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NUR 676 Final Exam 2025 | Verified Exam
Questions with Correct Answers | Graded A+
| Just Released Updated Version
1. A nurse practitioner (NP) is evaluating a patient with acute chest pain. Which diagnostic
test is most critical to rule out myocardial infarction?
A. Chest X-ray
B. Troponin levels
C. Complete blood count
D. D-dimer
Correct Answer: B. Troponin levels
Rationale: Troponin levels are highly specific for myocardial injury and are the gold
standard for diagnosing myocardial infarction. Chest X-ray evaluates lung conditions,
CBC assesses infection or anemia, and D-dimer screens for thromboembolism.
2. A patient with chronic kidney disease (CKD) stage 4 presents with a potassium level of
6.2 mEq/L. What is the priority intervention?
A. Administer furosemide
B. Initiate sodium polystyrene sulfonate
C. Increase dietary potassium intake
D. Administer IV fluids
Correct Answer: B. Initiate sodium polystyrene sulfonate
Rationale: Hyperkalemia in CKD requires urgent treatment to prevent cardiac
arrhythmias. Sodium polystyrene sulfonate (Kayexalate) reduces potassium levels by
exchanging sodium for potassium in the GI tract. Furosemide is less effective in
advanced CKD, dietary potassium should be restricted, and IV fluids are not the priority.
3. An NP is managing a patient with type 2 diabetes and an A1c of 8.5%. Which medication
adjustment is most appropriate?
A. Discontinue metformin
B. Add a GLP-1 receptor agonist
C. Reduce insulin dosage
D. Switch to sulfonylureas
Correct Answer: B. Add a GLP-1 receptor agonist
Rationale: An A1c of 8.5% indicates poor glycemic control. Adding a GLP-1 receptor
agonist enhances glucose control and promotes weight loss. Discontinuing metformin is
inappropriate, insulin reduction risks hyperglycemia, and sulfonylureas increase
hypoglycemia risk.
4. A patient with suspected pulmonary embolism presents with dyspnea and tachycardia.
What is the initial diagnostic step?
A. Order a V/Q scan
B. Perform a D-dimer test
C. Initiate heparin therapy
D. Request a chest CT angiogram
Correct Answer: B. Perform a D-dimer test
, 2
Rationale: A D-dimer test is a sensitive screening tool for pulmonary embolism in
patients with low to moderate risk. A negative result may rule out PE, while a positive
result warrants further imaging (e.g., CT angiogram). Starting heparin or ordering
imaging without screening is premature.
5. A patient with hypertension is prescribed lisinopril. Which electrolyte should be
monitored closely?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Correct Answer: B. Potassium
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia by reducing aldosterone
secretion. Sodium, calcium, and magnesium are less affected.
6. A 65-year-old patient with COPD reports worsening dyspnea when lying flat. Which
intervention should the NP recommend?
A. Lie flat to promote lung expansion
B. Use an incentive spirometer hourly
C. Sleep in a semi-Fowler’s position
D. Avoid oxygen therapy
Correct Answer: C. Sleep in a semi-Fowler’s position
Rationale: Semi-Fowler’s position (head elevated) reduces diaphragm pressure and
improves breathing in COPD. Lying flat worsens dyspnea, spirometry is not position-
specific, and oxygen may be necessary.
7. A patient with a history of atrial fibrillation is prescribed warfarin. Which dietary
instruction is most important?
A. Increase vitamin C intake
B. Limit foods high in vitamin K
C. Avoid carbohydrates
D. Reduce protein intake
Correct Answer: B. Limit foods high in vitamin K
Rationale: Vitamin K antagonizes warfarin’s anticoagulant effect. Limiting foods like
spinach and kale ensures consistent INR levels. Other nutrients have minimal impact.
8. A patient presents with right-sided weakness and slurred speech. What is the NP’s
priority action?
A. Order an EKG
B. Administer aspirin
C. Evaluate for stroke and arrange transport
D. Perform a blood glucose test
Correct Answer: C. Evaluate for stroke and arrange transport
Rationale: Right-sided weakness and slurred speech suggest stroke, requiring urgent
evaluation and hospital transfer for imaging and possible thrombolytics. EKG, aspirin,
and glucose tests are secondary.
9. A patient with heart failure reports a 4-pound weight gain in 3 days. What is the NP’s
first action?
A. Increase diuretic dosage
B. Assess for fluid overload
, 3
C. Order a chest X-ray
D. Restrict physical activity
Correct Answer: B. Assess for fluid overload
Rationale: Rapid weight gain in heart failure suggests fluid retention. Assessment (e.g.,
lung sounds, edema) guides treatment. Adjusting diuretics, ordering imaging, or
restricting activity follows assessment.
10. Which finding in a patient with acute pancreatitis requires immediate intervention?
A. Epigastric pain
B. Nausea and vomiting
C. Hypotension
D. Elevated amylase
Correct Answer: C. Hypotension
Rationale: Hypotension indicates shock, a life-threatening complication of pancreatitis.
Pain, nausea, and elevated amylase are expected but less urgent.
11. A patient with a new diagnosis of hypothyroidism is prescribed levothyroxine. When
should it be taken?
A. With meals
B. At bedtime
C. On an empty stomach
D. With other medications
Correct Answer: C. On an empty stomach
Rationale: Levothyroxine is best absorbed on an empty stomach, typically in the
morning, to maximize efficacy. Food and other medications reduce absorption.
12. A patient with rheumatoid arthritis is prescribed methotrexate. Which laboratory test is
most critical to monitor?
A. Creatinine
B. Liver function tests
C. Hemoglobin
D. Platelet count
Correct Answer: B. Liver function tests
Rationale: Methotrexate can cause hepatotoxicity, requiring regular liver function
monitoring. Other tests are important but secondary.
13. A patient with suspected appendicitis reports right lower quadrant pain. Which physical
exam technique confirms the diagnosis?
A. Murphy’s sign
B. Rovsing’s sign
C. Psoas sign
D. Cullen’s sign
Correct Answer: B. Rovsing’s sign
Rationale: Rovsing’s sign (pain in the right lower quadrant when palpating the left) is
specific for appendicitis. Murphy’s sign indicates gallbladder issues, psoas sign suggests
retrocecal appendix, and Cullen’s sign is for internal bleeding.
14. A patient with a history of seizures is prescribed phenytoin. Which adverse effect should
the NP monitor?
A. Hyperglycemia
B. Gingival hyperplasia
NUR 676 Final Exam 2025 | Verified Exam
Questions with Correct Answers | Graded A+
| Just Released Updated Version
1. A nurse practitioner (NP) is evaluating a patient with acute chest pain. Which diagnostic
test is most critical to rule out myocardial infarction?
A. Chest X-ray
B. Troponin levels
C. Complete blood count
D. D-dimer
Correct Answer: B. Troponin levels
Rationale: Troponin levels are highly specific for myocardial injury and are the gold
standard for diagnosing myocardial infarction. Chest X-ray evaluates lung conditions,
CBC assesses infection or anemia, and D-dimer screens for thromboembolism.
2. A patient with chronic kidney disease (CKD) stage 4 presents with a potassium level of
6.2 mEq/L. What is the priority intervention?
A. Administer furosemide
B. Initiate sodium polystyrene sulfonate
C. Increase dietary potassium intake
D. Administer IV fluids
Correct Answer: B. Initiate sodium polystyrene sulfonate
Rationale: Hyperkalemia in CKD requires urgent treatment to prevent cardiac
arrhythmias. Sodium polystyrene sulfonate (Kayexalate) reduces potassium levels by
exchanging sodium for potassium in the GI tract. Furosemide is less effective in
advanced CKD, dietary potassium should be restricted, and IV fluids are not the priority.
3. An NP is managing a patient with type 2 diabetes and an A1c of 8.5%. Which medication
adjustment is most appropriate?
A. Discontinue metformin
B. Add a GLP-1 receptor agonist
C. Reduce insulin dosage
D. Switch to sulfonylureas
Correct Answer: B. Add a GLP-1 receptor agonist
Rationale: An A1c of 8.5% indicates poor glycemic control. Adding a GLP-1 receptor
agonist enhances glucose control and promotes weight loss. Discontinuing metformin is
inappropriate, insulin reduction risks hyperglycemia, and sulfonylureas increase
hypoglycemia risk.
4. A patient with suspected pulmonary embolism presents with dyspnea and tachycardia.
What is the initial diagnostic step?
A. Order a V/Q scan
B. Perform a D-dimer test
C. Initiate heparin therapy
D. Request a chest CT angiogram
Correct Answer: B. Perform a D-dimer test
, 2
Rationale: A D-dimer test is a sensitive screening tool for pulmonary embolism in
patients with low to moderate risk. A negative result may rule out PE, while a positive
result warrants further imaging (e.g., CT angiogram). Starting heparin or ordering
imaging without screening is premature.
5. A patient with hypertension is prescribed lisinopril. Which electrolyte should be
monitored closely?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Correct Answer: B. Potassium
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia by reducing aldosterone
secretion. Sodium, calcium, and magnesium are less affected.
6. A 65-year-old patient with COPD reports worsening dyspnea when lying flat. Which
intervention should the NP recommend?
A. Lie flat to promote lung expansion
B. Use an incentive spirometer hourly
C. Sleep in a semi-Fowler’s position
D. Avoid oxygen therapy
Correct Answer: C. Sleep in a semi-Fowler’s position
Rationale: Semi-Fowler’s position (head elevated) reduces diaphragm pressure and
improves breathing in COPD. Lying flat worsens dyspnea, spirometry is not position-
specific, and oxygen may be necessary.
7. A patient with a history of atrial fibrillation is prescribed warfarin. Which dietary
instruction is most important?
A. Increase vitamin C intake
B. Limit foods high in vitamin K
C. Avoid carbohydrates
D. Reduce protein intake
Correct Answer: B. Limit foods high in vitamin K
Rationale: Vitamin K antagonizes warfarin’s anticoagulant effect. Limiting foods like
spinach and kale ensures consistent INR levels. Other nutrients have minimal impact.
8. A patient presents with right-sided weakness and slurred speech. What is the NP’s
priority action?
A. Order an EKG
B. Administer aspirin
C. Evaluate for stroke and arrange transport
D. Perform a blood glucose test
Correct Answer: C. Evaluate for stroke and arrange transport
Rationale: Right-sided weakness and slurred speech suggest stroke, requiring urgent
evaluation and hospital transfer for imaging and possible thrombolytics. EKG, aspirin,
and glucose tests are secondary.
9. A patient with heart failure reports a 4-pound weight gain in 3 days. What is the NP’s
first action?
A. Increase diuretic dosage
B. Assess for fluid overload
, 3
C. Order a chest X-ray
D. Restrict physical activity
Correct Answer: B. Assess for fluid overload
Rationale: Rapid weight gain in heart failure suggests fluid retention. Assessment (e.g.,
lung sounds, edema) guides treatment. Adjusting diuretics, ordering imaging, or
restricting activity follows assessment.
10. Which finding in a patient with acute pancreatitis requires immediate intervention?
A. Epigastric pain
B. Nausea and vomiting
C. Hypotension
D. Elevated amylase
Correct Answer: C. Hypotension
Rationale: Hypotension indicates shock, a life-threatening complication of pancreatitis.
Pain, nausea, and elevated amylase are expected but less urgent.
11. A patient with a new diagnosis of hypothyroidism is prescribed levothyroxine. When
should it be taken?
A. With meals
B. At bedtime
C. On an empty stomach
D. With other medications
Correct Answer: C. On an empty stomach
Rationale: Levothyroxine is best absorbed on an empty stomach, typically in the
morning, to maximize efficacy. Food and other medications reduce absorption.
12. A patient with rheumatoid arthritis is prescribed methotrexate. Which laboratory test is
most critical to monitor?
A. Creatinine
B. Liver function tests
C. Hemoglobin
D. Platelet count
Correct Answer: B. Liver function tests
Rationale: Methotrexate can cause hepatotoxicity, requiring regular liver function
monitoring. Other tests are important but secondary.
13. A patient with suspected appendicitis reports right lower quadrant pain. Which physical
exam technique confirms the diagnosis?
A. Murphy’s sign
B. Rovsing’s sign
C. Psoas sign
D. Cullen’s sign
Correct Answer: B. Rovsing’s sign
Rationale: Rovsing’s sign (pain in the right lower quadrant when palpating the left) is
specific for appendicitis. Murphy’s sign indicates gallbladder issues, psoas sign suggests
retrocecal appendix, and Cullen’s sign is for internal bleeding.
14. A patient with a history of seizures is prescribed phenytoin. Which adverse effect should
the NP monitor?
A. Hyperglycemia
B. Gingival hyperplasia
