NURS 5220 TEST 2 EXAM – EXAM-STYLE
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE |
EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A 45-year-old patient with type 2 diabetes presents with complaints of
bilateral lower extremity numbness and tingling that worsens at night. The
patient reports no prior trauma to the extremities. Which of the following is
the most appropriate initial diagnostic step?
A. Prescribe gabapentin for neuropathic pain management
B. Order nerve conduction studies to confirm peripheral neuropathy
C. Assess for protective sensation using a 10-g monofilament test
D. Refer to neurology for electromyography evaluation
Correct Answer: C. Assess for protective sensation using a 10-g monofilament
test
Rationale: The 10-g monofilament test is the recommended initial screening tool
for diabetic peripheral neuropathy and loss of protective sensation in patients with
diabetes. This is a simple, cost-effective, and validated bedside test that should be
performed annually in patients with type 2 diabetes. While nerve conduction
studies and referral to neurology may be appropriate if diagnosis is uncertain or for
further characterization, they are not the initial diagnostic step. Prescribing
gabapentin without confirming the diagnosis and establishing baseline sensory
,function would be premature, as the medication is indicated for management after
diagnosis and may have significant side effects.
2. A 68-year-old female with hypertension and osteoarthritis presents with a
new-onset non-productive cough, fever, and shortness of breath. Chest
auscultation reveals crackles in the right lower lobe. Her vital signs show
temperature 38.2°C, heart rate 98 bpm, respiratory rate 22/min, and oxygen
saturation 90% on room air. Which of the following is the most appropriate
management strategy?
A. Prescribe oral azithromycin and schedule outpatient follow-up
B. Order a chest X-ray and obtain sputum culture before initiating antibiotics
C. Admit to the hospital for intravenous antibiotics and supportive care
D. Recommend over-the-counter cough suppressants and reassure the patient
Correct Answer: B. Order a chest X-ray and obtain sputum culture before
initiating antibiotics
Rationale: This patient presents with signs of community-acquired pneumonia,
including fever, productive cough, crackles on auscultation, and hypoxemia. The
most appropriate initial management is to obtain imaging to confirm the diagnosis
and collect sputum culture to guide antibiotic therapy, especially given her age and
comorbidities. While azithromycin is an appropriate antibiotic choice for
community-acquired pneumonia, the decision to treat and the setting should be
based on severity assessment using tools such as CURB-65 or Pneumonia Severity
Index. Admission criteria are not met based on the information provided. Over-the-
counter cough suppressants would delay treatment of a potentially serious
infection.
,3. Which of the following findings is most characteristic of systolic heart failure
on physical examination?
A. Jugular venous distension and hepatomegaly
B. S3 gallop and displaced apical impulse
C. Peripheral edema and ascites
D. Crackles in the lung bases and tachypnea
Correct Answer: B. S3 gallop and displaced apical impulse
Rationale: An S3 gallop is a hallmark finding of systolic heart failure, indicating
impaired left ventricular compliance and elevated filling pressures. A displaced
apical impulse reflects left ventricular dilation, which is common in systolic
dysfunction. While jugular venous distension, hepatomegaly, peripheral edema,
ascites, crackles, and tachypnea are all findings associated with heart failure, they
are not specific to systolic dysfunction and can occur in diastolic heart failure as
well. The combination of S3 and displaced apical impulse is most characteristic of
decreased left ventricular ejection fraction.
4. A 52-year-old male with a 30-pack-year smoking history presents with a
three-week history of hoarseness, sore throat, and a sensation of a lump in his
throat. He reports occasional blood-tinged sputum in the mornings. Which of
the following is the most appropriate initial diagnostic test?
A. Complete blood count with differential
B. Chest X-ray
, C. Direct laryngoscopy
D. Sputum culture and sensitivity
Correct Answer: C. Direct laryngoscopy
Rationale: Hoarseness lasting longer than three weeks, particularly in a patient
with significant smoking history and hemoptysis, raises concern for laryngeal or
pharyngeal malignancy. Direct laryngoscopy allows direct visualization of the vocal
cords and surrounding structures, providing the opportunity for biopsy of suspicious
lesions. This is the gold standard for diagnosing laryngeal pathology. Chest X-ray
may be helpful to evaluate for lung pathology but does not directly visualize the
larynx. Sputum culture is not useful for malignancy, and while complete blood
count may show anemia, it is not diagnostic of laryngeal pathology.
5. A 70-year-old male with known chronic obstructive pulmonary disease is
prescribed tiotropium for symptom management. Which of the following is the
most important instruction the nurse practitioner should provide regarding this
medication?
A. "Take this medication only when you feel short of breath"
B. "You may experience relief of symptoms within 5 to 10 minutes"
C. "Rinse your mouth after each use to prevent oral thrush"
D. "This medication should be taken with meals to enhance absorption"
Correct Answer: C. "Rinse your mouth after each use to prevent oral thrush"
Rationale: Tiotropium is a long-acting anticholinergic bronchodilator administered
via inhalation. A critical patient education point is rinsing the mouth after each use
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE |
EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A 45-year-old patient with type 2 diabetes presents with complaints of
bilateral lower extremity numbness and tingling that worsens at night. The
patient reports no prior trauma to the extremities. Which of the following is
the most appropriate initial diagnostic step?
A. Prescribe gabapentin for neuropathic pain management
B. Order nerve conduction studies to confirm peripheral neuropathy
C. Assess for protective sensation using a 10-g monofilament test
D. Refer to neurology for electromyography evaluation
Correct Answer: C. Assess for protective sensation using a 10-g monofilament
test
Rationale: The 10-g monofilament test is the recommended initial screening tool
for diabetic peripheral neuropathy and loss of protective sensation in patients with
diabetes. This is a simple, cost-effective, and validated bedside test that should be
performed annually in patients with type 2 diabetes. While nerve conduction
studies and referral to neurology may be appropriate if diagnosis is uncertain or for
further characterization, they are not the initial diagnostic step. Prescribing
gabapentin without confirming the diagnosis and establishing baseline sensory
,function would be premature, as the medication is indicated for management after
diagnosis and may have significant side effects.
2. A 68-year-old female with hypertension and osteoarthritis presents with a
new-onset non-productive cough, fever, and shortness of breath. Chest
auscultation reveals crackles in the right lower lobe. Her vital signs show
temperature 38.2°C, heart rate 98 bpm, respiratory rate 22/min, and oxygen
saturation 90% on room air. Which of the following is the most appropriate
management strategy?
A. Prescribe oral azithromycin and schedule outpatient follow-up
B. Order a chest X-ray and obtain sputum culture before initiating antibiotics
C. Admit to the hospital for intravenous antibiotics and supportive care
D. Recommend over-the-counter cough suppressants and reassure the patient
Correct Answer: B. Order a chest X-ray and obtain sputum culture before
initiating antibiotics
Rationale: This patient presents with signs of community-acquired pneumonia,
including fever, productive cough, crackles on auscultation, and hypoxemia. The
most appropriate initial management is to obtain imaging to confirm the diagnosis
and collect sputum culture to guide antibiotic therapy, especially given her age and
comorbidities. While azithromycin is an appropriate antibiotic choice for
community-acquired pneumonia, the decision to treat and the setting should be
based on severity assessment using tools such as CURB-65 or Pneumonia Severity
Index. Admission criteria are not met based on the information provided. Over-the-
counter cough suppressants would delay treatment of a potentially serious
infection.
,3. Which of the following findings is most characteristic of systolic heart failure
on physical examination?
A. Jugular venous distension and hepatomegaly
B. S3 gallop and displaced apical impulse
C. Peripheral edema and ascites
D. Crackles in the lung bases and tachypnea
Correct Answer: B. S3 gallop and displaced apical impulse
Rationale: An S3 gallop is a hallmark finding of systolic heart failure, indicating
impaired left ventricular compliance and elevated filling pressures. A displaced
apical impulse reflects left ventricular dilation, which is common in systolic
dysfunction. While jugular venous distension, hepatomegaly, peripheral edema,
ascites, crackles, and tachypnea are all findings associated with heart failure, they
are not specific to systolic dysfunction and can occur in diastolic heart failure as
well. The combination of S3 and displaced apical impulse is most characteristic of
decreased left ventricular ejection fraction.
4. A 52-year-old male with a 30-pack-year smoking history presents with a
three-week history of hoarseness, sore throat, and a sensation of a lump in his
throat. He reports occasional blood-tinged sputum in the mornings. Which of
the following is the most appropriate initial diagnostic test?
A. Complete blood count with differential
B. Chest X-ray
, C. Direct laryngoscopy
D. Sputum culture and sensitivity
Correct Answer: C. Direct laryngoscopy
Rationale: Hoarseness lasting longer than three weeks, particularly in a patient
with significant smoking history and hemoptysis, raises concern for laryngeal or
pharyngeal malignancy. Direct laryngoscopy allows direct visualization of the vocal
cords and surrounding structures, providing the opportunity for biopsy of suspicious
lesions. This is the gold standard for diagnosing laryngeal pathology. Chest X-ray
may be helpful to evaluate for lung pathology but does not directly visualize the
larynx. Sputum culture is not useful for malignancy, and while complete blood
count may show anemia, it is not diagnostic of laryngeal pathology.
5. A 70-year-old male with known chronic obstructive pulmonary disease is
prescribed tiotropium for symptom management. Which of the following is the
most important instruction the nurse practitioner should provide regarding this
medication?
A. "Take this medication only when you feel short of breath"
B. "You may experience relief of symptoms within 5 to 10 minutes"
C. "Rinse your mouth after each use to prevent oral thrush"
D. "This medication should be taken with meals to enhance absorption"
Correct Answer: C. "Rinse your mouth after each use to prevent oral thrush"
Rationale: Tiotropium is a long-acting anticholinergic bronchodilator administered
via inhalation. A critical patient education point is rinsing the mouth after each use
