NUR 6111 – Exam 2 (Advanced Practice
Nursing I) – 2026 Actual Exam Questions and
Correct Answers
Q001:
Type: NGN - Diagnostic
Scenario: 58-year-old man presents to primary care with 3-hour history of substernal
chest pressure radiating to left jaw, diaphoresis, and nausea. PMH: HTN, hyperlipidemia,
40 pack-year tobacco use. Vitals: BP 162/94 mmHg, HR 104 bpm, RR 22/min, SpO₂ 96%
RA. Focused exam: diaphoretic, S4 gallop, no murmurs, lungs clear, no leg edema.
Question: Which is the most likely diagnosis?
Options:
A. Stable angina
B. ST-elevation myocardial infarction (STEMI)
C. Gastroesophageal reflux disease
D. Costochondritis
(Correct: B)
Rationale:
● Answer: ST-elevation myocardial infarction (STEMI)
, ● Why (2026 Standard): Acute substernal pressure with radiation, autonomic
symptoms, tachycardia, and S4 (↓ compliance) in a high-risk male strongly
suggest acute coronary syndrome; immediate ECG is indicated.
● Errors: Stable angina lasts <15 min; GERD lacks radiation/autonomic symptoms;
costochondritis is reproducible chest wall pain.
Q002:
Type: Complex MCQ
Scenario: 34-year-old woman presents with 2-week history of pleuritic chest pain and
dyspnea. Returned from Paris flight 10 days ago. Vitals: BP 118/74, HR 96, RR 24, SpO₂
91% RA. Exam: clear lungs, no wheezes, L calf circumference 2 cm > R, Homans +.
D-dimer 950 ng/mL (ref <500).
Question: Next most appropriate diagnostic test?
Options:
A. Chest X-ray
B. Ventilation–perfusion (V/Q) scan
C. CT pulmonary angiography
D. Lower-extremity venous duplex
(Correct: C)
Rationale:
● Answer: CT pulmonary angiography
● Why (2026 Standard): High Wells score + elevated D-dimer mandates imaging;
CTPA is first-line to confirm PE.
● Errors: V/Q reserved if contrast contraindicated; duplex shows DVT but doesn’t
rule out PE; CXR lacks sensitivity.
,Q003:
Type: NGN - Diagnostic
Scenario: 71-year-old man with COPD GOLD stage III presents with 3-day increase in
dyspnea, purulent sputum, and fever. T 38.4 °C, BP 134/82, HR 94, RR 28, SpO₂ 87% on 2
L NC. Accessory muscle use, distant breath sounds, no crackles.
Question: Most likely diagnosis?
Options:
A. Pneumothorax
B. Acute exacerbation of COPD (infectious)
C. Pulmonary embolism
D. Acute heart failure
(Correct: B)
Rationale:
● Answer: Acute exacerbation of COPD (infectious)
● Why (2026 Standard): Increased dyspnea + purulent sputum + fever = Anthonisen
type I exacerbation.
● Errors: No sudden sharp pain or unilateral findings for pneumothorax; no
unilateral leg swelling or pleuritic pain for PE; no crackles/S3 for HF.
Q004:
Type: Complex MCQ
, Scenario: 29-year-old woman, 16 weeks pregnant, complains of progressive dyspnea on
exertion and occasional palpitations. Vitals: BP 106/70, HR 105 regular, RR 22, SpO₂
97%. JVP 8 cm, normal S1/S2, no murmurs, lungs clear. Hgb 9.8 g/dL.
Question: Most appropriate next test?
Options:
A. Arterial blood gas
B. Echocardiography
C. Spirometry
D. Chest CT
(Correct: B)
Rationale:
● Answer: Echocardiography
● Why (2026 Standard): Physiologic dyspnea is common, but resting tachycardia +
elevated JVP warrant echo to exclude peripartum cardiomyopathy.
● Errors: ABG unnecessary with normal SpO₂; CT has radiation risk; spirometry
rarely changes management in pregnancy.
Q005:
Type: NGN - Diagnostic
Scenario: 55-year-old man with HTN, DM presents to clinic with 4-week fatigue, bilateral
ankle edema, and 2-pillow orthopnea. Vitals: BP 150/92, HR 88, RR 20, SpO₂ 94%.
Bibasilar crackles, JVP 12 cm, S3 present, 2+ pitting edema. NT-proBNP 1,800 pg/mL
(ref <300).
Nursing I) – 2026 Actual Exam Questions and
Correct Answers
Q001:
Type: NGN - Diagnostic
Scenario: 58-year-old man presents to primary care with 3-hour history of substernal
chest pressure radiating to left jaw, diaphoresis, and nausea. PMH: HTN, hyperlipidemia,
40 pack-year tobacco use. Vitals: BP 162/94 mmHg, HR 104 bpm, RR 22/min, SpO₂ 96%
RA. Focused exam: diaphoretic, S4 gallop, no murmurs, lungs clear, no leg edema.
Question: Which is the most likely diagnosis?
Options:
A. Stable angina
B. ST-elevation myocardial infarction (STEMI)
C. Gastroesophageal reflux disease
D. Costochondritis
(Correct: B)
Rationale:
● Answer: ST-elevation myocardial infarction (STEMI)
, ● Why (2026 Standard): Acute substernal pressure with radiation, autonomic
symptoms, tachycardia, and S4 (↓ compliance) in a high-risk male strongly
suggest acute coronary syndrome; immediate ECG is indicated.
● Errors: Stable angina lasts <15 min; GERD lacks radiation/autonomic symptoms;
costochondritis is reproducible chest wall pain.
Q002:
Type: Complex MCQ
Scenario: 34-year-old woman presents with 2-week history of pleuritic chest pain and
dyspnea. Returned from Paris flight 10 days ago. Vitals: BP 118/74, HR 96, RR 24, SpO₂
91% RA. Exam: clear lungs, no wheezes, L calf circumference 2 cm > R, Homans +.
D-dimer 950 ng/mL (ref <500).
Question: Next most appropriate diagnostic test?
Options:
A. Chest X-ray
B. Ventilation–perfusion (V/Q) scan
C. CT pulmonary angiography
D. Lower-extremity venous duplex
(Correct: C)
Rationale:
● Answer: CT pulmonary angiography
● Why (2026 Standard): High Wells score + elevated D-dimer mandates imaging;
CTPA is first-line to confirm PE.
● Errors: V/Q reserved if contrast contraindicated; duplex shows DVT but doesn’t
rule out PE; CXR lacks sensitivity.
,Q003:
Type: NGN - Diagnostic
Scenario: 71-year-old man with COPD GOLD stage III presents with 3-day increase in
dyspnea, purulent sputum, and fever. T 38.4 °C, BP 134/82, HR 94, RR 28, SpO₂ 87% on 2
L NC. Accessory muscle use, distant breath sounds, no crackles.
Question: Most likely diagnosis?
Options:
A. Pneumothorax
B. Acute exacerbation of COPD (infectious)
C. Pulmonary embolism
D. Acute heart failure
(Correct: B)
Rationale:
● Answer: Acute exacerbation of COPD (infectious)
● Why (2026 Standard): Increased dyspnea + purulent sputum + fever = Anthonisen
type I exacerbation.
● Errors: No sudden sharp pain or unilateral findings for pneumothorax; no
unilateral leg swelling or pleuritic pain for PE; no crackles/S3 for HF.
Q004:
Type: Complex MCQ
, Scenario: 29-year-old woman, 16 weeks pregnant, complains of progressive dyspnea on
exertion and occasional palpitations. Vitals: BP 106/70, HR 105 regular, RR 22, SpO₂
97%. JVP 8 cm, normal S1/S2, no murmurs, lungs clear. Hgb 9.8 g/dL.
Question: Most appropriate next test?
Options:
A. Arterial blood gas
B. Echocardiography
C. Spirometry
D. Chest CT
(Correct: B)
Rationale:
● Answer: Echocardiography
● Why (2026 Standard): Physiologic dyspnea is common, but resting tachycardia +
elevated JVP warrant echo to exclude peripartum cardiomyopathy.
● Errors: ABG unnecessary with normal SpO₂; CT has radiation risk; spirometry
rarely changes management in pregnancy.
Q005:
Type: NGN - Diagnostic
Scenario: 55-year-old man with HTN, DM presents to clinic with 4-week fatigue, bilateral
ankle edema, and 2-pillow orthopnea. Vitals: BP 150/92, HR 88, RR 20, SpO₂ 94%.
Bibasilar crackles, JVP 12 cm, S3 present, 2+ pitting edema. NT-proBNP 1,800 pg/mL
(ref <300).
