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 acute
midsternal chest pressure radiating to left jaw, associated with diaphoresis and nausea.
No prior cardiac history. Vitals: BP 148/92 mmHg, HR 104 bpm, RR 22/min, O2 sat 96%
RA. Focused exam: diaphoresis noted; lungs clear; cardiac exam reveals regular
tachycardia without murmur; no lower-extremity edema.
Question: Which single additional finding on 12-lead ECG most strongly supports the
diagnosis of acute inferior ST-elevation myocardial infarction (STEMI)?
Options:
A. ≥1 mm ST elevation in V2–V3
B. ≥1 mm ST elevation in leads II, III, aVF
C. ≥1 mm ST depression in leads V1–V3
D. New left bundle-branch block
(Correct: B)
Rationale:
● Answer: B
, ● Why (2026 Standard): Inferior wall is supplied by RCA (→ leads II, III, aVF); ≥1 mm
ST elevation in two contiguous inferior leads meets STEMI criteria per 2020
AHA/ACC guidelines.
● Errors: A reflects anterior STEMI; C suggests posterior ischemia; D is nonspecific
without prior tracing.
Q002:
Type: Complex MCQ
Scenario: 44-year-old woman with asthma reports 2 weeks of intermittent chest
tightness and non-productive cough that awakens her nightly. No fever; no leg edema.
Albuterol relieves symptoms only transiently. Vitals stable; lungs with end-expiratory
wheezes; no cardiac gallop. Peak flow 65% personal best.
Question: What is the most appropriate next diagnostic test?
Options:
A. High-resolution CT chest
B. Spirometry with bronchodilator response
C. B-type natriuretic peptide (BNP)
D. 24-hour Holter monitor
(Correct: B)
Rationale:
● Answer: B
● Why (2026 Standard): Objective airflow obstruction and reversibility (>12% & 200
mL FEV1 increase) confirm asthma exacerbation and guide step-up therapy per
GINA 2025.
, ● Errors: A premature before spirometry; C low yield without heart failure signs; D
unrelated to symptoms.
Q003:
Type: NGN - Diagnostic
Scenario: 72-year-old man presents with 4-day history of progressive dyspnea on
exertion, orthopnea, and bilateral ankle edema. PMH: HTN, T2DM. Vitals: BP 160/88, HR
96, RR 24, O2 sat 93% RA. JVP 10 cm; bibasilar crackles; S3 gallop; 2+ pitting edema to
knees. BNP 950 pg/mL (ref <100).
Question: Which echocardiographic finding best distinguishes heart failure with
preserved ejection fraction (HFpEF) from HFrEF in this patient?
Options:
A. Left ventricular EF 30%
B. Left atrial volume index 18 mL/m²
C. E/e′ ratio 18
D. Moderate mitral regurgitation
(Correct: C)
Rationale:
● Answer: C
● Why (2026 Standard): E/e′ ≥15 (or 13–15 with additional markers) indicates
elevated filling pressures consistent with HFpEF despite EF ≥50%.
● Errors: A indicates HFrEF; B value is normal; D is not specific for diastolic
dysfunction.
Q004:
, Type: Complex MCQ
Scenario: 38-year-old woman complains of 3 days of right lower-quadrant pain that
began peri-umbilically. Pain now localized, worse with movement. Anorexia but no
vomiting. LMP 2 weeks ago; cycles regular. Temp 37.8 °C; WBC 12 500/µL with left
shift. Urine hCG negative.
Question: What is the priority differential diagnosis?
Options:
A. Ruptured ovarian cyst
B. Acute appendicitis
C. Pelvic inflammatory disease
D. Crohn’s terminal ileitis
(Correct: B)
Rationale:
● Answer: B
● Why (2026 Standard): Classic migratory RLQ pain, low-grade fever, leukocytosis,
and negative hCG point to appendicitis (Alvarado 7–8).
● Errors: A typically sudden onset; C usually bilateral pain with cervical motion
tenderness; D chronic diarrhea often present.
Q005:
Type: NGN - Diagnostic
Scenario: 55-year-old man with 30 pack-year smoking history presents with acute-onset
right-sided chest pain and dyspnea while climbing stairs. Pain is sharp, pleuritic; no
Actual Exam Questions and Correct Answers
Q001:
Type: NGN - Diagnostic
Scenario: 58-year-old man presents to primary care with 3-hour history of acute
midsternal chest pressure radiating to left jaw, associated with diaphoresis and nausea.
No prior cardiac history. Vitals: BP 148/92 mmHg, HR 104 bpm, RR 22/min, O2 sat 96%
RA. Focused exam: diaphoresis noted; lungs clear; cardiac exam reveals regular
tachycardia without murmur; no lower-extremity edema.
Question: Which single additional finding on 12-lead ECG most strongly supports the
diagnosis of acute inferior ST-elevation myocardial infarction (STEMI)?
Options:
A. ≥1 mm ST elevation in V2–V3
B. ≥1 mm ST elevation in leads II, III, aVF
C. ≥1 mm ST depression in leads V1–V3
D. New left bundle-branch block
(Correct: B)
Rationale:
● Answer: B
, ● Why (2026 Standard): Inferior wall is supplied by RCA (→ leads II, III, aVF); ≥1 mm
ST elevation in two contiguous inferior leads meets STEMI criteria per 2020
AHA/ACC guidelines.
● Errors: A reflects anterior STEMI; C suggests posterior ischemia; D is nonspecific
without prior tracing.
Q002:
Type: Complex MCQ
Scenario: 44-year-old woman with asthma reports 2 weeks of intermittent chest
tightness and non-productive cough that awakens her nightly. No fever; no leg edema.
Albuterol relieves symptoms only transiently. Vitals stable; lungs with end-expiratory
wheezes; no cardiac gallop. Peak flow 65% personal best.
Question: What is the most appropriate next diagnostic test?
Options:
A. High-resolution CT chest
B. Spirometry with bronchodilator response
C. B-type natriuretic peptide (BNP)
D. 24-hour Holter monitor
(Correct: B)
Rationale:
● Answer: B
● Why (2026 Standard): Objective airflow obstruction and reversibility (>12% & 200
mL FEV1 increase) confirm asthma exacerbation and guide step-up therapy per
GINA 2025.
, ● Errors: A premature before spirometry; C low yield without heart failure signs; D
unrelated to symptoms.
Q003:
Type: NGN - Diagnostic
Scenario: 72-year-old man presents with 4-day history of progressive dyspnea on
exertion, orthopnea, and bilateral ankle edema. PMH: HTN, T2DM. Vitals: BP 160/88, HR
96, RR 24, O2 sat 93% RA. JVP 10 cm; bibasilar crackles; S3 gallop; 2+ pitting edema to
knees. BNP 950 pg/mL (ref <100).
Question: Which echocardiographic finding best distinguishes heart failure with
preserved ejection fraction (HFpEF) from HFrEF in this patient?
Options:
A. Left ventricular EF 30%
B. Left atrial volume index 18 mL/m²
C. E/e′ ratio 18
D. Moderate mitral regurgitation
(Correct: C)
Rationale:
● Answer: C
● Why (2026 Standard): E/e′ ≥15 (or 13–15 with additional markers) indicates
elevated filling pressures consistent with HFpEF despite EF ≥50%.
● Errors: A indicates HFrEF; B value is normal; D is not specific for diastolic
dysfunction.
Q004:
, Type: Complex MCQ
Scenario: 38-year-old woman complains of 3 days of right lower-quadrant pain that
began peri-umbilically. Pain now localized, worse with movement. Anorexia but no
vomiting. LMP 2 weeks ago; cycles regular. Temp 37.8 °C; WBC 12 500/µL with left
shift. Urine hCG negative.
Question: What is the priority differential diagnosis?
Options:
A. Ruptured ovarian cyst
B. Acute appendicitis
C. Pelvic inflammatory disease
D. Crohn’s terminal ileitis
(Correct: B)
Rationale:
● Answer: B
● Why (2026 Standard): Classic migratory RLQ pain, low-grade fever, leukocytosis,
and negative hCG point to appendicitis (Alvarado 7–8).
● Errors: A typically sudden onset; C usually bilateral pain with cervical motion
tenderness; D chronic diarrhea often present.
Q005:
Type: NGN - Diagnostic
Scenario: 55-year-old man with 30 pack-year smoking history presents with acute-onset
right-sided chest pain and dyspnea while climbing stairs. Pain is sharp, pleuritic; no
