MSN 612 Final Exam 2025 with Correct Answers – Advanced
Nursing Practice Review Material
1. A 55-year-old male with a history of hypertension presents with a blood pressure of 150/95 mmHg.
According to the Eighth Joint National Committee (JNC 8) guidelines, what is the recommended target
blood pressure for this patient?
A) <130/80 mmHg
B) <140/90 mmHg
C) <150/90 mmHg
D) <160/100 mmHg
Answer: B – Explanation: JNC 8 recommends target BP <140/90 mmHg for adults aged <60 years and
<150/90 for those ≥60 years or with diabetes/CKD. This patient is 55 with hypertension but no other
conditions, so target is <140/90.
2. A nurse practitioner is managing a patient with type 2 diabetes and stage 3 chronic kidney disease
(eGFR 45 mL/min). Which antidiabetic medication requires dose adjustment in this patient?
A) Metformin
B) Pioglitazone
C) Sitagliptin
D) Liraglutide
Answer: A – Explanation: Metformin is contraindicated or requires dose adjustment when eGFR <45
mL/min due to risk of lactic acidosis. Pioglitazone and liraglutide are not primarily renally excreted;
sitagliptin requires adjustment but less acutely toxic.
3. A 70-year-old female with heart failure with preserved ejection fraction (HFpEF) is admitted with
acute dyspnea. Which medication is most effective for symptom management in acute decompensated
HFpEF?
A) Digoxin
B) Furosemide
C) Spironolactone
D) Metoprolol
,Answer: B – Explanation: Loop diuretics (furosemide) are first-line for volume overload in both HFrEF
and HFpEF. Digoxin is not indicated in HFpEF. Spironolactone and metoprolol are chronic therapies.
4. A patient on warfarin has an INR of 4.5 with no signs of bleeding. The next appropriate action is:
A) Administer vitamin K 10 mg IV
B) Hold warfarin and recheck INR in 24 hours
C) Give fresh frozen plasma
D) Increase warfarin dose
Answer: B – Explanation: For INR 4.5 without bleeding, hold warfarin and recheck. Vitamin K is given if
INR >10 or bleeding. FFP for life-threatening bleeding.
5. Which antibiotic class is associated with the highest risk of Clostridioides difficile infection?
A) Macrolides
B) Tetracyclines
C) Fluoroquinolones
D) Sulfonamides
Answer: C – Explanation: Fluoroquinolones (levofloxacin, ciprofloxacin), clindamycin, and broad-
spectrum cephalosporins have the highest risk for CDI. Macrolides and tetracyclines have lower risk.
6. A 45-year-old female presents with fatigue, weight gain, constipation, and cold intolerance. Labs show
TSH 12 mIU/L (normal 0.4-4.0), free T4 low. What is the most appropriate initial treatment?
A) Methimazole
B) Levothyroxine 1.6 mcg/kg/day
C) Levothyroxine 50 mcg/day with gradual titration
D) Radioactive iodine ablation
Answer: C – Explanation: Overt hypothyroidism is treated with levothyroxine starting at 50-100 mcg/day
(lower in elderly or cardiac disease). Full replacement is 1.6 mcg/kg but start lower and titrate.
7. A patient with chronic obstructive pulmonary disease (COPD) has an FEV1/FVC ratio of 0.65 and FEV1
55% predicted. According to GOLD guidelines, what is the severity stage?
A) GOLD 1 (mild)
,B) GOLD 2 (moderate)
C) GOLD 3 (severe)
D) GOLD 4 (very severe)
Answer: C – Explanation: GOLD stages: 1: FEV1 ≥80%; 2: 50-79%; 3: 30-49%; 4: <30%. FEV1 55% is
moderate (GOLD 2). Wait: 55% is 50-79%, so GOLD 2. I mis-spoke. Correct: GOLD 2 is moderate. So
answer B. Let me correct: Answer B.
8. A nurse practitioner is evaluating a patient for possible statin-induced myopathy. Which laboratory
finding is most specific?
A) Elevated AST/ALT
B) Elevated creatine kinase (CK) more than 10 times upper limit of normal
C) Elevated BUN and creatinine
D) Elevated troponin
Answer: B – Explanation: Statin myopathy is suggested by muscle pain with CK elevation >10x ULN. Mild
CK elevation is common. AST/ALT elevation indicates hepatotoxicity.
9. A patient with atrial fibrillation and CHA2DS2-VASc score of 4 is prescribed apixaban. Which patient
characteristic would require a dose reduction?
A) Age >75 years
B) Body weight <60 kg
C) Creatinine clearance 25 mL/min
D) All of the above
Answer: D – Explanation: Apixaban dose reduction (5 mg → 2.5 mg BID) if any two of: age ≥80, weight
≤60 kg, Cr ≥1.5 mg/dL (CrCl ~30). Also for CrCl 15-29 mL/min. So all three are dose reduction criteria.
10. A 68-year-old male with heart failure with reduced ejection fraction (HFrEF) is on
sacubitril/valsartan. Which adverse effect requires immediate discontinuation?
A) Dry cough
B) Angioedema
C) Hypotension
D) Hyperkalemia
, Answer: B – Explanation: Angioedema (swelling of lips, tongue, airway) is a serious adverse effect of
ARNI/ACE inhibitors/ARBs. Stop drug immediately. Dry cough is less common with ARNI. Hypotension is
managed by dose adjustment.
11. A patient with type 2 diabetes has an HbA1c of 9.5% despite metformin 2000 mg/day and lifestyle
modification. The patient has established atherosclerotic cardiovascular disease (ASCVD). Which second-
line agent is preferred?
A) Sulfonylurea
B) DPP-4 inhibitor
C) SGLT2 inhibitor (empagliflozin) or GLP-1 receptor agonist (liraglutide)
D) Insulin
Answer: C – Explanation: For patients with T2DM and ASCVD, SGLT2 inhibitors or GLP-1 agonists with
proven cardiovascular benefit are preferred second-line agents.
12. A 72-year-old female is prescribed low-dose aspirin for secondary prevention of cardiovascular
disease. She has a history of peptic ulcer disease. Which concomitant medication should be added to
reduce GI bleeding risk?
A) Omeprazole
B) Famotidine
C) Misoprostol
D) Sucralfate
Answer: A – Explanation: Proton pump inhibitor (omeprazole) is recommended for patients at high GI
bleeding risk who require antiplatelet therapy. PPI reduces ulcer risk.
13. A patient with gout is started on allopurinol. Which instruction is most important to prevent acute
flare?
A) Take allopurinol with food
B) Start colchicine or NSAID prophylaxis for 3-6 months
C) Increase fluid intake to 3 L/day
D) Avoid alcohol completely
Answer: B – Explanation: Allopurinol can precipitate acute gout flares when initiated. Prophylaxis with
colchicine or NSAID for 3-6 months is recommended. Fluid intake and avoidance of triggers are also
important but not specific to flare prevention.
Nursing Practice Review Material
1. A 55-year-old male with a history of hypertension presents with a blood pressure of 150/95 mmHg.
According to the Eighth Joint National Committee (JNC 8) guidelines, what is the recommended target
blood pressure for this patient?
A) <130/80 mmHg
B) <140/90 mmHg
C) <150/90 mmHg
D) <160/100 mmHg
Answer: B – Explanation: JNC 8 recommends target BP <140/90 mmHg for adults aged <60 years and
<150/90 for those ≥60 years or with diabetes/CKD. This patient is 55 with hypertension but no other
conditions, so target is <140/90.
2. A nurse practitioner is managing a patient with type 2 diabetes and stage 3 chronic kidney disease
(eGFR 45 mL/min). Which antidiabetic medication requires dose adjustment in this patient?
A) Metformin
B) Pioglitazone
C) Sitagliptin
D) Liraglutide
Answer: A – Explanation: Metformin is contraindicated or requires dose adjustment when eGFR <45
mL/min due to risk of lactic acidosis. Pioglitazone and liraglutide are not primarily renally excreted;
sitagliptin requires adjustment but less acutely toxic.
3. A 70-year-old female with heart failure with preserved ejection fraction (HFpEF) is admitted with
acute dyspnea. Which medication is most effective for symptom management in acute decompensated
HFpEF?
A) Digoxin
B) Furosemide
C) Spironolactone
D) Metoprolol
,Answer: B – Explanation: Loop diuretics (furosemide) are first-line for volume overload in both HFrEF
and HFpEF. Digoxin is not indicated in HFpEF. Spironolactone and metoprolol are chronic therapies.
4. A patient on warfarin has an INR of 4.5 with no signs of bleeding. The next appropriate action is:
A) Administer vitamin K 10 mg IV
B) Hold warfarin and recheck INR in 24 hours
C) Give fresh frozen plasma
D) Increase warfarin dose
Answer: B – Explanation: For INR 4.5 without bleeding, hold warfarin and recheck. Vitamin K is given if
INR >10 or bleeding. FFP for life-threatening bleeding.
5. Which antibiotic class is associated with the highest risk of Clostridioides difficile infection?
A) Macrolides
B) Tetracyclines
C) Fluoroquinolones
D) Sulfonamides
Answer: C – Explanation: Fluoroquinolones (levofloxacin, ciprofloxacin), clindamycin, and broad-
spectrum cephalosporins have the highest risk for CDI. Macrolides and tetracyclines have lower risk.
6. A 45-year-old female presents with fatigue, weight gain, constipation, and cold intolerance. Labs show
TSH 12 mIU/L (normal 0.4-4.0), free T4 low. What is the most appropriate initial treatment?
A) Methimazole
B) Levothyroxine 1.6 mcg/kg/day
C) Levothyroxine 50 mcg/day with gradual titration
D) Radioactive iodine ablation
Answer: C – Explanation: Overt hypothyroidism is treated with levothyroxine starting at 50-100 mcg/day
(lower in elderly or cardiac disease). Full replacement is 1.6 mcg/kg but start lower and titrate.
7. A patient with chronic obstructive pulmonary disease (COPD) has an FEV1/FVC ratio of 0.65 and FEV1
55% predicted. According to GOLD guidelines, what is the severity stage?
A) GOLD 1 (mild)
,B) GOLD 2 (moderate)
C) GOLD 3 (severe)
D) GOLD 4 (very severe)
Answer: C – Explanation: GOLD stages: 1: FEV1 ≥80%; 2: 50-79%; 3: 30-49%; 4: <30%. FEV1 55% is
moderate (GOLD 2). Wait: 55% is 50-79%, so GOLD 2. I mis-spoke. Correct: GOLD 2 is moderate. So
answer B. Let me correct: Answer B.
8. A nurse practitioner is evaluating a patient for possible statin-induced myopathy. Which laboratory
finding is most specific?
A) Elevated AST/ALT
B) Elevated creatine kinase (CK) more than 10 times upper limit of normal
C) Elevated BUN and creatinine
D) Elevated troponin
Answer: B – Explanation: Statin myopathy is suggested by muscle pain with CK elevation >10x ULN. Mild
CK elevation is common. AST/ALT elevation indicates hepatotoxicity.
9. A patient with atrial fibrillation and CHA2DS2-VASc score of 4 is prescribed apixaban. Which patient
characteristic would require a dose reduction?
A) Age >75 years
B) Body weight <60 kg
C) Creatinine clearance 25 mL/min
D) All of the above
Answer: D – Explanation: Apixaban dose reduction (5 mg → 2.5 mg BID) if any two of: age ≥80, weight
≤60 kg, Cr ≥1.5 mg/dL (CrCl ~30). Also for CrCl 15-29 mL/min. So all three are dose reduction criteria.
10. A 68-year-old male with heart failure with reduced ejection fraction (HFrEF) is on
sacubitril/valsartan. Which adverse effect requires immediate discontinuation?
A) Dry cough
B) Angioedema
C) Hypotension
D) Hyperkalemia
, Answer: B – Explanation: Angioedema (swelling of lips, tongue, airway) is a serious adverse effect of
ARNI/ACE inhibitors/ARBs. Stop drug immediately. Dry cough is less common with ARNI. Hypotension is
managed by dose adjustment.
11. A patient with type 2 diabetes has an HbA1c of 9.5% despite metformin 2000 mg/day and lifestyle
modification. The patient has established atherosclerotic cardiovascular disease (ASCVD). Which second-
line agent is preferred?
A) Sulfonylurea
B) DPP-4 inhibitor
C) SGLT2 inhibitor (empagliflozin) or GLP-1 receptor agonist (liraglutide)
D) Insulin
Answer: C – Explanation: For patients with T2DM and ASCVD, SGLT2 inhibitors or GLP-1 agonists with
proven cardiovascular benefit are preferred second-line agents.
12. A 72-year-old female is prescribed low-dose aspirin for secondary prevention of cardiovascular
disease. She has a history of peptic ulcer disease. Which concomitant medication should be added to
reduce GI bleeding risk?
A) Omeprazole
B) Famotidine
C) Misoprostol
D) Sucralfate
Answer: A – Explanation: Proton pump inhibitor (omeprazole) is recommended for patients at high GI
bleeding risk who require antiplatelet therapy. PPI reduces ulcer risk.
13. A patient with gout is started on allopurinol. Which instruction is most important to prevent acute
flare?
A) Take allopurinol with food
B) Start colchicine or NSAID prophylaxis for 3-6 months
C) Increase fluid intake to 3 L/day
D) Avoid alcohol completely
Answer: B – Explanation: Allopurinol can precipitate acute gout flares when initiated. Prophylaxis with
colchicine or NSAID for 3-6 months is recommended. Fluid intake and avoidance of triggers are also
important but not specific to flare prevention.
