NUR 6111 – Exam 2 (Advanced Nursing I) – 2026 Actual
Exam Questions and Correct Answers
Q001:
Type: NGN - Diagnostic
Scenario: A 62-year-old male presents to the primary care clinic with acute onset of
substernal chest pain that began 2 hours ago while mowing his lawn. He describes the
pain as pressure-like, 8/10 intensity, radiating to his left jaw and arm. Associated
symptoms include diaphoresis, nausea, and shortness of breath. PMH: hypertension,
hyperlipidemia, 30-pack-year smoking history. Vitals: BP 148/92, HR 106, RR 22, Temp
98.6°F, O2 sat 94% RA. Physical exam: diaphoretic, mild distress, lungs clear bilaterally,
heart RRR without murmurs, no peripheral edema. ECG shows ST-segment elevation in
leads II, III, aVF with reciprocal changes in I and aVL. Troponin I pending.
Question: What is the most likely diagnosis?
Options:
A. Unstable angina
B. Inferior wall ST-elevation myocardial infarction
C. Acute pericarditis
D. Aortic dissection
(Correct: B)
Rationale:
● Answer: Inferior wall ST-elevation myocardial infarction
● Why (2026 Standard): The presentation classic for MI with crushing substernal
chest pain, radiation to jaw/arm, diaphoresis, and ST-elevation in inferior leads (II,
III, aVF) with reciprocal changes. The pathophysiology involves complete
thrombotic occlusion of the right coronary artery (RCA) supplying the inferior
wall. 2023 ACC/AHA guidelines maintain that ST-elevation in contiguous leads
with clinical symptoms confirms STEMI diagnosis requiring immediate
reperfusion.
● Errors: A is incorrect because unstable angina shows no ST-elevation or troponin
rise. C is incorrect because pericarditis presents with diffuse ST-elevation and PR
, depression, not localized inferior changes with reciprocal depression. D is
incorrect because aortic dissection typically presents with tearing back pain,
asymmetric pulses, and widened mediastinum on imaging.
Q002:
Type: Complex MCQ
Scenario: A 45-year-old female presents with 3 days of worsening pleuritic chest pain
and dyspnea. Pain is left-sided and worsens with deep inspiration. She reports recent
12-hour flight 5 days ago. Vitals: HR 118, RR 24, BP 132/78, Temp 99.1°F, O2 sat 89%
RA. Physical exam: left leg swelling noted, tachypneic with clear lungs bilaterally, no
wheezes. Heart tachycardic without murmurs. D-dimer elevated at 2.5 mcg/mL.
Question: What is the next most appropriate diagnostic test?
Options:
A. Chest X-ray
B. CT pulmonary angiography
C. Ventilation-perfusion scan
D. Lower extremity venous Doppler ultrasound
(Correct: B)
Rationale:
● Answer: CT pulmonary angiography
● Why (2026 Standard): The Wells score is high (clinical signs of DVT, no
alternative diagnosis, tachycardia, hemoptysis, immobilization). With high pre-test
probability and elevated D-dimer, CTPA is the gold standard for diagnosing
pulmonary embolism. It provides direct visualization of the pulmonary vasculature
and can detect subsegmental emboli. 2020 ACCP guidelines recommend CTPA as
first-line imaging for suspected PE in patients with high clinical probability.
● Errors: A is incorrect because CXR is often normal in PE and cannot confirm
diagnosis. C is incorrect because VQ scans are reserved for patients with
contraindications to CTPA (allergy, renal failure) or pregnancy. D is incorrect
because while it confirms DVT, it doesn't evaluate for PE which is the
life-threatening condition requiring urgent diagnosis.
Q003:
Type: NGN - Diagnostic
,Scenario: A 78-year-old male with COPD (GOLD Stage 3) presents with progressively
worsening dyspnea over 3 days. He reports increased cough with purulent sputum, mild
pleuritic chest pain, and fever. PMH: COPD, hypertension. Vitals: Temp 101.2°F, HR 96,
RR 28, BP 138/84, O2 sat 86% on 2L NC (baseline 92%). Physical exam: accessory
muscle use, hyperresonant chest, diminished breath sounds bilaterally with diffuse
wheezing and rhonchi. CXR shows hyperinflation and a new right lower lobe infiltrate.
Question: What is the most likely diagnosis?
Options:
A. Acute COPD exacerbation due to viral infection
B. Community-acquired pneumonia with COPD exacerbation
C. Pulmonary embolism
D. Pneumothorax
(Correct: B)
Rationale:
● Answer: Community-acquired pneumonia with COPD exacerbation
● Why (2026 Standard): The patient meets criteria for both conditions: increased
dyspnea, sputum purulence, and volume for COPD exacerbation, PLUS fever,
pleuritic chest pain, and new infiltrate on CXR confirming pneumonia. The
pathophysiology involves bacterial infection (commonly Streptococcus
pneumoniae or Haemophilus influenzae) triggering both airway inflammation and
alveolar consolidation. GOLD 2024 guidelines emphasize that pneumonia should
be ruled out in COPD exacerbations with focal findings.
● Errors: A is incorrect because viral exacerbations typically lack purulent sputum
and fever, and wouldn't explain the infiltrate. C is incorrect because PE presents
with clear lungs, not wheezing/rhonchi or infiltrates. D is incorrect because
pneumothorax would show absent breath sounds, hyperresonance in a focal area,
and tracheal deviation.
Q004:
Type: Complex MCQ
Scenario: A 56-year-old female presents with intermittent, squeezing chest discomfort for
2 weeks occurring with exertion and relieved by rest. Each episode lasts 5-10 minutes.
No radiation or associated symptoms. PMH: diabetes type 2, obesity. Vitals: BP 142/88,
HR 82, RR 16, O2 sat 97% RA. Physical exam: obese, non-distressed, cardiac exam
normal, lungs clear. ECG normal sinus rhythm, no ST-T changes. Troponin negative.
, Question: What is the most likely diagnosis?
Options:
A. Stable angina
B. Non-ST elevation myocardial infarction
C. Costochondritis
D. Gastroesophageal reflux disease
(Correct: A)
Rationale:
● Answer: Stable angina
● Why (2026 Standard): Classic stable angina presents as exertional chest
discomfort, predictable, reproducible, and relieved by rest within 5-15 minutes.
The pathophysiology is fixed atherosclerotic stenosis causing demand-supply
mismatch. Normal ECG and troponins between episodes are typical. 2021
AHA/ACC chest pain guidelines classify this as "obstructive CAD, stable
presentation" requiring stress testing for definitive diagnosis.
● Errors: B is incorrect because NSTEMI would have positive troponins and
possibly ECG changes. C is incorrect because costochondritis pain is
musculoskeletal, reproducible on palpation, and not exertional. D is incorrect
because GERD pain is burning, postprandial, and not reliably exertional.
Q005:
Type: NGN - Diagnostic
Scenario: A 34-year-old male presents with sharp, pleuritic left-sided chest pain for 6
hours, worsened by deep breathing and coughing. He reports feeling "achy" for 3 days
prior with low-grade fever. Pain improves when leaning forward. Vitals: Temp 100.8°F,
HR 102, RR 20, BP 124/76. Physical exam: friction rub audible at left lower sternal
border, no murmurs. ECG shows diffuse ST-elevation in I, II, aVL, V2-V6 with PR
depression in multiple leads. Troponin I 0.05 ng/mL (normal <0.04), CK-MB normal.
Question: What is the most likely diagnosis?
Options:
A. Acute pericarditis
B. ST-elevation myocardial infarction
C. Acute myocarditis
D. Pulmonary embolism
(Correct: A)
Exam Questions and Correct Answers
Q001:
Type: NGN - Diagnostic
Scenario: A 62-year-old male presents to the primary care clinic with acute onset of
substernal chest pain that began 2 hours ago while mowing his lawn. He describes the
pain as pressure-like, 8/10 intensity, radiating to his left jaw and arm. Associated
symptoms include diaphoresis, nausea, and shortness of breath. PMH: hypertension,
hyperlipidemia, 30-pack-year smoking history. Vitals: BP 148/92, HR 106, RR 22, Temp
98.6°F, O2 sat 94% RA. Physical exam: diaphoretic, mild distress, lungs clear bilaterally,
heart RRR without murmurs, no peripheral edema. ECG shows ST-segment elevation in
leads II, III, aVF with reciprocal changes in I and aVL. Troponin I pending.
Question: What is the most likely diagnosis?
Options:
A. Unstable angina
B. Inferior wall ST-elevation myocardial infarction
C. Acute pericarditis
D. Aortic dissection
(Correct: B)
Rationale:
● Answer: Inferior wall ST-elevation myocardial infarction
● Why (2026 Standard): The presentation classic for MI with crushing substernal
chest pain, radiation to jaw/arm, diaphoresis, and ST-elevation in inferior leads (II,
III, aVF) with reciprocal changes. The pathophysiology involves complete
thrombotic occlusion of the right coronary artery (RCA) supplying the inferior
wall. 2023 ACC/AHA guidelines maintain that ST-elevation in contiguous leads
with clinical symptoms confirms STEMI diagnosis requiring immediate
reperfusion.
● Errors: A is incorrect because unstable angina shows no ST-elevation or troponin
rise. C is incorrect because pericarditis presents with diffuse ST-elevation and PR
, depression, not localized inferior changes with reciprocal depression. D is
incorrect because aortic dissection typically presents with tearing back pain,
asymmetric pulses, and widened mediastinum on imaging.
Q002:
Type: Complex MCQ
Scenario: A 45-year-old female presents with 3 days of worsening pleuritic chest pain
and dyspnea. Pain is left-sided and worsens with deep inspiration. She reports recent
12-hour flight 5 days ago. Vitals: HR 118, RR 24, BP 132/78, Temp 99.1°F, O2 sat 89%
RA. Physical exam: left leg swelling noted, tachypneic with clear lungs bilaterally, no
wheezes. Heart tachycardic without murmurs. D-dimer elevated at 2.5 mcg/mL.
Question: What is the next most appropriate diagnostic test?
Options:
A. Chest X-ray
B. CT pulmonary angiography
C. Ventilation-perfusion scan
D. Lower extremity venous Doppler ultrasound
(Correct: B)
Rationale:
● Answer: CT pulmonary angiography
● Why (2026 Standard): The Wells score is high (clinical signs of DVT, no
alternative diagnosis, tachycardia, hemoptysis, immobilization). With high pre-test
probability and elevated D-dimer, CTPA is the gold standard for diagnosing
pulmonary embolism. It provides direct visualization of the pulmonary vasculature
and can detect subsegmental emboli. 2020 ACCP guidelines recommend CTPA as
first-line imaging for suspected PE in patients with high clinical probability.
● Errors: A is incorrect because CXR is often normal in PE and cannot confirm
diagnosis. C is incorrect because VQ scans are reserved for patients with
contraindications to CTPA (allergy, renal failure) or pregnancy. D is incorrect
because while it confirms DVT, it doesn't evaluate for PE which is the
life-threatening condition requiring urgent diagnosis.
Q003:
Type: NGN - Diagnostic
,Scenario: A 78-year-old male with COPD (GOLD Stage 3) presents with progressively
worsening dyspnea over 3 days. He reports increased cough with purulent sputum, mild
pleuritic chest pain, and fever. PMH: COPD, hypertension. Vitals: Temp 101.2°F, HR 96,
RR 28, BP 138/84, O2 sat 86% on 2L NC (baseline 92%). Physical exam: accessory
muscle use, hyperresonant chest, diminished breath sounds bilaterally with diffuse
wheezing and rhonchi. CXR shows hyperinflation and a new right lower lobe infiltrate.
Question: What is the most likely diagnosis?
Options:
A. Acute COPD exacerbation due to viral infection
B. Community-acquired pneumonia with COPD exacerbation
C. Pulmonary embolism
D. Pneumothorax
(Correct: B)
Rationale:
● Answer: Community-acquired pneumonia with COPD exacerbation
● Why (2026 Standard): The patient meets criteria for both conditions: increased
dyspnea, sputum purulence, and volume for COPD exacerbation, PLUS fever,
pleuritic chest pain, and new infiltrate on CXR confirming pneumonia. The
pathophysiology involves bacterial infection (commonly Streptococcus
pneumoniae or Haemophilus influenzae) triggering both airway inflammation and
alveolar consolidation. GOLD 2024 guidelines emphasize that pneumonia should
be ruled out in COPD exacerbations with focal findings.
● Errors: A is incorrect because viral exacerbations typically lack purulent sputum
and fever, and wouldn't explain the infiltrate. C is incorrect because PE presents
with clear lungs, not wheezing/rhonchi or infiltrates. D is incorrect because
pneumothorax would show absent breath sounds, hyperresonance in a focal area,
and tracheal deviation.
Q004:
Type: Complex MCQ
Scenario: A 56-year-old female presents with intermittent, squeezing chest discomfort for
2 weeks occurring with exertion and relieved by rest. Each episode lasts 5-10 minutes.
No radiation or associated symptoms. PMH: diabetes type 2, obesity. Vitals: BP 142/88,
HR 82, RR 16, O2 sat 97% RA. Physical exam: obese, non-distressed, cardiac exam
normal, lungs clear. ECG normal sinus rhythm, no ST-T changes. Troponin negative.
, Question: What is the most likely diagnosis?
Options:
A. Stable angina
B. Non-ST elevation myocardial infarction
C. Costochondritis
D. Gastroesophageal reflux disease
(Correct: A)
Rationale:
● Answer: Stable angina
● Why (2026 Standard): Classic stable angina presents as exertional chest
discomfort, predictable, reproducible, and relieved by rest within 5-15 minutes.
The pathophysiology is fixed atherosclerotic stenosis causing demand-supply
mismatch. Normal ECG and troponins between episodes are typical. 2021
AHA/ACC chest pain guidelines classify this as "obstructive CAD, stable
presentation" requiring stress testing for definitive diagnosis.
● Errors: B is incorrect because NSTEMI would have positive troponins and
possibly ECG changes. C is incorrect because costochondritis pain is
musculoskeletal, reproducible on palpation, and not exertional. D is incorrect
because GERD pain is burning, postprandial, and not reliably exertional.
Q005:
Type: NGN - Diagnostic
Scenario: A 34-year-old male presents with sharp, pleuritic left-sided chest pain for 6
hours, worsened by deep breathing and coughing. He reports feeling "achy" for 3 days
prior with low-grade fever. Pain improves when leaning forward. Vitals: Temp 100.8°F,
HR 102, RR 20, BP 124/76. Physical exam: friction rub audible at left lower sternal
border, no murmurs. ECG shows diffuse ST-elevation in I, II, aVL, V2-V6 with PR
depression in multiple leads. Troponin I 0.05 ng/mL (normal <0.04), CK-MB normal.
Question: What is the most likely diagnosis?
Options:
A. Acute pericarditis
B. ST-elevation myocardial infarction
C. Acute myocarditis
D. Pulmonary embolism
(Correct: A)
