NSG 5240 Final Exam Study Guide |
Questions and Answers | Latest
2025/2026 Update with complete
solutions.
Domain: Advanced Health Assessment & Clinical Reasoning
1. A 58-year-old patient presents with progressive shortness of breath
over 3 weeks. On auscultation, you note late inspiratory crackles in the
lower lung fields bilaterally. The patient also has bilateral lower
extremity edema. Which additional finding would MOST strongly
suggest heart failure over pneumonia?
A) Fever of 101.2°F
B) Elevated jugular venous pressure (JVP)
C) Productive cough with green sputum
D) Leukocytosis on complete blood count
Rationale: B - Elevated JVP indicates increased right-sided heart
pressure, a key finding in heart failure. While crackles and edema can
occur in both conditions, JVP elevation specifically points to cardiac
etiology. Fever (A), productive cough (C), and leukocytosis (D) are more
characteristic of infectious processes like pneumonia.
,2. When performing a neurological assessment on a patient with
suspected stroke, which finding represents the MOST urgent
neurological deficit requiring immediate intervention?
A) Mild weakness in the left hand (4/5 strength)
B) Complete left-sided neglect
C) Slurred speech
D) Decreasing level of consciousness (LOC)
Rationale: D - A decreasing LOC indicates potential increasing
intracranial pressure or brainstem involvement and requires immediate
intervention. While all findings are concerning in stroke, changes in
consciousness represent the most urgent threat to airway, breathing, and
circulation. The NIH Stroke Scale prioritizes LOC assessment for this
reason.
3. A 45-year-old patient with type 2 diabetes reports burning pain in
both feet worse at night. On examination, you find decreased vibration
sense at the great toes and absent ankle reflexes. Which diagnostic
test is MOST appropriate initially?
A) Nerve conduction studies
B) MRI of the lumbar spine
C) Fasting blood glucose and HbA1c
D) Vitamin B12 level
Rationale: C - This presentation is classic for diabetic peripheral
neuropathy. The first step is confirming glycemic control status, as this is
the most likely etiology in a diabetic patient. While nerve studies (A) may
be needed eventually, they're not the first test. Spine MRI (B) would be for
radiculopathy (typically unilateral), and B12 deficiency (D) is less likely
given the bilateral, symmetric presentation.
4. During a cardiovascular assessment, you note a murmur that
increases with handgrip exercise. This maneuver most likely indicates
which type of murmur?
, A) Aortic stenosis
B) Mitral regurgitation
C) Hypertrophic cardiomyopathy
D) Aortic regurgitation
Rationale: B - Handgrip increases afterload (peripheral resistance), which
increases the volume of regurgitation in mitral regurgitation, making the
murmur louder. Aortic stenosis (A) typically decreases with handgrip.
Hypertrophic cardiomyopathy (C) murmur increases with decreased
preload (Valsalva), not handgrip. Aortic regurgitation (D) may have
variable responses.
5. A 72-year-old patient presents with unintentional 15-pound weight
loss over 3 months. In your comprehensive assessment, which finding
would be MOST concerning for malignancy?
A) Hemoglobin 11.8 g/dL
B) Recent onset of dysphagia to solids
C) Mild elevation in alkaline phosphatase
D) Fatigue and decreased appetite
Rationale: B - New dysphagia in an older adult, especially progressive
from solids to liquids, raises concern for esophageal or gastric cancer and
requires urgent evaluation. While anemia (A), mild liver enzyme elevation
(C), and constitutional symptoms (D) can occur with many conditions
including cancer, dysphagia is a specific "red flag" symptom.
6. When assessing a patient with suspected sepsis, which vital sign
change is the MOST sensitive early indicator of compensated shock?
A) Decreased blood pressure
B) Increased respiratory rate
C) Decreased urine output
D) Tachycardia
Rationale: D - Tachycardia is typically the first vital sign to change in early
shock as the body attempts to maintain cardiac output. Hypotension (A)
Questions and Answers | Latest
2025/2026 Update with complete
solutions.
Domain: Advanced Health Assessment & Clinical Reasoning
1. A 58-year-old patient presents with progressive shortness of breath
over 3 weeks. On auscultation, you note late inspiratory crackles in the
lower lung fields bilaterally. The patient also has bilateral lower
extremity edema. Which additional finding would MOST strongly
suggest heart failure over pneumonia?
A) Fever of 101.2°F
B) Elevated jugular venous pressure (JVP)
C) Productive cough with green sputum
D) Leukocytosis on complete blood count
Rationale: B - Elevated JVP indicates increased right-sided heart
pressure, a key finding in heart failure. While crackles and edema can
occur in both conditions, JVP elevation specifically points to cardiac
etiology. Fever (A), productive cough (C), and leukocytosis (D) are more
characteristic of infectious processes like pneumonia.
,2. When performing a neurological assessment on a patient with
suspected stroke, which finding represents the MOST urgent
neurological deficit requiring immediate intervention?
A) Mild weakness in the left hand (4/5 strength)
B) Complete left-sided neglect
C) Slurred speech
D) Decreasing level of consciousness (LOC)
Rationale: D - A decreasing LOC indicates potential increasing
intracranial pressure or brainstem involvement and requires immediate
intervention. While all findings are concerning in stroke, changes in
consciousness represent the most urgent threat to airway, breathing, and
circulation. The NIH Stroke Scale prioritizes LOC assessment for this
reason.
3. A 45-year-old patient with type 2 diabetes reports burning pain in
both feet worse at night. On examination, you find decreased vibration
sense at the great toes and absent ankle reflexes. Which diagnostic
test is MOST appropriate initially?
A) Nerve conduction studies
B) MRI of the lumbar spine
C) Fasting blood glucose and HbA1c
D) Vitamin B12 level
Rationale: C - This presentation is classic for diabetic peripheral
neuropathy. The first step is confirming glycemic control status, as this is
the most likely etiology in a diabetic patient. While nerve studies (A) may
be needed eventually, they're not the first test. Spine MRI (B) would be for
radiculopathy (typically unilateral), and B12 deficiency (D) is less likely
given the bilateral, symmetric presentation.
4. During a cardiovascular assessment, you note a murmur that
increases with handgrip exercise. This maneuver most likely indicates
which type of murmur?
, A) Aortic stenosis
B) Mitral regurgitation
C) Hypertrophic cardiomyopathy
D) Aortic regurgitation
Rationale: B - Handgrip increases afterload (peripheral resistance), which
increases the volume of regurgitation in mitral regurgitation, making the
murmur louder. Aortic stenosis (A) typically decreases with handgrip.
Hypertrophic cardiomyopathy (C) murmur increases with decreased
preload (Valsalva), not handgrip. Aortic regurgitation (D) may have
variable responses.
5. A 72-year-old patient presents with unintentional 15-pound weight
loss over 3 months. In your comprehensive assessment, which finding
would be MOST concerning for malignancy?
A) Hemoglobin 11.8 g/dL
B) Recent onset of dysphagia to solids
C) Mild elevation in alkaline phosphatase
D) Fatigue and decreased appetite
Rationale: B - New dysphagia in an older adult, especially progressive
from solids to liquids, raises concern for esophageal or gastric cancer and
requires urgent evaluation. While anemia (A), mild liver enzyme elevation
(C), and constitutional symptoms (D) can occur with many conditions
including cancer, dysphagia is a specific "red flag" symptom.
6. When assessing a patient with suspected sepsis, which vital sign
change is the MOST sensitive early indicator of compensated shock?
A) Decreased blood pressure
B) Increased respiratory rate
C) Decreased urine output
D) Tachycardia
Rationale: D - Tachycardia is typically the first vital sign to change in early
shock as the body attempts to maintain cardiac output. Hypotension (A)
