NR-581NP-0 FOUNDATIONAL CONCEPTS FOR ANP
(QUESTIONS AND CORRECT ANSWERS) EXAM DUE JULY
2026
[1] A 65-year-old male with a history of hypertension presents with a
new onset of confusion, nausea, and muscle twitching. His labs reveal a
serum sodium of 118 mEq/L. Which of the following is the most
appropriate initial management strategy for this patient to avoid
complications?
A. Administer 3% hypertonic saline at 100 mL/hr until sodium reaches
125 mEq/L
B. Fluid restrict to 1 L per day and administer a loop diuretic
C. Administer 0.9% normal saline at 150 mL/hr
D. Discontinue all current medications and recheck sodium in 24 hours
Correct Answer: B
Explanation: In chronic hyponatremia, overly rapid correction can lead
to osmotic demyelination syndrome. The standard of care is fluid
restriction and judicious use of loop diuretics to promote free water
excretion. Hypertonic saline (A) is reserved for severe symptoms like
seizures and must be given at a controlled rate. Normal saline (C) is
generally ineffective and can worsen hyponatremia. Discontinuing
medications (D) without addressing the underlying cause is not a
sufficient acute management strategy.
[2] A 78-year-old female with known aortic stenosis is scheduled for a
total knee arthroplasty. Which of the following is the most critical
,perioperative concern for this patient?
A. Risk of malignant hyperthermia
B. Risk of profound bradycardia
C. Risk of myocardial ischemia and hemodynamic instability
D. Risk of acute kidney injury from nephrotoxic antibiotics
Correct Answer: C
Explanation: Patients with severe aortic stenosis have a fixed cardiac
output. The perioperative risk of myocardial ischemia and hemodynamic
collapse is high due to the inability to increase cardiac output and the
high afterload. While the other options are valid concerns, they are not
the primary, most critical risk associated with aortic stenosis in this
context.
[3] A patient with a history of atrial fibrillation on warfarin presents with
an INR of 9.2 and a small subdural hematoma. Which of the following is
the most appropriate immediate management step?
A. Hold warfarin and administer vitamin K 10 mg IV
B. Administer fresh frozen plasma (FFP) immediately
C. Hold warfarin and administer prothrombin complex concentrate
(PCC) and vitamin K
D. Administer recombinant factor VIIa and observe
Correct Answer: C
Explanation: In the presence of an intracranial hemorrhage and a
significantly elevated INR, the standard of care is rapid reversal using
PCC (4-factor) and vitamin K. PCC is preferred over FFP due to faster
onset and lower volume. Vitamin K alone (A) is too slow. FFP alone (B) is
not as rapid or effective as PCC.
,[4] A 55-year-old patient presents with a chief complaint of nocturia,
hesitancy, and a weak urinary stream. A digital rectal exam reveals an
enlarged, smooth, non-tender prostate. Which of the following is the
most appropriate initial pharmacologic therapy?
A. Dutasteride
B. Tamsulosin
C. Terazosin
D. Bicalutamide
Correct Answer: B
Explanation: Alpha-blockers like tamsulosin and terazosin are effective
for symptomatic relief of benign prostatic hyperplasia (BPH). Tamsulosin
is often preferred due to its uroselectivity and lower side effect profile
compared to non-selective alpha-blockers like terazosin. Dutasteride (A)
is a 5-alpha-reductase inhibitor, which is effective but takes longer to
work. Bicalutamide (D) is an anti-androgen used for prostate cancer, not
BPH.
[5] An APRN is evaluating a patient with a chronic cough. The patient is
a non-smoker and denies any post-nasal drip or gastroesophageal
reflux. A chest X-ray shows a peripheral, solitary pulmonary nodule.
What is the next most appropriate step in management?
A. Schedule a follow-up chest X-ray in 3 months
B. Initiate a course of antibiotics for community-acquired pneumonia
C. Obtain a CT scan of the chest with contrast for further
characterization
D. Order a positron emission tomography (PET) scan immediately
, Correct Answer: C
Explanation: The initial step in evaluating a solitary pulmonary nodule is
a high-resolution CT scan to better characterize its features (size,
margins, calcification). A PET scan may be used later in risk stratification
but is not the immediate next step. A wait-and-see approach is not
appropriate for a new, undifferentiated nodule.
[6] A 68-year-old female with a past medical history of osteoporosis
presents with severe mid-back pain after a minor fall. She is on
alendronate. An MRI of the spine reveals an acute vertebral
compression fracture at T12. Which of the following is the most
appropriate treatment for her acute pain?
A. Percutaneous vertebroplasty
B. High-dose opioids
C. NSAIDs and a short course of muscle relaxants
D. Bed rest for 6 weeks
Correct Answer: C
Explanation: Acute pain from a compression fracture is initially
managed with analgesics, including NSAIDs and muscle relaxants, with
a focus on early mobilization. Vertebroplasty (A) is controversial and
generally reserved for refractory pain. High-dose opioids (B) may be
used but are not the first line. Prolonged bed rest (D) is detrimental to
recovery.
[7] A 72-year-old male presents with a progressive, painless loss of
vision in his left eye over the past year. He has a history of diabetes and
hypertension. Fundoscopic exam reveals a pale, swollen optic disc with
(QUESTIONS AND CORRECT ANSWERS) EXAM DUE JULY
2026
[1] A 65-year-old male with a history of hypertension presents with a
new onset of confusion, nausea, and muscle twitching. His labs reveal a
serum sodium of 118 mEq/L. Which of the following is the most
appropriate initial management strategy for this patient to avoid
complications?
A. Administer 3% hypertonic saline at 100 mL/hr until sodium reaches
125 mEq/L
B. Fluid restrict to 1 L per day and administer a loop diuretic
C. Administer 0.9% normal saline at 150 mL/hr
D. Discontinue all current medications and recheck sodium in 24 hours
Correct Answer: B
Explanation: In chronic hyponatremia, overly rapid correction can lead
to osmotic demyelination syndrome. The standard of care is fluid
restriction and judicious use of loop diuretics to promote free water
excretion. Hypertonic saline (A) is reserved for severe symptoms like
seizures and must be given at a controlled rate. Normal saline (C) is
generally ineffective and can worsen hyponatremia. Discontinuing
medications (D) without addressing the underlying cause is not a
sufficient acute management strategy.
[2] A 78-year-old female with known aortic stenosis is scheduled for a
total knee arthroplasty. Which of the following is the most critical
,perioperative concern for this patient?
A. Risk of malignant hyperthermia
B. Risk of profound bradycardia
C. Risk of myocardial ischemia and hemodynamic instability
D. Risk of acute kidney injury from nephrotoxic antibiotics
Correct Answer: C
Explanation: Patients with severe aortic stenosis have a fixed cardiac
output. The perioperative risk of myocardial ischemia and hemodynamic
collapse is high due to the inability to increase cardiac output and the
high afterload. While the other options are valid concerns, they are not
the primary, most critical risk associated with aortic stenosis in this
context.
[3] A patient with a history of atrial fibrillation on warfarin presents with
an INR of 9.2 and a small subdural hematoma. Which of the following is
the most appropriate immediate management step?
A. Hold warfarin and administer vitamin K 10 mg IV
B. Administer fresh frozen plasma (FFP) immediately
C. Hold warfarin and administer prothrombin complex concentrate
(PCC) and vitamin K
D. Administer recombinant factor VIIa and observe
Correct Answer: C
Explanation: In the presence of an intracranial hemorrhage and a
significantly elevated INR, the standard of care is rapid reversal using
PCC (4-factor) and vitamin K. PCC is preferred over FFP due to faster
onset and lower volume. Vitamin K alone (A) is too slow. FFP alone (B) is
not as rapid or effective as PCC.
,[4] A 55-year-old patient presents with a chief complaint of nocturia,
hesitancy, and a weak urinary stream. A digital rectal exam reveals an
enlarged, smooth, non-tender prostate. Which of the following is the
most appropriate initial pharmacologic therapy?
A. Dutasteride
B. Tamsulosin
C. Terazosin
D. Bicalutamide
Correct Answer: B
Explanation: Alpha-blockers like tamsulosin and terazosin are effective
for symptomatic relief of benign prostatic hyperplasia (BPH). Tamsulosin
is often preferred due to its uroselectivity and lower side effect profile
compared to non-selective alpha-blockers like terazosin. Dutasteride (A)
is a 5-alpha-reductase inhibitor, which is effective but takes longer to
work. Bicalutamide (D) is an anti-androgen used for prostate cancer, not
BPH.
[5] An APRN is evaluating a patient with a chronic cough. The patient is
a non-smoker and denies any post-nasal drip or gastroesophageal
reflux. A chest X-ray shows a peripheral, solitary pulmonary nodule.
What is the next most appropriate step in management?
A. Schedule a follow-up chest X-ray in 3 months
B. Initiate a course of antibiotics for community-acquired pneumonia
C. Obtain a CT scan of the chest with contrast for further
characterization
D. Order a positron emission tomography (PET) scan immediately
, Correct Answer: C
Explanation: The initial step in evaluating a solitary pulmonary nodule is
a high-resolution CT scan to better characterize its features (size,
margins, calcification). A PET scan may be used later in risk stratification
but is not the immediate next step. A wait-and-see approach is not
appropriate for a new, undifferentiated nodule.
[6] A 68-year-old female with a past medical history of osteoporosis
presents with severe mid-back pain after a minor fall. She is on
alendronate. An MRI of the spine reveals an acute vertebral
compression fracture at T12. Which of the following is the most
appropriate treatment for her acute pain?
A. Percutaneous vertebroplasty
B. High-dose opioids
C. NSAIDs and a short course of muscle relaxants
D. Bed rest for 6 weeks
Correct Answer: C
Explanation: Acute pain from a compression fracture is initially
managed with analgesics, including NSAIDs and muscle relaxants, with
a focus on early mobilization. Vertebroplasty (A) is controversial and
generally reserved for refractory pain. High-dose opioids (B) may be
used but are not the first line. Prolonged bed rest (D) is detrimental to
recovery.
[7] A 72-year-old male presents with a progressive, painless loss of
vision in his left eye over the past year. He has a history of diabetes and
hypertension. Fundoscopic exam reveals a pale, swollen optic disc with
