NU 578 – ADVANCED NURSING PRACTICE:
UNIT 3 EXAM UNIVERSITY OF SOUTH ALABAMA
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES ||
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 62-year-old patient with chronic heart failure presents with worsening dyspnea
and edema. Labs reveal sodium 132 mEq/L, potassium 3.2 mEq/L, and BNP
elevated. Which pharmacologic agent is most appropriate to initiate immediately?
A. Furosemide
B. Spironolactone
C. Digoxin
D. Lisinopril
Answer: A. Furosemide
Rationale: The patient presents with fluid overload and hyponatremia, indicating
decompensated heart failure. Loop diuretics such as furosemide are first-line for
rapid fluid removal. Spironolactone is potassium-sparing but slower-acting.
Digoxin is used mainly for rate control in HF with reduced EF, and ACE inhibitors
like lisinopril are maintenance therapy, not for acute decompensation.
,Question 2
A patient with type 2 diabetes is prescribed metformin. Which instruction is most
important to include regarding lab monitoring?
A. Monitor ALT and AST regularly due to hepatotoxicity risk
B. Monitor serum creatinine and eGFR to assess renal function
C. Monitor serum potassium for hyperkalemia
D. Monitor blood pressure daily for hypotension
Answer: B. Monitor serum creatinine and eGFR to assess renal function
Rationale: Metformin is contraindicated in renal impairment due to the risk of
lactic acidosis. Monitoring liver enzymes is less critical unless preexisting liver
disease exists. Hyperkalemia and hypotension are not primary concerns with
metformin.
Question 3
A 48-year-old patient presents with sudden-onset severe headache, nausea, and
vomiting. CT scan confirms subarachnoid hemorrhage. Which medication is most
important to administer first?
A. Nimodipine
B. Labetalol
C. Mannitol
D. Phenytoin
Answer: B. Labetalol
Rationale: Initial management of subarachnoid hemorrhage focuses on blood
pressure control to prevent rebleeding. Labetalol is preferred for rapid blood
pressure reduction. Nimodipine is used to prevent vasospasm but is not for acute
BP management. Mannitol is for increased ICP, and phenytoin may be considered
for seizure prophylaxis later.
,Question 4
A patient with chronic obstructive pulmonary disease (COPD) has a partial
pressure of oxygen (PaO₂) of 55 mmHg on room air. Which intervention is most
appropriate?
A. Administer high-flow oxygen at 10 L/min via non-rebreather mask
B. Initiate long-term oxygen therapy at 1–2 L/min via nasal cannula
C. Begin noninvasive positive pressure ventilation immediately
D. Encourage incentive spirometry only
Answer: B. Initiate long-term oxygen therapy at 1–2 L/min via nasal cannula
Rationale: COPD patients are at risk of CO₂ retention; high-flow oxygen may
worsen hypercapnia. Long-term supplemental oxygen is indicated for PaO₂ ≤ 55
mmHg. Noninvasive ventilation is indicated for acute exacerbation with
hypercapnia or respiratory distress. Incentive spirometry supports lung expansion
but is insufficient alone.
Question 5
A patient taking warfarin presents with an INR of 5.2 without bleeding. What is
the recommended management?
A. Administer vitamin K immediately
B. Hold warfarin and monitor INR
C. Increase warfarin dose
D. Administer fresh frozen plasma
Answer: B. Hold warfarin and monitor INR
Rationale: For an elevated INR without bleeding (5–9), warfarin should be held,
and INR monitored. Vitamin K is reserved for INR >10 or active bleeding.
Increasing the dose is contraindicated, and fresh frozen plasma is reserved for life-
threatening hemorrhage.
, Question 6
A patient with severe sepsis is hypotensive despite adequate fluid resuscitation.
Which pharmacologic therapy is first-line to maintain perfusion?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
Answer: B. Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock to maintain
MAP ≥ 65 mmHg after fluid resuscitation. Dopamine is reserved for selected
cases. Epinephrine is second-line, and vasopressin may be added but not first-line.
Question 7
A patient presents with hyperthyroidism secondary to Graves’ disease. Which
laboratory finding is most consistent with this diagnosis?
A. Low TSH, high free T4
B. High TSH, high free T4
C. Low TSH, low free T4
D. High TSH, low free T4
Answer: A. Low TSH, high free T4
Rationale: Graves’ disease causes primary hyperthyroidism. Negative feedback
suppresses TSH while T4 is elevated. Elevated TSH with high T4 suggests
secondary (pituitary) hyperthyroidism.
Question 8
A patient with newly diagnosed atrial fibrillation is being considered for
anticoagulation. Which assessment tool helps determine stroke risk?
A. CHADS₂ score
B. HAS-BLED score
C. APACHE II score
D. Wells criteria
UNIT 3 EXAM UNIVERSITY OF SOUTH ALABAMA
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES ||
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 62-year-old patient with chronic heart failure presents with worsening dyspnea
and edema. Labs reveal sodium 132 mEq/L, potassium 3.2 mEq/L, and BNP
elevated. Which pharmacologic agent is most appropriate to initiate immediately?
A. Furosemide
B. Spironolactone
C. Digoxin
D. Lisinopril
Answer: A. Furosemide
Rationale: The patient presents with fluid overload and hyponatremia, indicating
decompensated heart failure. Loop diuretics such as furosemide are first-line for
rapid fluid removal. Spironolactone is potassium-sparing but slower-acting.
Digoxin is used mainly for rate control in HF with reduced EF, and ACE inhibitors
like lisinopril are maintenance therapy, not for acute decompensation.
,Question 2
A patient with type 2 diabetes is prescribed metformin. Which instruction is most
important to include regarding lab monitoring?
A. Monitor ALT and AST regularly due to hepatotoxicity risk
B. Monitor serum creatinine and eGFR to assess renal function
C. Monitor serum potassium for hyperkalemia
D. Monitor blood pressure daily for hypotension
Answer: B. Monitor serum creatinine and eGFR to assess renal function
Rationale: Metformin is contraindicated in renal impairment due to the risk of
lactic acidosis. Monitoring liver enzymes is less critical unless preexisting liver
disease exists. Hyperkalemia and hypotension are not primary concerns with
metformin.
Question 3
A 48-year-old patient presents with sudden-onset severe headache, nausea, and
vomiting. CT scan confirms subarachnoid hemorrhage. Which medication is most
important to administer first?
A. Nimodipine
B. Labetalol
C. Mannitol
D. Phenytoin
Answer: B. Labetalol
Rationale: Initial management of subarachnoid hemorrhage focuses on blood
pressure control to prevent rebleeding. Labetalol is preferred for rapid blood
pressure reduction. Nimodipine is used to prevent vasospasm but is not for acute
BP management. Mannitol is for increased ICP, and phenytoin may be considered
for seizure prophylaxis later.
,Question 4
A patient with chronic obstructive pulmonary disease (COPD) has a partial
pressure of oxygen (PaO₂) of 55 mmHg on room air. Which intervention is most
appropriate?
A. Administer high-flow oxygen at 10 L/min via non-rebreather mask
B. Initiate long-term oxygen therapy at 1–2 L/min via nasal cannula
C. Begin noninvasive positive pressure ventilation immediately
D. Encourage incentive spirometry only
Answer: B. Initiate long-term oxygen therapy at 1–2 L/min via nasal cannula
Rationale: COPD patients are at risk of CO₂ retention; high-flow oxygen may
worsen hypercapnia. Long-term supplemental oxygen is indicated for PaO₂ ≤ 55
mmHg. Noninvasive ventilation is indicated for acute exacerbation with
hypercapnia or respiratory distress. Incentive spirometry supports lung expansion
but is insufficient alone.
Question 5
A patient taking warfarin presents with an INR of 5.2 without bleeding. What is
the recommended management?
A. Administer vitamin K immediately
B. Hold warfarin and monitor INR
C. Increase warfarin dose
D. Administer fresh frozen plasma
Answer: B. Hold warfarin and monitor INR
Rationale: For an elevated INR without bleeding (5–9), warfarin should be held,
and INR monitored. Vitamin K is reserved for INR >10 or active bleeding.
Increasing the dose is contraindicated, and fresh frozen plasma is reserved for life-
threatening hemorrhage.
, Question 6
A patient with severe sepsis is hypotensive despite adequate fluid resuscitation.
Which pharmacologic therapy is first-line to maintain perfusion?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
Answer: B. Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock to maintain
MAP ≥ 65 mmHg after fluid resuscitation. Dopamine is reserved for selected
cases. Epinephrine is second-line, and vasopressin may be added but not first-line.
Question 7
A patient presents with hyperthyroidism secondary to Graves’ disease. Which
laboratory finding is most consistent with this diagnosis?
A. Low TSH, high free T4
B. High TSH, high free T4
C. Low TSH, low free T4
D. High TSH, low free T4
Answer: A. Low TSH, high free T4
Rationale: Graves’ disease causes primary hyperthyroidism. Negative feedback
suppresses TSH while T4 is elevated. Elevated TSH with high T4 suggests
secondary (pituitary) hyperthyroidism.
Question 8
A patient with newly diagnosed atrial fibrillation is being considered for
anticoagulation. Which assessment tool helps determine stroke risk?
A. CHADS₂ score
B. HAS-BLED score
C. APACHE II score
D. Wells criteria
