NUR 452 ADVANCED NURSING EXAM 1 | 2026/2027
Advanced Nursing Practice Exam with Complete Questions & Verified Correct Answers | Latest Version
Overview
This 2026/2027 updated resource contains the latest NUR 452 Advanced Nursing Exam 1 with
the exact 90 questions and verified correct answers, following current AACN (American Association of
Colleges of Nursing) essentials for advanced nursing practice, NLN (National League for Nursing)
competencies, and evidence-based advanced clinical reasoning and decision-making frameworks.
Key Features
● ✓ Actual advanced nursing exam format with the official 90 questions
● ✓ Comprehensive coverage of advanced health assessment, pathophysiology, and
pharmacology
● ✓ Updated 2026/2027 clinical practice guidelines and treatment protocols
● ✓ Complex patient scenario integration with multi-system disease processes
● ✓ Evidence-based practice applications and translational research implementation
Core Content Areas (90 Total Questions)
● Advanced Health Assessment & Diagnostic Reasoning (22 Qs)
● Complex Pathophysiology & Disease Management (20 Qs)
● Advanced Pharmacology & Therapeutics (18 Qs)
● Clinical Decision-Making & Ethical Dilemmas (15 Qs)
● Evidence-Based Practice & Quality Improvement (10 Qs)
● Healthcare Policy & Leadership Applications (5 Qs)
Answer Format
Correct answers are marked in bold green and include:
● AACN advanced practice nursing competency applications
● Complex differential diagnosis development and prioritization
● Pharmacokinetic and pharmacodynamic considerations in complex patients
● Ethical decision-making frameworks for advanced practice scenarios
● Evidence-based guideline implementation and adaptation rationales
● Health policy implications for clinical practice decisions
Updates for 2026/2027
● 🔹 Reflects 2026-2027 AACN Essentials for Advanced-Level Nursing Education
● 🔹
updates
🔹 Updated complex chronic disease management protocols
●
● 🔹
🔹
Enhanced pharmacogenomics integration in treatment planning
New telehealth competencies for advanced nursing practice
●
● 🔹 Revised health equity and social determinants of health assessments
Updated interprofessional collaboration and team leadership standards
, ●
●
🔹
🔹 New artificial intelligence applications in clinical decision support
Revised healthcare financing and value-based care models
Full Exam: 90 Questions with Verified Answers
1. A 68-year-old patient presents with progressive dyspnea, orthopnea, and bilateral lower
extremity edema. On cardiac auscultation, you note an S3 gallop. Which diagnostic test is
most appropriate to confirm the suspected diagnosis?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. B-type natriuretic peptide (BNP)
D. Transthoracic echocardiogram (TTE)
D. Transthoracic echocardiogram (TTE) — While BNP supports heart failure diagnosis, TTE is
the gold standard for assessing ejection fraction, chamber size, and valvular function, essential for
differentiating HFrEF from HFpEF per 2026 ACC/AHA guidelines.
2. During a comprehensive skin assessment of an immunocompromised patient, you
observe a painless, indurated ulcer with rolled borders on the lower lip. This finding is
most consistent with:
A. Herpes simplex virus (HSV) infection
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Aphthous ulcer
B. Squamous cell carcinoma — SCC commonly presents as a non-healing, indurated ulcer with
rolled edges, especially in sun-exposed areas. BCC typically appears as a pearly papule with
telangiectasia.
3. A patient with a history of intravenous drug use presents with fever, new-onset murmur,
and petechiae. Which physical finding would most strongly support a diagnosis of infective
endocarditis?
A. Janeway lesions
B. Osler nodes
C. Roth spots
, D. Splinter hemorrhages
B. Osler nodes — Osler nodes (tender, red nodules on fingers/toes) are immunologic phenomena
highly specific for endocarditis. Janeway lesions are painless and caused by septic emboli.
4. Which neurological assessment finding in a patient with suspected stroke indicates
brainstem involvement?
A. Unilateral facial droop
B. Dysarthria and ataxia
C> Crossed sensory deficits (ipsilateral face, contralateral body)
D. Aphasia
C. Crossed sensory deficits (ipsilateral face, contralateral body) — Brainstem lesions
produce “crossed” signs due to cranial nerve nuclei (ipsilateral) and descending tracts (contralateral).
5. A 55-year-old woman presents with weight loss, heat intolerance, and tremor. On
examination, you note a diffusely enlarged, non-tender thyroid and brisk deep tendon
reflexes. Which laboratory test is most appropriate to order first?
A. Thyroid-stimulating hormone (TSH)
B. Free T4
C. Thyroid peroxidase antibodies
D. Radioactive iodine uptake
A. Thyroid-stimulating hormone (TSH) — TSH is the most sensitive initial test for thyroid
dysfunction. A suppressed TSH with elevated free T4 confirms hyperthyroidism.
6. In abdominal assessment, a positive fluid wave test is indicative of:
A. Ascites
B. Peritonitis
C. Hepatomegaly
D. Bowel obstruction
A. Ascites — The fluid wave test detects free fluid in the peritoneal cavity. It requires an assistant and
is most reliable with >1–2 liters of fluid.
7. A patient with chronic kidney disease (CKD) stage 4 presents with muscle cramps and
paresthesias. Which electrolyte abnormality should you assess immediately?
Advanced Nursing Practice Exam with Complete Questions & Verified Correct Answers | Latest Version
Overview
This 2026/2027 updated resource contains the latest NUR 452 Advanced Nursing Exam 1 with
the exact 90 questions and verified correct answers, following current AACN (American Association of
Colleges of Nursing) essentials for advanced nursing practice, NLN (National League for Nursing)
competencies, and evidence-based advanced clinical reasoning and decision-making frameworks.
Key Features
● ✓ Actual advanced nursing exam format with the official 90 questions
● ✓ Comprehensive coverage of advanced health assessment, pathophysiology, and
pharmacology
● ✓ Updated 2026/2027 clinical practice guidelines and treatment protocols
● ✓ Complex patient scenario integration with multi-system disease processes
● ✓ Evidence-based practice applications and translational research implementation
Core Content Areas (90 Total Questions)
● Advanced Health Assessment & Diagnostic Reasoning (22 Qs)
● Complex Pathophysiology & Disease Management (20 Qs)
● Advanced Pharmacology & Therapeutics (18 Qs)
● Clinical Decision-Making & Ethical Dilemmas (15 Qs)
● Evidence-Based Practice & Quality Improvement (10 Qs)
● Healthcare Policy & Leadership Applications (5 Qs)
Answer Format
Correct answers are marked in bold green and include:
● AACN advanced practice nursing competency applications
● Complex differential diagnosis development and prioritization
● Pharmacokinetic and pharmacodynamic considerations in complex patients
● Ethical decision-making frameworks for advanced practice scenarios
● Evidence-based guideline implementation and adaptation rationales
● Health policy implications for clinical practice decisions
Updates for 2026/2027
● 🔹 Reflects 2026-2027 AACN Essentials for Advanced-Level Nursing Education
● 🔹
updates
🔹 Updated complex chronic disease management protocols
●
● 🔹
🔹
Enhanced pharmacogenomics integration in treatment planning
New telehealth competencies for advanced nursing practice
●
● 🔹 Revised health equity and social determinants of health assessments
Updated interprofessional collaboration and team leadership standards
, ●
●
🔹
🔹 New artificial intelligence applications in clinical decision support
Revised healthcare financing and value-based care models
Full Exam: 90 Questions with Verified Answers
1. A 68-year-old patient presents with progressive dyspnea, orthopnea, and bilateral lower
extremity edema. On cardiac auscultation, you note an S3 gallop. Which diagnostic test is
most appropriate to confirm the suspected diagnosis?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. B-type natriuretic peptide (BNP)
D. Transthoracic echocardiogram (TTE)
D. Transthoracic echocardiogram (TTE) — While BNP supports heart failure diagnosis, TTE is
the gold standard for assessing ejection fraction, chamber size, and valvular function, essential for
differentiating HFrEF from HFpEF per 2026 ACC/AHA guidelines.
2. During a comprehensive skin assessment of an immunocompromised patient, you
observe a painless, indurated ulcer with rolled borders on the lower lip. This finding is
most consistent with:
A. Herpes simplex virus (HSV) infection
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Aphthous ulcer
B. Squamous cell carcinoma — SCC commonly presents as a non-healing, indurated ulcer with
rolled edges, especially in sun-exposed areas. BCC typically appears as a pearly papule with
telangiectasia.
3. A patient with a history of intravenous drug use presents with fever, new-onset murmur,
and petechiae. Which physical finding would most strongly support a diagnosis of infective
endocarditis?
A. Janeway lesions
B. Osler nodes
C. Roth spots
, D. Splinter hemorrhages
B. Osler nodes — Osler nodes (tender, red nodules on fingers/toes) are immunologic phenomena
highly specific for endocarditis. Janeway lesions are painless and caused by septic emboli.
4. Which neurological assessment finding in a patient with suspected stroke indicates
brainstem involvement?
A. Unilateral facial droop
B. Dysarthria and ataxia
C> Crossed sensory deficits (ipsilateral face, contralateral body)
D. Aphasia
C. Crossed sensory deficits (ipsilateral face, contralateral body) — Brainstem lesions
produce “crossed” signs due to cranial nerve nuclei (ipsilateral) and descending tracts (contralateral).
5. A 55-year-old woman presents with weight loss, heat intolerance, and tremor. On
examination, you note a diffusely enlarged, non-tender thyroid and brisk deep tendon
reflexes. Which laboratory test is most appropriate to order first?
A. Thyroid-stimulating hormone (TSH)
B. Free T4
C. Thyroid peroxidase antibodies
D. Radioactive iodine uptake
A. Thyroid-stimulating hormone (TSH) — TSH is the most sensitive initial test for thyroid
dysfunction. A suppressed TSH with elevated free T4 confirms hyperthyroidism.
6. In abdominal assessment, a positive fluid wave test is indicative of:
A. Ascites
B. Peritonitis
C. Hepatomegaly
D. Bowel obstruction
A. Ascites — The fluid wave test detects free fluid in the peritoneal cavity. It requires an assistant and
is most reliable with >1–2 liters of fluid.
7. A patient with chronic kidney disease (CKD) stage 4 presents with muscle cramps and
paresthesias. Which electrolyte abnormality should you assess immediately?
