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NUR 6111 Actual Exam Questions and Answers
with Rationales 2026/2027 | Advanced Nursing I
Exam 2 | Pass Guarantee
Item ID: NUR6111-EX2-001
Item Type: NGN - Diagnostic Judgment
Scenario:
A 58-year-old man presents to the primary care clinic with 3 weeks of exertional
chest pressure that radiates to the left shoulder and resolves within 10 min of rest.
He denies nausea or diaphoresis. PMH: hyperlipidemia (LDL 142 mg/dL on
atorvastatin 20 mg), former smoker (25 pack-years, quit 8 years ago). Father had
MI at 61 yr. BP 142/88 mmHg, HR 78 reg, SpO₂ 97%, BMI 29 kg/m². HEENT: no
xanthelasma. Chest: clear. Cardiac: RRR, no murmurs/rubs/gallops. Extremities:
no edema, dorsalis pedis 2+. EKG in office: normal sinus rhythm, horizontal ST
depressions 1 mm in leads V₄–V₆. Troponin I (high-sensitivity) drawn at rest: <2
ng/L.
Question:
Which two actions are MOST appropriate to narrow the differential today?
Options:
A. Order resting transthoracic echocardiogram
B. Arrange urgent coronary CT angiography
C. Schedule exercise stress echocardiography
D. Prescribe empiric omeprazole trial
(Correct Choices: Order B and C to rule out the priority diagnosis)
Rationale (Correct | 2026/2027):
• Correct Answer: Order B and C to rule out the priority diagnosis.
• Diagnostic Reasoning Justification: 2026 ACC/AHA guidelines grade
Class I indication for anatomical (CTA) or functional testing in patients with
stable chest pain and intermediate 10-year ASCVD risk (>7.5%). His age,
sex, LDL, and smoking history yield ≈15% risk. Resting echo adds no
ischemic data; stress echo provides functional ischemia assessment, while
, 2
CTA visualizes plaque burden—either fulfills guideline mandate. Negative
troponin excludes acute injury but not stable CAD.
• Distractor Analysis: A—resting echo lacks ischemic sensitivity. D—GERD
is plausible but must not precede cardiac work-up in a patient with EKG
ischemia.
Item ID: NUR6111-EX2-002
Item Type: Complex APN MCQ
Scenario:
A 34-year-old woman is seen for 4 days of pleuritic left-sided chest pain and
dyspnea after a 10-hour car ride. She takes oral contraceptives for PCOS. Vital
signs: BP 118/70, HR 104, RR 22, SpO₂ 91% on room air, temp 37 °C. Lungs:
clear bilaterally. Heart: tachycardic, regular. Legs: mild right calf swelling (+1
pitting) and tenderness along posterior calf. Chest CT angiogram is pending.
Question:
Which diagnostic strategy is MOST appropriate while awaiting imaging?
Options:
A. Order quantitative D-dimer; if negative, discharge with NSAIDs
B. Start therapeutic enoxaparin immediately
C. Obtain bilateral lower-extremity venous duplex ultrasound
D. Prescribe ibuprofen 600 mg TID and reassess in 48 h
Rationale (Correct | 2026/2027):
• Correct Answer: C. Obtain bilateral lower-extremity venous duplex
ultrasound.
• Diagnostic Reasoning Justification: 2026 ESC guidelines endorse
proximal lower-extremity compression ultrasound as first-line when pre-test
probability for PE is intermediate (Wells ≈4–10) and imaging delayed;
detection of proximal DVT warrants anticoagulation without CT. Starting
empiric anticoagulation (B) is acceptable only if high suspicion AND
significant delay, but ultrasound first avoids unnecessary drug. D-dimer (A)
would still require imaging if positive.
, 3
• Distractor Analysis: A—D-dimer alone insufficient; negative d-dimer only
safely rules out PE in low-probability patients. B—premature without
objective clot. D—delays diagnosis of life-threatening PE.
Item ID: NUR6111-EX2-003
Item Type: NGN - Diagnostic Judgment
Scenario:
A 71-year-old woman with HTN, DM-2, and CKD stage 3 (eGFR 42 mL/min)
reports 2 weeks of progressive dull right upper-quadrant pain, anorexia, and 4 kg
weight loss. No fever. Medications: metformin 1000 mg BID, lisinopril 10 mg
daily. Vitals: afebrile, BP 138/78, HR 82. Exam: RLQ surgical scar (appendectomy
30 yr ago), liver span 11 cm by percussion, no splenomegaly, negative Murphy
sign. Labs: WBC 8.9, Hgb 12.1, ALT 66 U/L (↑), AST 55 U/L (↑), ALP 180 U/L
(↑), total bilirubin 0.9 mg/dL, CA 19-9 85 U/mL (nl <37). RUQ US shows 1.8 cm
irregular hypoechoic liver mass in segment VI, no gallstones.
Question:
Select the TWO next best investigations to refine the differential.
Options:
A. Contrast-enhanced CT abdomen/pelvis
B. Serum AFP and CEA
C. Hepatic MRI with Eovist
D. PET-CT whole body
(Correct Choices: Order A and C)
Rationale (Correct | 2026/2027):
• Correct Answer: Order A and C.
• Diagnostic Reasoning Justification: 2026 AASLD guidelines recommend
triple-phase CT or MRI to characterize indeterminate liver lesions >1 cm in
cirrhotic or high-risk patients; MRI preferred if renal impairment due to
gadolinium-based agents being safer than repeated iodinated contrast. CT
first provides rapid assessment of metastatic disease and arterial
, 4
enhancement pattern. AFP/CEA (B) are adjuncts but do not replace imaging.
PET-CT (D) has limited sensitivity for HCC and is not first-line.
• Distractor Analysis: B—tumor markers alone insufficient for diagnosis.
D—exposes to high radiation and low yield for primary characterization.
Item ID: NUR6111-EX2-004
Item Type: Complex APN MCQ
Scenario:
A 49-year-old man describes daily retrosternal burning for 6 weeks, worse after
late-night meals and when reclining. He denies dysphagia or weight loss. PMH:
obesity (BMI 34), asthma. Medications: albuterol PRN, OTC omeprazole 20 mg
daily started 2 weeks ago with partial relief. Vitals stable. Exam: mild temporal
wasting, abdomen soft, nontender. Stool guaiac negative.
Question:
Which next step is MOST appropriate?
Options:
A. Urgent EGD within 2 weeks
B. Increase omeprazole to 40 mg BID for 8 weeks
C. Order barium swallow
D. 24-h esophageal pH impedance study
Rationale (Correct | 2026/2027):
• Correct Answer: B. Increase omeprazole to 40 mg BID for 8 weeks.
• Diagnostic Reasoning Justification: 2026 ACG guidelines endorse empiric
PPI bid for 4–8 weeks in classic GERD without alarm features (bleeding,
dysphagia, weight loss). EGD (A) reserved for alarm symptoms or
inadequate response. Barium swallow (C) lacks sensitivity for mucosal
injury. pH study (D) is confirmatory but unnecessary when therapeutic trial
suffices.
• Distractor Analysis: A—over-utilization; no alarms. C—poor sensitivity.
D—third-line after failed PPI.
NUR 6111 Actual Exam Questions and Answers
with Rationales 2026/2027 | Advanced Nursing I
Exam 2 | Pass Guarantee
Item ID: NUR6111-EX2-001
Item Type: NGN - Diagnostic Judgment
Scenario:
A 58-year-old man presents to the primary care clinic with 3 weeks of exertional
chest pressure that radiates to the left shoulder and resolves within 10 min of rest.
He denies nausea or diaphoresis. PMH: hyperlipidemia (LDL 142 mg/dL on
atorvastatin 20 mg), former smoker (25 pack-years, quit 8 years ago). Father had
MI at 61 yr. BP 142/88 mmHg, HR 78 reg, SpO₂ 97%, BMI 29 kg/m². HEENT: no
xanthelasma. Chest: clear. Cardiac: RRR, no murmurs/rubs/gallops. Extremities:
no edema, dorsalis pedis 2+. EKG in office: normal sinus rhythm, horizontal ST
depressions 1 mm in leads V₄–V₆. Troponin I (high-sensitivity) drawn at rest: <2
ng/L.
Question:
Which two actions are MOST appropriate to narrow the differential today?
Options:
A. Order resting transthoracic echocardiogram
B. Arrange urgent coronary CT angiography
C. Schedule exercise stress echocardiography
D. Prescribe empiric omeprazole trial
(Correct Choices: Order B and C to rule out the priority diagnosis)
Rationale (Correct | 2026/2027):
• Correct Answer: Order B and C to rule out the priority diagnosis.
• Diagnostic Reasoning Justification: 2026 ACC/AHA guidelines grade
Class I indication for anatomical (CTA) or functional testing in patients with
stable chest pain and intermediate 10-year ASCVD risk (>7.5%). His age,
sex, LDL, and smoking history yield ≈15% risk. Resting echo adds no
ischemic data; stress echo provides functional ischemia assessment, while
, 2
CTA visualizes plaque burden—either fulfills guideline mandate. Negative
troponin excludes acute injury but not stable CAD.
• Distractor Analysis: A—resting echo lacks ischemic sensitivity. D—GERD
is plausible but must not precede cardiac work-up in a patient with EKG
ischemia.
Item ID: NUR6111-EX2-002
Item Type: Complex APN MCQ
Scenario:
A 34-year-old woman is seen for 4 days of pleuritic left-sided chest pain and
dyspnea after a 10-hour car ride. She takes oral contraceptives for PCOS. Vital
signs: BP 118/70, HR 104, RR 22, SpO₂ 91% on room air, temp 37 °C. Lungs:
clear bilaterally. Heart: tachycardic, regular. Legs: mild right calf swelling (+1
pitting) and tenderness along posterior calf. Chest CT angiogram is pending.
Question:
Which diagnostic strategy is MOST appropriate while awaiting imaging?
Options:
A. Order quantitative D-dimer; if negative, discharge with NSAIDs
B. Start therapeutic enoxaparin immediately
C. Obtain bilateral lower-extremity venous duplex ultrasound
D. Prescribe ibuprofen 600 mg TID and reassess in 48 h
Rationale (Correct | 2026/2027):
• Correct Answer: C. Obtain bilateral lower-extremity venous duplex
ultrasound.
• Diagnostic Reasoning Justification: 2026 ESC guidelines endorse
proximal lower-extremity compression ultrasound as first-line when pre-test
probability for PE is intermediate (Wells ≈4–10) and imaging delayed;
detection of proximal DVT warrants anticoagulation without CT. Starting
empiric anticoagulation (B) is acceptable only if high suspicion AND
significant delay, but ultrasound first avoids unnecessary drug. D-dimer (A)
would still require imaging if positive.
, 3
• Distractor Analysis: A—D-dimer alone insufficient; negative d-dimer only
safely rules out PE in low-probability patients. B—premature without
objective clot. D—delays diagnosis of life-threatening PE.
Item ID: NUR6111-EX2-003
Item Type: NGN - Diagnostic Judgment
Scenario:
A 71-year-old woman with HTN, DM-2, and CKD stage 3 (eGFR 42 mL/min)
reports 2 weeks of progressive dull right upper-quadrant pain, anorexia, and 4 kg
weight loss. No fever. Medications: metformin 1000 mg BID, lisinopril 10 mg
daily. Vitals: afebrile, BP 138/78, HR 82. Exam: RLQ surgical scar (appendectomy
30 yr ago), liver span 11 cm by percussion, no splenomegaly, negative Murphy
sign. Labs: WBC 8.9, Hgb 12.1, ALT 66 U/L (↑), AST 55 U/L (↑), ALP 180 U/L
(↑), total bilirubin 0.9 mg/dL, CA 19-9 85 U/mL (nl <37). RUQ US shows 1.8 cm
irregular hypoechoic liver mass in segment VI, no gallstones.
Question:
Select the TWO next best investigations to refine the differential.
Options:
A. Contrast-enhanced CT abdomen/pelvis
B. Serum AFP and CEA
C. Hepatic MRI with Eovist
D. PET-CT whole body
(Correct Choices: Order A and C)
Rationale (Correct | 2026/2027):
• Correct Answer: Order A and C.
• Diagnostic Reasoning Justification: 2026 AASLD guidelines recommend
triple-phase CT or MRI to characterize indeterminate liver lesions >1 cm in
cirrhotic or high-risk patients; MRI preferred if renal impairment due to
gadolinium-based agents being safer than repeated iodinated contrast. CT
first provides rapid assessment of metastatic disease and arterial
, 4
enhancement pattern. AFP/CEA (B) are adjuncts but do not replace imaging.
PET-CT (D) has limited sensitivity for HCC and is not first-line.
• Distractor Analysis: B—tumor markers alone insufficient for diagnosis.
D—exposes to high radiation and low yield for primary characterization.
Item ID: NUR6111-EX2-004
Item Type: Complex APN MCQ
Scenario:
A 49-year-old man describes daily retrosternal burning for 6 weeks, worse after
late-night meals and when reclining. He denies dysphagia or weight loss. PMH:
obesity (BMI 34), asthma. Medications: albuterol PRN, OTC omeprazole 20 mg
daily started 2 weeks ago with partial relief. Vitals stable. Exam: mild temporal
wasting, abdomen soft, nontender. Stool guaiac negative.
Question:
Which next step is MOST appropriate?
Options:
A. Urgent EGD within 2 weeks
B. Increase omeprazole to 40 mg BID for 8 weeks
C. Order barium swallow
D. 24-h esophageal pH impedance study
Rationale (Correct | 2026/2027):
• Correct Answer: B. Increase omeprazole to 40 mg BID for 8 weeks.
• Diagnostic Reasoning Justification: 2026 ACG guidelines endorse empiric
PPI bid for 4–8 weeks in classic GERD without alarm features (bleeding,
dysphagia, weight loss). EGD (A) reserved for alarm symptoms or
inadequate response. Barium swallow (C) lacks sensitivity for mucosal
injury. pH study (D) is confirmatory but unnecessary when therapeutic trial
suffices.
• Distractor Analysis: A—over-utilization; no alarms. C—poor sensitivity.
D—third-line after failed PPI.
