Latest NR 605 Final Exam verified with correct answers plus rationales
2026/2027 instant pdf
1. A patient with hypertension has a blood pressure of 168/104 mmHg but denies headache,
chest pain, neurologic symptoms, or dyspnea. What is the most appropriate initial
approach?
A. Diagnose hypertensive emergency
B. Administer IV antihypertensive medication immediately
C. Confirm the blood pressure and assess for target-organ involvement
D. Tell the patient to discontinue all antihypertensive medications
Answer: C. Confirm the blood pressure and assess for target-organ involvement
Rationale: Severe blood pressure elevation without evidence of acute target-organ injury is
managed differently from hypertensive emergency. Accurate measurement and assessment for
symptoms or organ damage are essential.
2. A patient with type 2 diabetes has an A1C of 9.4% despite adherence to lifestyle
recommendations and metformin therapy. What is the next clinical consideration?
A. Discontinue metformin
B. Intensify glucose-lowering therapy
C. Stop monitoring glucose
D. Recommend avoiding all carbohydrates permanently
Answer: B. Intensify glucose-lowering therapy
Rationale: An A1C substantially above the individualized target despite metformin and lifestyle
intervention generally requires additional or intensified pharmacologic therapy.
3. A patient reports polyuria, polydipsia, fatigue, and unexplained weight loss. Which
laboratory abnormality would support diabetes mellitus?
A. Fasting glucose of 88 mg/dL
B. A1C of 4.9%
C. Fasting plasma glucose of 126 mg/dL or higher
D. Random glucose of 95 mg/dL
Answer: C. Fasting plasma glucose of 126 mg/dL or higher
,Rationale: A fasting plasma glucose of 126 mg/dL or higher is in the diagnostic range for
diabetes when appropriately confirmed or accompanied by qualifying diagnostic findings.
4. A patient with diabetes develops burning pain and decreased sensation in both feet.
What complication is most likely?
A. Nephropathy
B. Retinopathy
C. Peripheral diabetic neuropathy
D. Diabetic ketoacidosis
Answer: C. Peripheral diabetic neuropathy
Rationale: Distal symmetric sensory loss, burning, tingling, and pain in the feet are common
manifestations of diabetic peripheral neuropathy.
5. A patient reports fatigue, cold intolerance, constipation, dry skin, and weight gain.
Which condition should be suspected?
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing syndrome
D. Pheochromocytoma
Answer: B. Hypothyroidism
Rationale: Reduced thyroid hormone activity commonly produces fatigue, cold intolerance,
constipation, dry skin, weight gain, and slowed physiologic function.
6. A patient has weight loss despite increased appetite, heat intolerance, tremor, anxiety,
and palpitations. What diagnosis is most likely?
A. Hypothyroidism
B. Addison disease
C. Hyperthyroidism
D. Hypoparathyroidism
Answer: C. Hyperthyroidism
,Rationale: Increased metabolic activity associated with hyperthyroidism can cause weight loss,
heat intolerance, tremor, anxiety, and tachycardia.
7. A patient with hypothyroidism is prescribed levothyroxine. Which instruction is most
appropriate?
A. Take it only when symptoms occur
B. Take it with calcium supplements
C. Take it consistently, preferably on an empty stomach
D. Stop therapy once energy improves
Answer: C. Take it consistently, preferably on an empty stomach
Rationale: Levothyroxine absorption is more consistent when taken on an empty stomach.
Calcium and iron can interfere with absorption and should generally be separated from the
medication.
8. A patient reports progressive fatigue, dizziness when standing, weight loss, and
hyperpigmentation. Which endocrine disorder should be considered?
A. Cushing syndrome
B. Hyperthyroidism
C. Primary adrenal insufficiency
D. Hyperparathyroidism
Answer: C. Primary adrenal insufficiency
Rationale: Primary adrenal insufficiency can cause fatigue, weight loss, orthostatic hypotension,
and increased skin pigmentation due to elevated ACTH.
9. A patient with suspected Cushing syndrome has central obesity, facial rounding,
proximal muscle weakness, hypertension, and purple abdominal striae. What endocrine
abnormality is most likely?
A. Decreased cortisol production
B. Excess cortisol activity
C. Decreased aldosterone
D. Increased thyroid hormone only
Answer: B. Excess cortisol activity
, Rationale: Cushing syndrome results from prolonged exposure to excessive glucocorticoid
activity and can produce characteristic metabolic, cardiovascular, and physical findings.
10. A patient with asthma reports nighttime symptoms several times each week and
frequent rescue-inhaler use. What does this pattern indicate?
A. Excellent asthma control
B. Inadequately controlled asthma
C. Resolved asthma
D. Normal medication response
Answer: B. Inadequately controlled asthma
Rationale: Frequent symptoms and rescue-medication use suggest inadequate asthma control
and should prompt reassessment of treatment, adherence, triggers, and inhaler technique.
11. A patient with COPD has increasing dyspnea, increased sputum volume, and a change
in sputum purulence. What does this pattern suggest?
A. Stable COPD
B. Acute COPD exacerbation
C. Resolved airway disease
D. Pulmonary embolism exclusively
Answer: B. Acute COPD exacerbation
Rationale: Worsening dyspnea and changes in sputum amount or purulence are characteristic
features of COPD exacerbation.
12. A patient reports crushing substernal chest pressure radiating to the jaw with
diaphoresis and nausea. What is the priority action?
A. Schedule a routine clinic appointment
B. Recommend an antacid
C. Initiate immediate evaluation for acute coronary syndrome
D. Encourage exercise
Answer: C. Initiate immediate evaluation for acute coronary syndrome
2026/2027 instant pdf
1. A patient with hypertension has a blood pressure of 168/104 mmHg but denies headache,
chest pain, neurologic symptoms, or dyspnea. What is the most appropriate initial
approach?
A. Diagnose hypertensive emergency
B. Administer IV antihypertensive medication immediately
C. Confirm the blood pressure and assess for target-organ involvement
D. Tell the patient to discontinue all antihypertensive medications
Answer: C. Confirm the blood pressure and assess for target-organ involvement
Rationale: Severe blood pressure elevation without evidence of acute target-organ injury is
managed differently from hypertensive emergency. Accurate measurement and assessment for
symptoms or organ damage are essential.
2. A patient with type 2 diabetes has an A1C of 9.4% despite adherence to lifestyle
recommendations and metformin therapy. What is the next clinical consideration?
A. Discontinue metformin
B. Intensify glucose-lowering therapy
C. Stop monitoring glucose
D. Recommend avoiding all carbohydrates permanently
Answer: B. Intensify glucose-lowering therapy
Rationale: An A1C substantially above the individualized target despite metformin and lifestyle
intervention generally requires additional or intensified pharmacologic therapy.
3. A patient reports polyuria, polydipsia, fatigue, and unexplained weight loss. Which
laboratory abnormality would support diabetes mellitus?
A. Fasting glucose of 88 mg/dL
B. A1C of 4.9%
C. Fasting plasma glucose of 126 mg/dL or higher
D. Random glucose of 95 mg/dL
Answer: C. Fasting plasma glucose of 126 mg/dL or higher
,Rationale: A fasting plasma glucose of 126 mg/dL or higher is in the diagnostic range for
diabetes when appropriately confirmed or accompanied by qualifying diagnostic findings.
4. A patient with diabetes develops burning pain and decreased sensation in both feet.
What complication is most likely?
A. Nephropathy
B. Retinopathy
C. Peripheral diabetic neuropathy
D. Diabetic ketoacidosis
Answer: C. Peripheral diabetic neuropathy
Rationale: Distal symmetric sensory loss, burning, tingling, and pain in the feet are common
manifestations of diabetic peripheral neuropathy.
5. A patient reports fatigue, cold intolerance, constipation, dry skin, and weight gain.
Which condition should be suspected?
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing syndrome
D. Pheochromocytoma
Answer: B. Hypothyroidism
Rationale: Reduced thyroid hormone activity commonly produces fatigue, cold intolerance,
constipation, dry skin, weight gain, and slowed physiologic function.
6. A patient has weight loss despite increased appetite, heat intolerance, tremor, anxiety,
and palpitations. What diagnosis is most likely?
A. Hypothyroidism
B. Addison disease
C. Hyperthyroidism
D. Hypoparathyroidism
Answer: C. Hyperthyroidism
,Rationale: Increased metabolic activity associated with hyperthyroidism can cause weight loss,
heat intolerance, tremor, anxiety, and tachycardia.
7. A patient with hypothyroidism is prescribed levothyroxine. Which instruction is most
appropriate?
A. Take it only when symptoms occur
B. Take it with calcium supplements
C. Take it consistently, preferably on an empty stomach
D. Stop therapy once energy improves
Answer: C. Take it consistently, preferably on an empty stomach
Rationale: Levothyroxine absorption is more consistent when taken on an empty stomach.
Calcium and iron can interfere with absorption and should generally be separated from the
medication.
8. A patient reports progressive fatigue, dizziness when standing, weight loss, and
hyperpigmentation. Which endocrine disorder should be considered?
A. Cushing syndrome
B. Hyperthyroidism
C. Primary adrenal insufficiency
D. Hyperparathyroidism
Answer: C. Primary adrenal insufficiency
Rationale: Primary adrenal insufficiency can cause fatigue, weight loss, orthostatic hypotension,
and increased skin pigmentation due to elevated ACTH.
9. A patient with suspected Cushing syndrome has central obesity, facial rounding,
proximal muscle weakness, hypertension, and purple abdominal striae. What endocrine
abnormality is most likely?
A. Decreased cortisol production
B. Excess cortisol activity
C. Decreased aldosterone
D. Increased thyroid hormone only
Answer: B. Excess cortisol activity
, Rationale: Cushing syndrome results from prolonged exposure to excessive glucocorticoid
activity and can produce characteristic metabolic, cardiovascular, and physical findings.
10. A patient with asthma reports nighttime symptoms several times each week and
frequent rescue-inhaler use. What does this pattern indicate?
A. Excellent asthma control
B. Inadequately controlled asthma
C. Resolved asthma
D. Normal medication response
Answer: B. Inadequately controlled asthma
Rationale: Frequent symptoms and rescue-medication use suggest inadequate asthma control
and should prompt reassessment of treatment, adherence, triggers, and inhaler technique.
11. A patient with COPD has increasing dyspnea, increased sputum volume, and a change
in sputum purulence. What does this pattern suggest?
A. Stable COPD
B. Acute COPD exacerbation
C. Resolved airway disease
D. Pulmonary embolism exclusively
Answer: B. Acute COPD exacerbation
Rationale: Worsening dyspnea and changes in sputum amount or purulence are characteristic
features of COPD exacerbation.
12. A patient reports crushing substernal chest pressure radiating to the jaw with
diaphoresis and nausea. What is the priority action?
A. Schedule a routine clinic appointment
B. Recommend an antacid
C. Initiate immediate evaluation for acute coronary syndrome
D. Encourage exercise
Answer: C. Initiate immediate evaluation for acute coronary syndrome
