NURSING NR 602 FINAL EXAM
ADVANCED PRACTICE NURSING
REVIEW QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A 55-year-old patient presents with fatigue, pallor, and shortness of breath on
exertion. Laboratory results reveal hemoglobin 9 g/dL and mean corpuscular
volume (MCV) 70 fL. Which is the most likely diagnosis?
A. Iron-deficiency anemia
B. Vitamin B12 deficiency
C. Anemia of chronic disease
D. Aplastic anemia
Answer: A
Rationale: Low hemoglobin and low MCV indicate microcytic anemia, most
commonly caused by iron deficiency. Vitamin B12 deficiency causes macrocytic
anemia, anemia of chronic disease is usually normocytic, and aplastic anemia
presents with pancytopenia.
2. A patient with chronic kidney disease (CKD) presents with pruritus and bone
pain. Which laboratory finding is most consistent with secondary
hyperparathyroidism?
A. Low calcium, low phosphate, low PTH
B. Low calcium, high phosphate, high PTH
C. High calcium, high phosphate, high PTH
D. High calcium, low phosphate, low PTH
,Answer: B
Rationale: CKD leads to phosphate retention and hypocalcemia, stimulating
parathyroid hormone (PTH) release, resulting in secondary hyperparathyroidism.
3. During a cardiovascular assessment, the NP notes an S4 heart sound in a 68-
year-old patient. This is most commonly associated with:
A. Mitral regurgitation
B. Hypertension with left ventricular hypertrophy
C. Atrial septal defect
D. Aortic stenosis
Answer: B
Rationale: S4 is a late diastolic sound associated with a stiff ventricle, commonly
due to hypertension-induced left ventricular hypertrophy.
4. A 32-year-old woman presents with episodic palpitations, tremor, and weight
loss despite increased appetite. Her TSH is <0.01 mIU/L, free T4 is elevated. The
most likely diagnosis is:
A. Hypothyroidism
B. Hyperthyroidism
C. Subclinical hypothyroidism
D. Thyroiditis
Answer: B
Rationale: Suppressed TSH with elevated T4 indicates primary hyperthyroidism.
Symptoms of palpitations, tremor, and weight loss are classic for hyperthyroidism.
,5. A patient presents with sudden onset severe headache described as "worst ever,"
with nausea and photophobia. The NP suspects subarachnoid hemorrhage. The first
diagnostic test should be:
A. MRI brain
B. CT scan without contrast
C. Lumbar puncture
D. Carotid ultrasound
Answer: B
Rationale: Non-contrast CT scan is the first-line imaging for acute subarachnoid
hemorrhage due to its speed and high sensitivity within 24 hours.
6. A 45-year-old patient presents with abdominal pain, fever, and jaundice.
Laboratory tests show elevated alkaline phosphatase, AST, ALT, and bilirubin.
Which is the most likely cause?
A. Acute viral hepatitis
B. Cholelithiasis with choledocholithiasis
C. Pancreatitis
D. Peptic ulcer disease
Answer: B
Rationale: Fever, right upper quadrant pain, jaundice, and elevated liver enzymes
(particularly cholestatic pattern: ALP > AST/ALT) suggest obstructive jaundice,
often due to common bile duct stones.
7. A 60-year-old patient with type 2 diabetes presents for a routine exam. Which
screening test is recommended annually?
A. Colonoscopy
B. HbA1c
C. Chest X-ray
D. Thyroid function tests
Answer: B
Rationale: Patients with diabetes should have HbA1c measured at least annually
to monitor glycemic control.
, 8. A patient reports shortness of breath when lying flat and awakens at night with
dyspnea. The NP should document:
A. Orthopnea and paroxysmal nocturnal dyspnea
B. Tachypnea and pleuritic pain
C. Dyspnea on exertion
D. Chronic bronchitis
Answer: A
Rationale: Orthopnea is difficulty breathing when supine, and paroxysmal
nocturnal dyspnea is awakening at night due to shortness of breath—both suggest
heart failure.
9. In assessing a patient for deep vein thrombosis, which finding is most specific?
A. Calf tenderness
B. Edema
C. Homan’s sign
D. Unilateral leg swelling
Answer: D
Rationale: Unilateral leg swelling is the most specific clinical sign of DVT.
Homan’s sign is neither sensitive nor specific.
10. A patient presents with new-onset right-sided weakness and speech difficulty.
Which cranial nerve assessment is most relevant?
A. CN II (optic)
B. CN VII (facial)
C. CN X (vagus)
D. CN XI (accessory)
Answer: B
Rationale: CN VII controls facial movement. New-onset facial weakness can
indicate a stroke affecting the corticobulbar tract.
ADVANCED PRACTICE NURSING
REVIEW QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A 55-year-old patient presents with fatigue, pallor, and shortness of breath on
exertion. Laboratory results reveal hemoglobin 9 g/dL and mean corpuscular
volume (MCV) 70 fL. Which is the most likely diagnosis?
A. Iron-deficiency anemia
B. Vitamin B12 deficiency
C. Anemia of chronic disease
D. Aplastic anemia
Answer: A
Rationale: Low hemoglobin and low MCV indicate microcytic anemia, most
commonly caused by iron deficiency. Vitamin B12 deficiency causes macrocytic
anemia, anemia of chronic disease is usually normocytic, and aplastic anemia
presents with pancytopenia.
2. A patient with chronic kidney disease (CKD) presents with pruritus and bone
pain. Which laboratory finding is most consistent with secondary
hyperparathyroidism?
A. Low calcium, low phosphate, low PTH
B. Low calcium, high phosphate, high PTH
C. High calcium, high phosphate, high PTH
D. High calcium, low phosphate, low PTH
,Answer: B
Rationale: CKD leads to phosphate retention and hypocalcemia, stimulating
parathyroid hormone (PTH) release, resulting in secondary hyperparathyroidism.
3. During a cardiovascular assessment, the NP notes an S4 heart sound in a 68-
year-old patient. This is most commonly associated with:
A. Mitral regurgitation
B. Hypertension with left ventricular hypertrophy
C. Atrial septal defect
D. Aortic stenosis
Answer: B
Rationale: S4 is a late diastolic sound associated with a stiff ventricle, commonly
due to hypertension-induced left ventricular hypertrophy.
4. A 32-year-old woman presents with episodic palpitations, tremor, and weight
loss despite increased appetite. Her TSH is <0.01 mIU/L, free T4 is elevated. The
most likely diagnosis is:
A. Hypothyroidism
B. Hyperthyroidism
C. Subclinical hypothyroidism
D. Thyroiditis
Answer: B
Rationale: Suppressed TSH with elevated T4 indicates primary hyperthyroidism.
Symptoms of palpitations, tremor, and weight loss are classic for hyperthyroidism.
,5. A patient presents with sudden onset severe headache described as "worst ever,"
with nausea and photophobia. The NP suspects subarachnoid hemorrhage. The first
diagnostic test should be:
A. MRI brain
B. CT scan without contrast
C. Lumbar puncture
D. Carotid ultrasound
Answer: B
Rationale: Non-contrast CT scan is the first-line imaging for acute subarachnoid
hemorrhage due to its speed and high sensitivity within 24 hours.
6. A 45-year-old patient presents with abdominal pain, fever, and jaundice.
Laboratory tests show elevated alkaline phosphatase, AST, ALT, and bilirubin.
Which is the most likely cause?
A. Acute viral hepatitis
B. Cholelithiasis with choledocholithiasis
C. Pancreatitis
D. Peptic ulcer disease
Answer: B
Rationale: Fever, right upper quadrant pain, jaundice, and elevated liver enzymes
(particularly cholestatic pattern: ALP > AST/ALT) suggest obstructive jaundice,
often due to common bile duct stones.
7. A 60-year-old patient with type 2 diabetes presents for a routine exam. Which
screening test is recommended annually?
A. Colonoscopy
B. HbA1c
C. Chest X-ray
D. Thyroid function tests
Answer: B
Rationale: Patients with diabetes should have HbA1c measured at least annually
to monitor glycemic control.
, 8. A patient reports shortness of breath when lying flat and awakens at night with
dyspnea. The NP should document:
A. Orthopnea and paroxysmal nocturnal dyspnea
B. Tachypnea and pleuritic pain
C. Dyspnea on exertion
D. Chronic bronchitis
Answer: A
Rationale: Orthopnea is difficulty breathing when supine, and paroxysmal
nocturnal dyspnea is awakening at night due to shortness of breath—both suggest
heart failure.
9. In assessing a patient for deep vein thrombosis, which finding is most specific?
A. Calf tenderness
B. Edema
C. Homan’s sign
D. Unilateral leg swelling
Answer: D
Rationale: Unilateral leg swelling is the most specific clinical sign of DVT.
Homan’s sign is neither sensitive nor specific.
10. A patient presents with new-onset right-sided weakness and speech difficulty.
Which cranial nerve assessment is most relevant?
A. CN II (optic)
B. CN VII (facial)
C. CN X (vagus)
D. CN XI (accessory)
Answer: B
Rationale: CN VII controls facial movement. New-onset facial weakness can
indicate a stroke affecting the corticobulbar tract.
