NUR 6111 – Exam 2 (Advanced Practice Nursing I) –
2026 Actual Exam Questions and Correct Answers
Q001:
Type: NGN - Diagnostic
Scenario: 58-year-old man presents to primary care with 3-hour history of midsternal
chest pressure radiating to left jaw, associated with diaphoresis and nausea. PMH: HTN,
hyperlipidemia, 30-pack-year smoking. Vitals: BP 148/92 mmHg, HR 94 bpm, RR 22,
SpO₂ 96% RA. Focused exam: diaphoresis noted; lungs clear; regular S1/S2, no murmur;
no lower-extremity edema.
Question: Which single additional finding best increases the likelihood that the chest pain
is ACS?
Options:
A. Pain reproducible with palpation
B. Pain relieved with sublingual nitroglycerin
C. Pain duration >30 min
D. Pain relieved with antacid
(Correct: B)
Rationale:
● Answer: Pain relieved with sublingual nitroglycerin
, ● Why (2026 Standard): Relief with nitroglycerin within 5 min is associated with
higher likelihood ratio (LR ≈ 2.5) for ACS in meta-analyses.
● Errors: Reproducibility (A) lowers ACS probability; antacid relief (D) points
toward GI etiology; duration alone (C) lacks discriminatory power.
Q002:
Type: Complex MCQ
Scenario: 44-year-old woman with 2-day history of pleuritic right-anterior chest pain and
dyspnea after return from 10-hour car ride. PMH: migraine, OCP use. Vitals: afebrile, BP
126/78 mmHg, HR 108 bpm, RR 24, SpO₂ 90% RA. Exam: right calf circumference 3
cm larger than left; lungs clear; heart tachycardic, regular.
Question: Most appropriate next diagnostic test?
Options:
A. D-dimer
B. High-sensitivity troponin I
C. Chest X-ray
D. CT pulmonary angiography
(Correct: D)
Rationale:
● Answer: CT pulmonary angiography
● Why (2026 Standard): High Wells score plus hypoxemia mandates imaging;
CT-PA is gold standard.
● Errors: D-dimer (A) may be false-negative in submassive PE; troponin (B)
assesses myocardial injury, not PE diagnosis; CXR (C) insensitive.
,Q003:
Type: NGN - Diagnostic
Scenario: 67-year-old man with 3-week progressive exertional dyspnea and orthopnea.
PMH: MI 2 years ago, DM type 2. Vitals: BP 134/84 mmHg, HR 88 bpm, RR 20, SpO₂
94% RA. JVP 10 cm; bibasilar crackles; S3 gallop; 2+ pitting ankle edema. BNP 620
pg/mL (↑).
Question: Which finding best supports HFrEF rather than HFpEF?
Options:
A. S3 gallop
B. JVP 10 cm
C. BNP elevation
D. Ankle edema
(Correct: A)
Rationale:
● Answer: S3 gallop
● Why (2026 Standard): S3 correlates with rapid ventricular filling and systolic
dysfunction (ACC/AHA 2025).
● Errors: JVP, BNP, edema occur in both HFrEF & HFpEF; S3 more specific for
reduced EF.
Q004:
Type: Complex MCQ
, Scenario: 30-year-old woman with 1-day severe right-lower-quadrant pain, anorexia,
low-grade fever. LMP 3 weeks ago. Vitals: T 37.8 °C, BP 118/70 mmHg, HR 96 bpm.
Exam: RLQ tenderness with guarding; no CVA tenderness; negative Rovsing, positive
McBurney point. Urine hCG negative. WBC 12.8 ×10⁹/L with left shift.
Question: Most likely diagnosis?
Options:
A. Acute appendicitis
B. Ruptured ovarian cyst
C. Pelvic inflammatory disease
D. Nephrolithiasis
(Correct: A)
Rationale:
● Answer: Acute appendicitis
● Why (2026 Standard): Classic focal peritonitis, anorexia, leukocytosis, negative
hCG.
● Errors: Ovarian cyst (B) lacks peritoneal signs; PID (C) usually bilateral/CVA
tenderness; nephrolithiasis (D) presents with flank pain.
Q005:
Type: NGN - Diagnostic
Scenario: 55-year-old man with 6-hour retrosternal burning pain after large meal. No
SOB or diaphoresis. PMH: GERD, HTN. Vitals stable. Exam: epigastric tenderness; no
rebound; no murmur. ECG: normal. Chest X-ray: normal.
2026 Actual Exam Questions and Correct Answers
Q001:
Type: NGN - Diagnostic
Scenario: 58-year-old man presents to primary care with 3-hour history of midsternal
chest pressure radiating to left jaw, associated with diaphoresis and nausea. PMH: HTN,
hyperlipidemia, 30-pack-year smoking. Vitals: BP 148/92 mmHg, HR 94 bpm, RR 22,
SpO₂ 96% RA. Focused exam: diaphoresis noted; lungs clear; regular S1/S2, no murmur;
no lower-extremity edema.
Question: Which single additional finding best increases the likelihood that the chest pain
is ACS?
Options:
A. Pain reproducible with palpation
B. Pain relieved with sublingual nitroglycerin
C. Pain duration >30 min
D. Pain relieved with antacid
(Correct: B)
Rationale:
● Answer: Pain relieved with sublingual nitroglycerin
, ● Why (2026 Standard): Relief with nitroglycerin within 5 min is associated with
higher likelihood ratio (LR ≈ 2.5) for ACS in meta-analyses.
● Errors: Reproducibility (A) lowers ACS probability; antacid relief (D) points
toward GI etiology; duration alone (C) lacks discriminatory power.
Q002:
Type: Complex MCQ
Scenario: 44-year-old woman with 2-day history of pleuritic right-anterior chest pain and
dyspnea after return from 10-hour car ride. PMH: migraine, OCP use. Vitals: afebrile, BP
126/78 mmHg, HR 108 bpm, RR 24, SpO₂ 90% RA. Exam: right calf circumference 3
cm larger than left; lungs clear; heart tachycardic, regular.
Question: Most appropriate next diagnostic test?
Options:
A. D-dimer
B. High-sensitivity troponin I
C. Chest X-ray
D. CT pulmonary angiography
(Correct: D)
Rationale:
● Answer: CT pulmonary angiography
● Why (2026 Standard): High Wells score plus hypoxemia mandates imaging;
CT-PA is gold standard.
● Errors: D-dimer (A) may be false-negative in submassive PE; troponin (B)
assesses myocardial injury, not PE diagnosis; CXR (C) insensitive.
,Q003:
Type: NGN - Diagnostic
Scenario: 67-year-old man with 3-week progressive exertional dyspnea and orthopnea.
PMH: MI 2 years ago, DM type 2. Vitals: BP 134/84 mmHg, HR 88 bpm, RR 20, SpO₂
94% RA. JVP 10 cm; bibasilar crackles; S3 gallop; 2+ pitting ankle edema. BNP 620
pg/mL (↑).
Question: Which finding best supports HFrEF rather than HFpEF?
Options:
A. S3 gallop
B. JVP 10 cm
C. BNP elevation
D. Ankle edema
(Correct: A)
Rationale:
● Answer: S3 gallop
● Why (2026 Standard): S3 correlates with rapid ventricular filling and systolic
dysfunction (ACC/AHA 2025).
● Errors: JVP, BNP, edema occur in both HFrEF & HFpEF; S3 more specific for
reduced EF.
Q004:
Type: Complex MCQ
, Scenario: 30-year-old woman with 1-day severe right-lower-quadrant pain, anorexia,
low-grade fever. LMP 3 weeks ago. Vitals: T 37.8 °C, BP 118/70 mmHg, HR 96 bpm.
Exam: RLQ tenderness with guarding; no CVA tenderness; negative Rovsing, positive
McBurney point. Urine hCG negative. WBC 12.8 ×10⁹/L with left shift.
Question: Most likely diagnosis?
Options:
A. Acute appendicitis
B. Ruptured ovarian cyst
C. Pelvic inflammatory disease
D. Nephrolithiasis
(Correct: A)
Rationale:
● Answer: Acute appendicitis
● Why (2026 Standard): Classic focal peritonitis, anorexia, leukocytosis, negative
hCG.
● Errors: Ovarian cyst (B) lacks peritoneal signs; PID (C) usually bilateral/CVA
tenderness; nephrolithiasis (D) presents with flank pain.
Q005:
Type: NGN - Diagnostic
Scenario: 55-year-old man with 6-hour retrosternal burning pain after large meal. No
SOB or diaphoresis. PMH: GERD, HTN. Vitals stable. Exam: epigastric tenderness; no
rebound; no murmur. ECG: normal. Chest X-ray: normal.
