evidence of old MI and
ventricular wall thinning. Physical examination likewise is not very particular to cardiac patients and their
cardiac disease state, and although there may be some associated signs, they are not specific.
Echocardiogram is also useful tool to evaluate ejection fraction and valve/wall function, but this is not
showcase ischemia well.
11. An adult female presents with the following symptoms: clear nasal discharge, nasal obstruction
and tenderness over the antrum, throbbing facial pain referred to the supraorbital area and
worsened by head movements or stooping for 15 days. Which antibiotic is appropriate for initial
treatment of sinusitis?
Correct answer:
Amoxicillin-clavulanate (Augmentin)
Amoxicillin-clavulanate, commonly known by the brand name Augmentin, is frequently prescribed for
sinusitis when the infection is suspected to be bacterial and is considered moderate to severe.
12. A patient who presents to your clinic with an acute change in facial symmetry, inability to speak
clearly and unilateral muscular weakness should be transported for evaluation immediately as
treatment for embolic stroke with tPA within which timeframe?
Correct answer:
Less than 4.5 hrs
4.5 hrs is considered the end of the window for tPA therapy unless otherwise contraindicated.
13. Your patient with a history of two coronary stents and a LDL of 190 has been started on lipid-
lowering statin therapy on three separate attempts with considerable side effects such as leg pain
, and in one event, hospitalization for rhabdomyolysis. Which is the best option moving forward to
manage their lipids?
Correct answer:
Initiate PCSK9 Inhibitor therapy
Aspirin is not considered a lipid lowering agent. History of statin-induced rhabdomyolysis is a
contraindication for further statin attempts. Ezetimibe as monotherapy does not provide any appreciable
decrease in LDL to goal of <100 for proven CAD (patient has stents in place). PCSK9 Inhibitors are the
best available drug class for this patient.
14. A geriatric patient with a history of gout presents with an acute attack. He had stopped taking
allopurinol (Zyloprim) for a few months but resumed taking it a few days ago when the pain
returned. He says that the pain is getting worse. The nurse practitioner should:
Correct Answer:
Start the patient on a short-term steroid
Starting a patient on a short-term steroid regimen during a gout attack can help provide rapid relief from
inflammation and pain associated with the condition. Steroids can provide quick relief from the severe
pain and swelling characteristic of a gout attack. This can significantly improve the patient's comfort and
mobility within a short period.
15. An adult female returns to the clinic with severe profuse watery diarrhea, abdominal pain, and
cramping after treatment with Cipro x 10 days. WBC is 12.5, stool culture is positive for c diff. The
NP would recommend:
Correct answer:
Metronidazole 500 tid for 10-14 d
Treatment of C Diff should include metronidazole (Flagyl) or PO vancomycin. Of these options, the only
correct option is metronidazole.
16. A patient diagnosed with iron deficiency anemia requires iron supplementation. Which of the
following treatments would likely be ineffective?
Correct Answer:
Ferrous sulfate 325 mg PO BID for a 43 y.o. F s/p gastric bypass 2 years ago
Patients who have undergone bariatric surgery have a permanent loss and/or alteration of gastric space
and subsequent decrease in the production of HCL and/or enterocytes. This loss decreases the
conversion/absorption of ferric iron (present in food) into the usable ferrous form. Any PO administration
of either ferrous or ferric iron is less likely to be absorbed in adequate amounts after gastric bypass or
other gastric procedures.
17. An 86-year-old patient is experiencing radiculopathy-associated lower back pain that has not
improved over the past 4 weeks. The medical history includes a lumbar discectomy. The best
type of imaging study for evaluating this patient would be a/an:
Correct answer:
MRI
MRI is the imaging modality of choice for evaluating the spine post-lumbar discectomy. It can help
visualize the anatomy of the spine, including any residual or recurrent disc herniation, scar tissue
formation, spinal stenosis, or other structural abnormalities affecting nerve roots.
18. A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle
spotting. She has not missed any doses and uses no other medication. Which of the following is
appropriate?
Correct answer:
Providing reassurance
1. A 50-year-old man with a history of osteoarthritis presents with knee pain that is interfering with
his daily activities. What is the most appropriate initial non-pharmacological management?
Correct answer:
Physical therapy and weight loss
For a patient with osteoarthritis experiencing knee pain that interferes with daily activities, the most
appropriate initial non-pharmacological management involves educating them about osteoarthritis,
recommending exercises to improve joint flexibility and strength, emphasizing weight management if
overweight.
2. Your patient with a large bump on their cheek should be evaluated and ruled out for which
cardiac complication-linked diagnosis?
Correct answer:
Perioral abscess
Perioral abscesses are linked to complications since the bloodstream access is so easy for pathogens.
The remainder do not represent any cardiac risk.
3. A grade III/VI, low-pitched, diastolic, rumbling murmur heard at the apex, and best heard in the
left lateral decubitus position, is most indicative of which of the following types of valve problem?
Correct Answer:
Mitral stenosis
4. A 70-year-old man presents with acute onset of right-sided weakness and difficulty speaking. His
symptoms started 2 hours ago. What is the most appropriate initial intervention?
Correct Answer:
Perform a CT scan of the head
A CT scan may be performed in cases of right-sided weakness and difficulty speaking (aphasia) to
assess for possible acute neurological conditions, such as stroke or intracranial hemorrhage. Stroke is a
leading cause of sudden onset right-sided weakness and aphasia. A CT scan of the brain is often the
initial imaging test used to assess for acute ischemic stroke (due to a blocked blood vessel) or
hemorrhagic stroke (due to bleeding into the brain).
5. Patients who present with SAIDH should be treated with which of the following regimens?
Correct Answer:
Free water restriction
SAIDH will have an increased expression of antidiuretic hormone (ADH) and as such free water should
be restricted to help normalize the sodium balance. In some cases, loop diuretics are used to help
promote elimination of free water.
6. The patient you are caring for has experienced a low blood pressure for a period of 2 hours
before treatment with a fluid bolus. Which type acute renal dysfunction is being described in this
scenario?
Correct answer:
Prerenal
Inability to provide driving pressure to the glomerulus of the kidney such as hypotension is an example of
prerenal source of renal dysfunction.
7. Multimodal analgesia involves the use of multiple agents to avoid reliance on which particular
class of medication?
Correct answer:
,Opioids
Multimodal analgesia is a concept of care designed to reduce the reliance and risks of overuse of opioids.
8. An adult male is seen for an initial visit. He denies tobacco, drug, or alcohol use. He has a
sedentary lifestyle and no family history of diabetes. BP = 120/80, P = 76, and BMI = 31. Which of
the following diabetes screening tests should the nurse practitioner order?
Correct answer:
Fasting plasma glucose
With a sedentary lifestyle, a BMI of 31, on an initial visit establish a baseline, a fasting glucose is an
appropriate response to specifically evaluate the diabetes screening for this patient.
9. Your patient has been noticing bilateral joint pain in the knees and feet for about 6 months and
has been started on methotrexate. Which of the following diagnoses correlate to this treatment
plan?
Correct answer:
Rheumatoid arthritis
This is a classic diagnosis and treatment of RA. OA is the same as DJD, and PMR is typically located in
the upper chest and shoulder girdle.
10. The most important diagnostic factor in evaluating angina pectoris is the patient’s:
Correct Answer:
History
When it comes to cardiac patients, it’s important to remember that history is the most important diagnostic
factor in evaluating angina pectoris. A patient’s history can easily make the diagnosis by simply providing
a history of their precipitating factors and symptoms, such as exertional dyspnea, Reproducible, cardiac
stressors such as exercise, strenuous activity, and the associated symptoms. Cardiac MRI may evaluate
the patient’s heart with find detail, but it does not show active ischemia well, rather evidence of old MI and
ventricular wall thinning. Physical examination likewise is not very particular to cardiac patients and their
cardiac disease state, and although there may be some associated signs, they are not specific.
Echocardiogram is also useful tool to evaluate ejection fraction and valve/wall function, but this is not
showcase ischemia well.
11. An adult female presents with the following symptoms: clear nasal discharge, nasal obstruction
and tenderness over the antrum, throbbing facial pain referred to the supraorbital area and
worsened by head movements or stooping for 15 days. Which antibiotic is appropriate for initial
treatment of sinusitis?
Correct answer:
Amoxicillin-clavulanate (Augmentin)
Amoxicillin-clavulanate, commonly known by the brand name Augmentin, is frequently prescribed for
sinusitis when the infection is suspected to be bacterial and is considered moderate to severe.
12. A patient who presents to your clinic with an acute change in facial symmetry, inability to speak
clearly and unilateral muscular weakness should be transported for evaluation immediately as
treatment for embolic stroke with tPA within which timeframe?
Correct answer:
Less than 4.5 hrs
4.5 hrs is considered the end of the window for tPA therapy unless otherwise contraindicated.
13. Your patient with a history of two coronary stents and a LDL of 190 has been started on lipid-
lowering statin therapy on three separate attempts with considerable side effects such as leg pain
, and in one event, hospitalization for rhabdomyolysis. Which is the best option moving forward to
manage their lipids?
Correct answer:
Initiate PCSK9 Inhibitor therapy
Aspirin is not considered a lipid lowering agent. History of statin-induced rhabdomyolysis is a
contraindication for further statin attempts. Ezetimibe as monotherapy does not provide any appreciable
decrease in LDL to goal of <100 for proven CAD (patient has stents in place). PCSK9 Inhibitors are the
best available drug class for this patient.
14. A geriatric patient with a history of gout presents with an acute attack. He had stopped taking
allopurinol (Zyloprim) for a few months but resumed taking it a few days ago when the pain
returned. He says that the pain is getting worse. The nurse practitioner should:
Correct Answer:
Start the patient on a short-term steroid
Starting a patient on a short-term steroid regimen during a gout attack can help provide rapid relief from
inflammation and pain associated with the condition. Steroids can provide quick relief from the severe
pain and swelling characteristic of a gout attack. This can significantly improve the patient's comfort and
mobility within a short period.
15. An adult female returns to the clinic with severe profuse watery diarrhea, abdominal pain, and
cramping after treatment with Cipro x 10 days. WBC is 12.5, stool culture is positive for c diff. The
NP would recommend:
Correct answer:
Metronidazole 500 tid for 10-14 d
Treatment of C Diff should include metronidazole (Flagyl) or PO vancomycin. Of these options, the only
correct option is metronidazole.
16. A patient diagnosed with iron deficiency anemia requires iron supplementation. Which of the
following treatments would likely be ineffective?
Correct Answer:
Ferrous sulfate 325 mg PO BID for a 43 y.o. F s/p gastric bypass 2 years ago
Patients who have undergone bariatric surgery have a permanent loss and/or alteration of gastric space
and subsequent decrease in the production of HCL and/or enterocytes. This loss decreases the
conversion/absorption of ferric iron (present in food) into the usable ferrous form. Any PO administration
of either ferrous or ferric iron is less likely to be absorbed in adequate amounts after gastric bypass or
other gastric procedures.
17. An 86-year-old patient is experiencing radiculopathy-associated lower back pain that has not
improved over the past 4 weeks. The medical history includes a lumbar discectomy. The best
type of imaging study for evaluating this patient would be a/an:
Correct answer:
MRI
MRI is the imaging modality of choice for evaluating the spine post-lumbar discectomy. It can help
visualize the anatomy of the spine, including any residual or recurrent disc herniation, scar tissue
formation, spinal stenosis, or other structural abnormalities affecting nerve roots.
18. A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle
spotting. She has not missed any doses and uses no other medication. Which of the following is
appropriate?
Correct answer:
Providing reassurance
