NUR 524 EXAM 1 NEWEST 2026 ACTUAL EXAM COMPLETE 350+ QUESTIONS AND CORRECT
DETAILED ANSWERS/NEWEST UPDATE!!!
A 14-year-old boy presents with symptoms of fatigue and oliguria with cola-colored urine,
following streptococcal pharyngitis two weeks ago. Physical examination reveals elevated blood
pressure and swelling in the hands and feet. Urinalysis shows proteinuria and hematuria with red
blood cell casts. What is the most likely diagnosis?
Acute glomerulonephritis
Acute pyelonephritis
Acute tubular necrosis
Initial onset of diabetes mellitus - (Correct Answer)-Acute glomerulonephritis
Acute glomerulonephritis can occur 1-3 weeks after a streptococcal infection. The reaction that
occurs as a result of streptococcal infection is the result of an abnormal immunologic response,
resulting in damage to the glomeruli. Symptoms include hematuria, cola-colored urine, oliguria,
hypertension, and edema of the face and extremities. Urinalysis reveals red blood cells, mild
proteinuria, and red blood cell casts. Pediatric patients usually have depressed C3 complement
levels. In adults, elevation of creatinine levels is more common. Management of postinfectious
glomerulonephritis is supportive, with water and salt restriction. Calcium channel blockers or
ACE inhibitors may be used in cases of severe hypertension. More than 90% of children achieve
full recovery; complete remission in adults is 26-56%, depending on age and other
comorbidities.
A 23-year-old woman presents to the clinic with a history of debilitating, unilateral headaches
that only occur shortly before her period and take her several days to recover. Which one of the
following triptans has been found to be effective in preventing these kinds of headaches?
Almotriptan
Frovatriptan
Rizatriptan
Sumatriptan - (Correct Answer)-Frovatriptan
Frovatriptan and naratriptan are two long-acting triptans that have been found to be effective in
preventing menstrual migraine if taken around-the-clock starting two days before menses and
continuing for a total of five to six days. Menstrual migraines are migraine headaches that occur
exclusively near the time of menses. Triptans are drugs specific to migraine treatment and bind to
, 2
serotonergic receptors. They are considered first-line treatment for moderate to severe migraines
or for mild-to-moderate migraine headaches that have failed other analgesics. Triptans have
vasoconstrictive properties so their use is contraindicated in those with ischemic heart disease,
stroke, uncontrolled hypertension, or basilar migraine
A 55-year-old woman with restless legs syndrome presents with worsening leg symptoms
described as crawling and fidgeting over the past 4 weeks. Her symptoms have been interfering
with her quality of sleep. When asked about medications, she reports only taking pramipexole
0.5 mg (normal dose range: 0.125-0.5 mg) in the evenings. Which of the following is the most
appropriate next step in management?
Discontinue pramipexole and start gabapentin
Offer reassurance and recommend a melatonin supplement at bedtime
Order a CBC
Refer to neurology - (Correct Answer)-Order a CBC
Restless legs syndrome is a condition characterized by sensory disturbances and an irresistible
urge to move the legs during periods of rest. Patients will often report disturbed sleep patterns
and daytime sleepiness. Certain conditions can predispose individuals to developing the
syndrome, such as family history of restless legs syndrome, Parkinson disease, pregnancy, iron
deficiency anemia, or diabetic peripheral neuropathy
A 42-year-old woman presents to the office with double vision and eye pain. She reports these
symptoms started 4 days ago, and she experienced a similar episode around 3 months ago. She
reports pain and blurring of vision in her left eye. She has no significant past medical history and
takes no medications. On physical examination, her vital signs are normal. A focused neurologic
examination reveals that the patient cannot fully adduct her left eye while at the same time you
notice nystagmus on abduction of the right eye. There is dysmetria with finger-nose testing in the
right arm. What would be the first test to order on this patient based on the suspected diagnosis?
Cerebrospinal fluid analysis for oligoclonal bands
Computed tomography of the brain with and without contrast
Magnetic resonance imaging of the brain with and without contrast
, 3
Visual evoked potentials - (Correct Answer)-Magnetic resonance imaging of the brain with and
without contrast
The first test to order in the above patient who is suspected of having multiple sclerosis (MS)
would be a contrast-enhanced MRI of the brain. She is presenting with what appears to be optic
neuritis along with examination findings of internuclear ophthalmoplegia
A 68-year-old man presents to the clinic with difficulty swallowing. He reports that this symptom
started 3 months ago and has progressively worsened. He describes a feeling of food sticking in
his throat after he eats solid foods, but he has no issue with liquids or soft foods, such as yogurt.
He reports no recent weight loss, anorexia, chest pain, throat pain, nausea, or vomiting. Which of
the following findings in this patient's history would increase suspicion for the likely cause of
this patient's dysphagia?
Family history of asthma
Personal history of gastroesophageal reflux disease
Personal history of liver cirrhosis
Recent personal history of influen - (Correct Answer)-Personal history of gastroesophageal
reflux disease
Esophageal stricture refers to abnormal narrowing of the esophageal lumen (≤ 13 mm in
diameter), which typically presents as progressive dysphagia with solid food. Other symptoms
may include weight loss, food impaction, odynophagia, and chest pain. The most common cause
of esophageal stricture is longstanding gastroesophageal reflux disease (GERD)
A 35-year-old woman presents to the clinic with a chief complaint of dyspepsia and epigastric
fullness. Which additional finding would warrant further testing for Helicobacter pylori
infection?
Heartburn and acid regurgitation
History of gastric bypass surgery
Short-term NSAID use
Unexplained iron deficiency anemia - (Correct Answer)-Unexplained iron deficiency anemia
, 4
Helicobacter pylori infection interferes with the absorption of oral iron and can result in iron
deficiency anemia. In patients with dyspepsia, unexplained iron deficiency anemia warrants
further evaluation for Helicobacter pylori infection.
A 63-year-old man with a 40-year history of alcohol and tobacco abuse presents with solid food
dysphagia. The patient has also had a 21 lb weight loss over the past 7 months. Which of the
following studies should be performed for a definitive diagnosis?
Barium esophagram
Chest X-ray
CT Scan
Endoscopy - (Correct Answer)-Endoscopy
Endoscopy with biopsy establishes the diagnosis of esophageal carcinoma with a high degree of
reliability when biopsy is included as part of the procedure. Esophageal cancer commonly
develops in persons between 50 and 70 years of age. The overall incidence ratio of men to
women is 3:1. There are two histological types: Squamous cell carcinoma and Adenocarcinoma.
Chronic alcohol and tobacco use are strongly associated with an increased risk of squamous cell
carcinoma
A 49-year-old woman presents with headaches that occur nearly every afternoon since she
switched jobs 6 months ago. She describes squeezing pain at her forehead, accompanied by
fatigue and poor concentration. Her exam is normal except for posterior neck tenderness, which
she attributes to stress at work. Which of the following interventions would be most helpful to
this patient?
Headache abortive therapy with sumatriptan
Headache prevention with amitriptyline
Headache prevention with daily verapamil
High dose prednisone taper - (Correct Answer)-Headache prevention with amitriptyline
DETAILED ANSWERS/NEWEST UPDATE!!!
A 14-year-old boy presents with symptoms of fatigue and oliguria with cola-colored urine,
following streptococcal pharyngitis two weeks ago. Physical examination reveals elevated blood
pressure and swelling in the hands and feet. Urinalysis shows proteinuria and hematuria with red
blood cell casts. What is the most likely diagnosis?
Acute glomerulonephritis
Acute pyelonephritis
Acute tubular necrosis
Initial onset of diabetes mellitus - (Correct Answer)-Acute glomerulonephritis
Acute glomerulonephritis can occur 1-3 weeks after a streptococcal infection. The reaction that
occurs as a result of streptococcal infection is the result of an abnormal immunologic response,
resulting in damage to the glomeruli. Symptoms include hematuria, cola-colored urine, oliguria,
hypertension, and edema of the face and extremities. Urinalysis reveals red blood cells, mild
proteinuria, and red blood cell casts. Pediatric patients usually have depressed C3 complement
levels. In adults, elevation of creatinine levels is more common. Management of postinfectious
glomerulonephritis is supportive, with water and salt restriction. Calcium channel blockers or
ACE inhibitors may be used in cases of severe hypertension. More than 90% of children achieve
full recovery; complete remission in adults is 26-56%, depending on age and other
comorbidities.
A 23-year-old woman presents to the clinic with a history of debilitating, unilateral headaches
that only occur shortly before her period and take her several days to recover. Which one of the
following triptans has been found to be effective in preventing these kinds of headaches?
Almotriptan
Frovatriptan
Rizatriptan
Sumatriptan - (Correct Answer)-Frovatriptan
Frovatriptan and naratriptan are two long-acting triptans that have been found to be effective in
preventing menstrual migraine if taken around-the-clock starting two days before menses and
continuing for a total of five to six days. Menstrual migraines are migraine headaches that occur
exclusively near the time of menses. Triptans are drugs specific to migraine treatment and bind to
, 2
serotonergic receptors. They are considered first-line treatment for moderate to severe migraines
or for mild-to-moderate migraine headaches that have failed other analgesics. Triptans have
vasoconstrictive properties so their use is contraindicated in those with ischemic heart disease,
stroke, uncontrolled hypertension, or basilar migraine
A 55-year-old woman with restless legs syndrome presents with worsening leg symptoms
described as crawling and fidgeting over the past 4 weeks. Her symptoms have been interfering
with her quality of sleep. When asked about medications, she reports only taking pramipexole
0.5 mg (normal dose range: 0.125-0.5 mg) in the evenings. Which of the following is the most
appropriate next step in management?
Discontinue pramipexole and start gabapentin
Offer reassurance and recommend a melatonin supplement at bedtime
Order a CBC
Refer to neurology - (Correct Answer)-Order a CBC
Restless legs syndrome is a condition characterized by sensory disturbances and an irresistible
urge to move the legs during periods of rest. Patients will often report disturbed sleep patterns
and daytime sleepiness. Certain conditions can predispose individuals to developing the
syndrome, such as family history of restless legs syndrome, Parkinson disease, pregnancy, iron
deficiency anemia, or diabetic peripheral neuropathy
A 42-year-old woman presents to the office with double vision and eye pain. She reports these
symptoms started 4 days ago, and she experienced a similar episode around 3 months ago. She
reports pain and blurring of vision in her left eye. She has no significant past medical history and
takes no medications. On physical examination, her vital signs are normal. A focused neurologic
examination reveals that the patient cannot fully adduct her left eye while at the same time you
notice nystagmus on abduction of the right eye. There is dysmetria with finger-nose testing in the
right arm. What would be the first test to order on this patient based on the suspected diagnosis?
Cerebrospinal fluid analysis for oligoclonal bands
Computed tomography of the brain with and without contrast
Magnetic resonance imaging of the brain with and without contrast
, 3
Visual evoked potentials - (Correct Answer)-Magnetic resonance imaging of the brain with and
without contrast
The first test to order in the above patient who is suspected of having multiple sclerosis (MS)
would be a contrast-enhanced MRI of the brain. She is presenting with what appears to be optic
neuritis along with examination findings of internuclear ophthalmoplegia
A 68-year-old man presents to the clinic with difficulty swallowing. He reports that this symptom
started 3 months ago and has progressively worsened. He describes a feeling of food sticking in
his throat after he eats solid foods, but he has no issue with liquids or soft foods, such as yogurt.
He reports no recent weight loss, anorexia, chest pain, throat pain, nausea, or vomiting. Which of
the following findings in this patient's history would increase suspicion for the likely cause of
this patient's dysphagia?
Family history of asthma
Personal history of gastroesophageal reflux disease
Personal history of liver cirrhosis
Recent personal history of influen - (Correct Answer)-Personal history of gastroesophageal
reflux disease
Esophageal stricture refers to abnormal narrowing of the esophageal lumen (≤ 13 mm in
diameter), which typically presents as progressive dysphagia with solid food. Other symptoms
may include weight loss, food impaction, odynophagia, and chest pain. The most common cause
of esophageal stricture is longstanding gastroesophageal reflux disease (GERD)
A 35-year-old woman presents to the clinic with a chief complaint of dyspepsia and epigastric
fullness. Which additional finding would warrant further testing for Helicobacter pylori
infection?
Heartburn and acid regurgitation
History of gastric bypass surgery
Short-term NSAID use
Unexplained iron deficiency anemia - (Correct Answer)-Unexplained iron deficiency anemia
, 4
Helicobacter pylori infection interferes with the absorption of oral iron and can result in iron
deficiency anemia. In patients with dyspepsia, unexplained iron deficiency anemia warrants
further evaluation for Helicobacter pylori infection.
A 63-year-old man with a 40-year history of alcohol and tobacco abuse presents with solid food
dysphagia. The patient has also had a 21 lb weight loss over the past 7 months. Which of the
following studies should be performed for a definitive diagnosis?
Barium esophagram
Chest X-ray
CT Scan
Endoscopy - (Correct Answer)-Endoscopy
Endoscopy with biopsy establishes the diagnosis of esophageal carcinoma with a high degree of
reliability when biopsy is included as part of the procedure. Esophageal cancer commonly
develops in persons between 50 and 70 years of age. The overall incidence ratio of men to
women is 3:1. There are two histological types: Squamous cell carcinoma and Adenocarcinoma.
Chronic alcohol and tobacco use are strongly associated with an increased risk of squamous cell
carcinoma
A 49-year-old woman presents with headaches that occur nearly every afternoon since she
switched jobs 6 months ago. She describes squeezing pain at her forehead, accompanied by
fatigue and poor concentration. Her exam is normal except for posterior neck tenderness, which
she attributes to stress at work. Which of the following interventions would be most helpful to
this patient?
Headache abortive therapy with sumatriptan
Headache prevention with amitriptyline
Headache prevention with daily verapamil
High dose prednisone taper - (Correct Answer)-Headache prevention with amitriptyline
