MSN 612 Final Exam – Advanced Nursing
Practice Academic Year: 2026/2027
Section 1: Advanced Health Assessment & Diagnostic Reasoning (Q1–20)
Q1. A 58-year-old male presents with episodic chest pressure during exertion, relieved by rest. Which
finding most suggests stable angina rather than unstable angina?
A) Pain at rest lasting >20 minutes
B) ST-segment elevation on ECG
C) Precipitated by cold weather and large meals
D) Troponin I >0.04 ng/mL
AnswerC
Rationale:
• C correct: Stable angina is predictable, triggered by exertion, cold, or large meals, and relieved
by rest/nitroglycerin.
• A incorrect: Pain at rest >20 min suggests unstable angina or MI.
• B incorrect: ST elevation indicates STEMI, not stable angina.
• D incorrect: Elevated troponin indicates myocardial necrosis.
Q2. A 72-year-old female has a new murmur. Which murmur increases in intensity with squatting?
A) Aortic stenosis
B) Mitral regurgitation
C) Hypertrophic cardiomyopathy
D) Mitral valve prolapse
AnswerB
Rationale:
• B correct: Squatting increases preload and afterload → increased volume of regurgitant flow in
mitral regurgitation → louder murmur.
• A incorrect: Aortic stenosis murmur may increase slightly but less consistent.
• C incorrect: Hypertrophic cardiomyopathy murmur decreases with squatting (increased preload
reduces obstruction).
• D incorrect: Mitral valve prolapse murmur decreases or moves later in systole with squatting.
,Q3. A patient reports “tearing” chest pain radiating to the back, with BP 160/90 in right arm, 100/60 in
left arm. Most likely diagnosis?
A) Acute coronary syndrome
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
AnswerC
Rationale:
• C correct: Blood pressure differential >20 mmHg and tearing pain are classic for aortic
dissection.
• A incorrect: ACS pain is crushing, no BP differential.
• B incorrect: PE presents with dyspnea, pleuritic chest pain.
• D incorrect: Pericarditis pain is positional, relieved by leaning forward.
Q4. A 45-year-old with diabetes reports bilateral burning foot pain worse at night. Exam: decreased
pinprick sensation, normal pulses. What is the most likely diagnosis?
A) Peripheral artery disease
B) Diabetic peripheral neuropathy
C) Lumbar radiculopathy
D) Restless legs syndrome
AnswerB
Rationale:
• B correct: Burning, nocturnal worsening, sensory loss with normal pulses = diabetic neuropathy.
• A incorrect: PAD causes claudication, cool extremities, weak pulses.
• C incorrect: Radiculopathy is unilateral, dermatomal.
• D incorrect: RLS causes urge to move, not burning.
Q5. A 68-year-old male with hypertension reports dizziness when standing up from bed. BP supine
140/85, standing 100/60. Most likely cause?
A) Dehydration
B) Medication-induced orthostatic hypotension
C) Cardiac arrhythmia
D) Parkinson’s disease
AnswerB
Rationale:
• B correct: Common cause in elderly on antihypertensives (e.g., alpha-blockers, diuretics).
• A incorrect: Dehydration possible but less likely without other signs.
, • C incorrect: Arrhythmia would cause random syncope, not positional.
• D incorrect: Parkinson’s can cause orthostasis but less common first dx.
Q6. A 32-year-old female has a positive Murphy’s sign. Which diagnosis is most likely?
A) Appendicitis
B) Cholecystitis
C) Pancreatitis
D) Peptic ulcer disease
AnswerB
Rationale:
• B correct: Murphy’s sign (inspiratory arrest with RUQ palpation) is classic for acute cholecystitis.
• A incorrect: Appendicitis has Rovsing’s, psoas sign.
• C incorrect: Pancreatitis has epigastric pain radiating to back.
• D incorrect: PUD has epigastric pain related to meals.
Q7. A 55-year-old smoker has a non-healing ulcer on the great toe. Diminished dorsalis pedis pulse, hair
loss on the foot. What is the most likely cause?
A) Venous insufficiency
B) Arterial insufficiency
C) Diabetic neuropathic ulcer
D) Pressure ulcer
AnswerB
Rationale:
• B correct: Diminished pulse, hair loss, smoking history → arterial insufficiency ulcer.
• A incorrect: Venous ulcers have hemosiderosis, edema, location over malleolus.
• C incorrect: Neuropathic ulcers occur over pressure points with intact pulses.
• D incorrect: Pressure ulcers over bony prominences in immobile patients.
Q8. A patient with HIV (CD4 120) presents with headache, fever, and confusion. Which test is most
urgently needed?
A) Serum cryptococcal antigen
B) CT head before lumbar puncture
C) Blood cultures
D) Toxoplasma serology
AnswerB
Rationale:
• B correct: CT head first to rule out mass lesion before LP to prevent herniation.
• A incorrect: Cryptococcal antigen is important but after CT/LP.
Practice Academic Year: 2026/2027
Section 1: Advanced Health Assessment & Diagnostic Reasoning (Q1–20)
Q1. A 58-year-old male presents with episodic chest pressure during exertion, relieved by rest. Which
finding most suggests stable angina rather than unstable angina?
A) Pain at rest lasting >20 minutes
B) ST-segment elevation on ECG
C) Precipitated by cold weather and large meals
D) Troponin I >0.04 ng/mL
AnswerC
Rationale:
• C correct: Stable angina is predictable, triggered by exertion, cold, or large meals, and relieved
by rest/nitroglycerin.
• A incorrect: Pain at rest >20 min suggests unstable angina or MI.
• B incorrect: ST elevation indicates STEMI, not stable angina.
• D incorrect: Elevated troponin indicates myocardial necrosis.
Q2. A 72-year-old female has a new murmur. Which murmur increases in intensity with squatting?
A) Aortic stenosis
B) Mitral regurgitation
C) Hypertrophic cardiomyopathy
D) Mitral valve prolapse
AnswerB
Rationale:
• B correct: Squatting increases preload and afterload → increased volume of regurgitant flow in
mitral regurgitation → louder murmur.
• A incorrect: Aortic stenosis murmur may increase slightly but less consistent.
• C incorrect: Hypertrophic cardiomyopathy murmur decreases with squatting (increased preload
reduces obstruction).
• D incorrect: Mitral valve prolapse murmur decreases or moves later in systole with squatting.
,Q3. A patient reports “tearing” chest pain radiating to the back, with BP 160/90 in right arm, 100/60 in
left arm. Most likely diagnosis?
A) Acute coronary syndrome
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
AnswerC
Rationale:
• C correct: Blood pressure differential >20 mmHg and tearing pain are classic for aortic
dissection.
• A incorrect: ACS pain is crushing, no BP differential.
• B incorrect: PE presents with dyspnea, pleuritic chest pain.
• D incorrect: Pericarditis pain is positional, relieved by leaning forward.
Q4. A 45-year-old with diabetes reports bilateral burning foot pain worse at night. Exam: decreased
pinprick sensation, normal pulses. What is the most likely diagnosis?
A) Peripheral artery disease
B) Diabetic peripheral neuropathy
C) Lumbar radiculopathy
D) Restless legs syndrome
AnswerB
Rationale:
• B correct: Burning, nocturnal worsening, sensory loss with normal pulses = diabetic neuropathy.
• A incorrect: PAD causes claudication, cool extremities, weak pulses.
• C incorrect: Radiculopathy is unilateral, dermatomal.
• D incorrect: RLS causes urge to move, not burning.
Q5. A 68-year-old male with hypertension reports dizziness when standing up from bed. BP supine
140/85, standing 100/60. Most likely cause?
A) Dehydration
B) Medication-induced orthostatic hypotension
C) Cardiac arrhythmia
D) Parkinson’s disease
AnswerB
Rationale:
• B correct: Common cause in elderly on antihypertensives (e.g., alpha-blockers, diuretics).
• A incorrect: Dehydration possible but less likely without other signs.
, • C incorrect: Arrhythmia would cause random syncope, not positional.
• D incorrect: Parkinson’s can cause orthostasis but less common first dx.
Q6. A 32-year-old female has a positive Murphy’s sign. Which diagnosis is most likely?
A) Appendicitis
B) Cholecystitis
C) Pancreatitis
D) Peptic ulcer disease
AnswerB
Rationale:
• B correct: Murphy’s sign (inspiratory arrest with RUQ palpation) is classic for acute cholecystitis.
• A incorrect: Appendicitis has Rovsing’s, psoas sign.
• C incorrect: Pancreatitis has epigastric pain radiating to back.
• D incorrect: PUD has epigastric pain related to meals.
Q7. A 55-year-old smoker has a non-healing ulcer on the great toe. Diminished dorsalis pedis pulse, hair
loss on the foot. What is the most likely cause?
A) Venous insufficiency
B) Arterial insufficiency
C) Diabetic neuropathic ulcer
D) Pressure ulcer
AnswerB
Rationale:
• B correct: Diminished pulse, hair loss, smoking history → arterial insufficiency ulcer.
• A incorrect: Venous ulcers have hemosiderosis, edema, location over malleolus.
• C incorrect: Neuropathic ulcers occur over pressure points with intact pulses.
• D incorrect: Pressure ulcers over bony prominences in immobile patients.
Q8. A patient with HIV (CD4 120) presents with headache, fever, and confusion. Which test is most
urgently needed?
A) Serum cryptococcal antigen
B) CT head before lumbar puncture
C) Blood cultures
D) Toxoplasma serology
AnswerB
Rationale:
• B correct: CT head first to rule out mass lesion before LP to prevent herniation.
• A incorrect: Cryptococcal antigen is important but after CT/LP.
