NUR 6111 – Exam 2 (Advanced Practice Nursing I) –
2026 Actual Exam Questions and Correct Answers
Q001:
Type: NGN - Diagnostic
Scenario: 54-year-old man presents to primary care with 3-hour history of acute
midsternal chest pressure radiating to left jaw. Describes “crushing” pain, 9/10, with
diaphoresis and nausea. PMH: hyperlipidemia, 40-pack-year smoker. Vitals: BP 158/94
mmHg, HR 104 bpm, RR 22, SpO₂ 96% RA. Focused exam: diaphoretic, S4 gallop, clear
lungs, no peripheral edema.
Question: What is the priority differential diagnosis?
Options:
A. Stable angina
B. ST-elevation myocardial infarction (STEMI)
C. Gastroesophageal reflux disease
D. Costochondritis
(Correct: B)
Rationale:
● Answer: STEMI
, ● Why (2026 Standard): Acute onset, crushing retrosternal pain with radiation,
autonomic symptoms, tachycardia, and S4 (ventricular stiffness) in a high-risk
male ≥40 y meet AHA/ACC STEMI criteria; immediate ECG required.
● Errors: Stable angina lasts <15 min and is not this severe; GERD lacks
radiation/autonomic signs; costochondritis is reproducible chest-wall pain.
Q002:
Type: Complex MCQ
Scenario: 68-year-old woman with 4-week progressive exertional dyspnea, orthopnea,
PND. PMH: HTN, T2DM. Vitals: BP 146/88, HR 92 reg, RR 20, O₂ sat 94%. JVP 10 cm,
bibasilar crackles, S3 present, 2+ pitting ankle edema. BNP 840 pg/mL (ref <100). Chest
X-ray: pulmonary venous congestion, cardiomegaly.
Question: Which additional finding best supports heart failure with preserved ejection
fraction (HFpEF) as the cause?
Options:
A. LVEF 30% on echo
B. Left atrial enlargement with normal LVEF 55%
D. ST-segment depression in lateral leads
C. Peak troponin-I 6 ng/mL
(Correct: B)
Rationale:
● Answer: Left atrial enlargement with normal LVEF 55%
, ● Why (2026 Standard): HFpEF requires EF ≥50%, elevated filling pressures (BNP
↑, S3, JVP ↑), and structural evidence—LA enlargement reflects chronic diastolic
dysfunction (ACC 2025).
● Errors: EF 30% defines HFrEF; troponin-ST depression suggest ischemia or
HFrEF, not HFpEF.
Q003:
Type: NGN - Diagnostic
Scenario: 29-year-old woman, 16-week pregnant, presents with 24-hour right-sided lower
abdominal pain that started peri-umbilical. Pain 7/10, sharp, worsens with movement,
low-grade fever, anorexia. PMH: none. Vitals: T 37.8 °C, HR 96, BP 110/70. Exam: R
lower quadrant tenderness, no rebound; cervical motion tenderness absent. WBC 12
400/µL with left shift. Urinalysis: 1+ leukocyte esterase, no nitrites.
Question: Most appropriate next diagnostic test?
Options:
A. Abdominal ultrasound
B. Pelvic MRI without gadolinium
C. Quantitative hCG level
D. CT abdomen/pelvis with contrast
(Correct: A)
Rationale:
● Answer: Abdominal ultrasound
, ● Why (2026 Standard): RLQ pain in pregnancy demands graded compression
ultrasound (no radiation) to visualize appendix; sensitivity 85% in 2nd trimester
(ACOG 2026).
● Errors: CT is teratogenic; MRI reserved for inconclusive US; hCG already known
pregnant; UA findings nonspecific.
Q004:
Type: Complex MCQ
Scenario: 45-year-old man comes in for “worst headache ever” that began abruptly 2
hours ago while lifting weights. Described as occipital, 10/10, with nausea but no focal
weakness. PMH: migraines. Vitals: BP 165/100, HR 58, afebrile. Neurologic exam:
photophobia, stiff neck, no papilledema.
Question: Next best diagnostic step?
Options:
A. CT head without contrast
B. MRI brain with/without contrast
C. ESR/CRP
D. Sumatriptan trial
(Correct: A)
Rationale:
● Answer: CT head without contrast
● Why (2026 Standard): Thunderclap headache requires ruling out subarachnoid
hemorrhage; non-contrast CT within 6 h has >98% sensitivity (AHA 2025).
2026 Actual Exam Questions and Correct Answers
Q001:
Type: NGN - Diagnostic
Scenario: 54-year-old man presents to primary care with 3-hour history of acute
midsternal chest pressure radiating to left jaw. Describes “crushing” pain, 9/10, with
diaphoresis and nausea. PMH: hyperlipidemia, 40-pack-year smoker. Vitals: BP 158/94
mmHg, HR 104 bpm, RR 22, SpO₂ 96% RA. Focused exam: diaphoretic, S4 gallop, clear
lungs, no peripheral edema.
Question: What is the priority differential diagnosis?
Options:
A. Stable angina
B. ST-elevation myocardial infarction (STEMI)
C. Gastroesophageal reflux disease
D. Costochondritis
(Correct: B)
Rationale:
● Answer: STEMI
, ● Why (2026 Standard): Acute onset, crushing retrosternal pain with radiation,
autonomic symptoms, tachycardia, and S4 (ventricular stiffness) in a high-risk
male ≥40 y meet AHA/ACC STEMI criteria; immediate ECG required.
● Errors: Stable angina lasts <15 min and is not this severe; GERD lacks
radiation/autonomic signs; costochondritis is reproducible chest-wall pain.
Q002:
Type: Complex MCQ
Scenario: 68-year-old woman with 4-week progressive exertional dyspnea, orthopnea,
PND. PMH: HTN, T2DM. Vitals: BP 146/88, HR 92 reg, RR 20, O₂ sat 94%. JVP 10 cm,
bibasilar crackles, S3 present, 2+ pitting ankle edema. BNP 840 pg/mL (ref <100). Chest
X-ray: pulmonary venous congestion, cardiomegaly.
Question: Which additional finding best supports heart failure with preserved ejection
fraction (HFpEF) as the cause?
Options:
A. LVEF 30% on echo
B. Left atrial enlargement with normal LVEF 55%
D. ST-segment depression in lateral leads
C. Peak troponin-I 6 ng/mL
(Correct: B)
Rationale:
● Answer: Left atrial enlargement with normal LVEF 55%
, ● Why (2026 Standard): HFpEF requires EF ≥50%, elevated filling pressures (BNP
↑, S3, JVP ↑), and structural evidence—LA enlargement reflects chronic diastolic
dysfunction (ACC 2025).
● Errors: EF 30% defines HFrEF; troponin-ST depression suggest ischemia or
HFrEF, not HFpEF.
Q003:
Type: NGN - Diagnostic
Scenario: 29-year-old woman, 16-week pregnant, presents with 24-hour right-sided lower
abdominal pain that started peri-umbilical. Pain 7/10, sharp, worsens with movement,
low-grade fever, anorexia. PMH: none. Vitals: T 37.8 °C, HR 96, BP 110/70. Exam: R
lower quadrant tenderness, no rebound; cervical motion tenderness absent. WBC 12
400/µL with left shift. Urinalysis: 1+ leukocyte esterase, no nitrites.
Question: Most appropriate next diagnostic test?
Options:
A. Abdominal ultrasound
B. Pelvic MRI without gadolinium
C. Quantitative hCG level
D. CT abdomen/pelvis with contrast
(Correct: A)
Rationale:
● Answer: Abdominal ultrasound
, ● Why (2026 Standard): RLQ pain in pregnancy demands graded compression
ultrasound (no radiation) to visualize appendix; sensitivity 85% in 2nd trimester
(ACOG 2026).
● Errors: CT is teratogenic; MRI reserved for inconclusive US; hCG already known
pregnant; UA findings nonspecific.
Q004:
Type: Complex MCQ
Scenario: 45-year-old man comes in for “worst headache ever” that began abruptly 2
hours ago while lifting weights. Described as occipital, 10/10, with nausea but no focal
weakness. PMH: migraines. Vitals: BP 165/100, HR 58, afebrile. Neurologic exam:
photophobia, stiff neck, no papilledema.
Question: Next best diagnostic step?
Options:
A. CT head without contrast
B. MRI brain with/without contrast
C. ESR/CRP
D. Sumatriptan trial
(Correct: A)
Rationale:
● Answer: CT head without contrast
● Why (2026 Standard): Thunderclap headache requires ruling out subarachnoid
hemorrhage; non-contrast CT within 6 h has >98% sensitivity (AHA 2025).
