NU 578 Unit 3 Exam Advanced
Nursing ACTUAL EXAM 2026/2027 |
USA NU 578 Unit 3 | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1: Advanced Health Assessment & Clinical Reasoning (12 Questions)
Q1. A 68-year-old male presents with acute-onset dyspnea, pleuritic chest pain, and tachycardia. He
recently underwent total knee arthroplasty 10 days ago. On exam, he is diaphoretic with a blood
pressure of 94/58 mmHg, heart rate 118 bpm, respiratory rate 28, and O₂ saturation 88% on room air.
Lung auscultation reveals clear bilaterally. Which diagnostic study is the next best action to confirm the
most likely diagnosis?
A. D-dimer assay
B. CT pulmonary angiography (CTPA)
C. Ventilation-perfusion (V/Q) scan
D. Lower extremity duplex ultrasound
Correct Answer: B
Rationale: CT pulmonary angiography (CTPA) is the gold standard imaging modality for diagnosing acute
pulmonary embolism (PE) in hemodynamically unstable patients with high pretest probability. This
patient exhibits the classic triad of PE (dyspnea, pleuritic chest pain, tachycardia) following orthopedic
surgery, a major risk factor for venous thromboembolism. The hemodynamic instability (hypotension,
tachycardia, hypoxemia) indicates a massive or submassive PE, requiring rapid definitive diagnosis to
guide potential thrombolysis or embolectomy. CTPA provides direct visualization of pulmonary arterial
filling defects with high sensitivity and specificity. (APRN Competency: Direct Clinical Practice –
Diagnostic Reasoning)
Q2. A 54-year-old female with a 20-pack-year smoking history presents with a persistent cough,
hemoptysis, and unintentional 15-pound weight loss over 3 months. Chest X-ray reveals a 3.5 cm
,spiculated mass in the left upper lobe. Which additional assessment finding would most strongly
support a diagnosis of small cell lung cancer (SCLC) rather than non-small cell lung cancer (NSCLC)?
A. Hypercalcemia
B. Hypertrophic pulmonary osteoarthropathy
C. Syndrome of inappropriate antidiuretic hormone (SIADH)
D. Pancoast syndrome
Correct Answer: C
Rationale: SIADH is a classic paraneoplastic syndrome associated with small cell lung cancer (SCLC),
occurring in approximately 10–15% of cases due to ectopic ADH production by neuroendocrine tumor
cells. This finding strongly favors SCLC over NSCLC, as NSCLC more commonly presents with
hypercalcemia (squamous cell), hypertrophic pulmonary osteoarthropathy (adenocarcinoma), or
Pancoast syndrome (superior sulcus tumors). The presence of a central mass with paraneoplastic
endocrine manifestation warrants urgent tissue biopsy and staging. (APRN Competency: Direct Clinical
Practice – Differential Diagnosis)
Q3. During a routine wellness visit, a 42-year-old female reports persistent fatigue, cold intolerance,
constipation, and dry skin. Physical exam reveals periorbital puffiness, bradycardia (52 bpm), and
delayed deep tendon reflexes. Laboratory studies show TSH 18.5 mIU/L (elevated) and free T4 0.6 ng/dL
(low). Which physical examination finding is most specific for confirming the suspected diagnosis?
A. Exophthalmos
B. Non-pitting edema (myxedema)
C. Thyroid bruit
D. Fine tremor
Correct Answer: B
Rationale: Non-pitting edema (myxedema) is a pathognomonic physical finding of severe
hypothyroidism, resulting from the accumulation of hyaluronic acid and glycosaminoglycans in the
dermis and subcutaneous tissues. This finding, combined with delayed relaxation phase of deep tendon
reflexes, periorbital puffiness, and the biochemical profile of primary hypothyroidism (elevated TSH, low
free T4), confirms the diagnosis. Myxedema represents advanced disease and warrants careful initiation
of levothyroxine replacement with cardiac monitoring. (APRN Competency: Direct Clinical Practice –
Physical Assessment)
Q4. A 71-year-old male with a history of atrial fibrillation on warfarin presents after a fall from standing
height. He is alert and oriented but complains of a severe headache. His INR is 4.2. Which next best
action should the APRN prioritize?
, A. Immediate non-contrast head CT
B. Administration of fresh frozen plasma (FFP)
C. Discontinuation of warfarin and initiation of heparin bridge
D. Administration of vitamin K 10 mg IV
Correct Answer: A
Rationale: In an anticoagulated patient with head trauma and severe headache, immediate non-
contrast head CT is the priority to rapidly identify intracranial hemorrhage, which carries high morbidity
and mortality in this population. The elevated INR of 4.2 increases bleeding risk significantly. While
reversal agents may ultimately be needed, the APRN must first establish whether life-threatening
intracranial bleeding is present before administering potentially unnecessary blood products. Time-
critical neuroimaging aligns with emergency department triage protocols for anticoagulated trauma
patients. (APRN Competency: Direct Clinical Practice – Prioritization & Clinical Decision-Making)
Q5. A 38-year-old female presents with episodic palpitations, heat intolerance, tremor, and a 10-pound
weight loss despite increased appetite. She has a family history of autoimmune thyroid disease. On
exam, she has a fine tremor, warm moist skin, lid lag, and a diffusely enlarged, non-tender thyroid.
Which laboratory pattern is most consistent with her likely diagnosis?
A. Elevated TSH, elevated free T4, positive TSI
B. Suppressed TSH, elevated free T4, positive TSI
C. Elevated TSH, suppressed free T4, positive TPO antibodies
D. Normal TSH, elevated free T4, elevated thyroglobulin
Correct Answer: B
Rationale: Graves' disease, the most common cause of hyperthyroidism, is characterized by a
suppressed TSH with elevated free T4 (or T3) due to thyroid-stimulating immunoglobulins (TSI) acting as
agonists at the TSH receptor. The positive TSI confirms the autoimmune etiology. The clinical
presentation of diffuse goiter, ophthalmopathy (lid lag), and systemic hypermetabolic symptoms in a
patient with family history of autoimmune thyroid disease strongly supports this diagnosis. This pattern
distinguishes Graves' from toxic multinodular goiter or thyroiditis. (APRN Competency: Direct Clinical
Practice – Diagnostic Testing Interpretation)
Q6. A 29-year-old male presents with acute right lower quadrant pain, nausea, and low-grade fever. On
exam, there is localized tenderness at McBurney's point with guarding and rebound. Which diagnostic
finding on imaging would most strongly support the diagnosis of acute appendicitis?
A. Dilated appendix >6 mm diameter with wall enhancement and periappendiceal fat stranding
B. Appendicolith visualized on plain abdominal X-ray
Nursing ACTUAL EXAM 2026/2027 |
USA NU 578 Unit 3 | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1: Advanced Health Assessment & Clinical Reasoning (12 Questions)
Q1. A 68-year-old male presents with acute-onset dyspnea, pleuritic chest pain, and tachycardia. He
recently underwent total knee arthroplasty 10 days ago. On exam, he is diaphoretic with a blood
pressure of 94/58 mmHg, heart rate 118 bpm, respiratory rate 28, and O₂ saturation 88% on room air.
Lung auscultation reveals clear bilaterally. Which diagnostic study is the next best action to confirm the
most likely diagnosis?
A. D-dimer assay
B. CT pulmonary angiography (CTPA)
C. Ventilation-perfusion (V/Q) scan
D. Lower extremity duplex ultrasound
Correct Answer: B
Rationale: CT pulmonary angiography (CTPA) is the gold standard imaging modality for diagnosing acute
pulmonary embolism (PE) in hemodynamically unstable patients with high pretest probability. This
patient exhibits the classic triad of PE (dyspnea, pleuritic chest pain, tachycardia) following orthopedic
surgery, a major risk factor for venous thromboembolism. The hemodynamic instability (hypotension,
tachycardia, hypoxemia) indicates a massive or submassive PE, requiring rapid definitive diagnosis to
guide potential thrombolysis or embolectomy. CTPA provides direct visualization of pulmonary arterial
filling defects with high sensitivity and specificity. (APRN Competency: Direct Clinical Practice –
Diagnostic Reasoning)
Q2. A 54-year-old female with a 20-pack-year smoking history presents with a persistent cough,
hemoptysis, and unintentional 15-pound weight loss over 3 months. Chest X-ray reveals a 3.5 cm
,spiculated mass in the left upper lobe. Which additional assessment finding would most strongly
support a diagnosis of small cell lung cancer (SCLC) rather than non-small cell lung cancer (NSCLC)?
A. Hypercalcemia
B. Hypertrophic pulmonary osteoarthropathy
C. Syndrome of inappropriate antidiuretic hormone (SIADH)
D. Pancoast syndrome
Correct Answer: C
Rationale: SIADH is a classic paraneoplastic syndrome associated with small cell lung cancer (SCLC),
occurring in approximately 10–15% of cases due to ectopic ADH production by neuroendocrine tumor
cells. This finding strongly favors SCLC over NSCLC, as NSCLC more commonly presents with
hypercalcemia (squamous cell), hypertrophic pulmonary osteoarthropathy (adenocarcinoma), or
Pancoast syndrome (superior sulcus tumors). The presence of a central mass with paraneoplastic
endocrine manifestation warrants urgent tissue biopsy and staging. (APRN Competency: Direct Clinical
Practice – Differential Diagnosis)
Q3. During a routine wellness visit, a 42-year-old female reports persistent fatigue, cold intolerance,
constipation, and dry skin. Physical exam reveals periorbital puffiness, bradycardia (52 bpm), and
delayed deep tendon reflexes. Laboratory studies show TSH 18.5 mIU/L (elevated) and free T4 0.6 ng/dL
(low). Which physical examination finding is most specific for confirming the suspected diagnosis?
A. Exophthalmos
B. Non-pitting edema (myxedema)
C. Thyroid bruit
D. Fine tremor
Correct Answer: B
Rationale: Non-pitting edema (myxedema) is a pathognomonic physical finding of severe
hypothyroidism, resulting from the accumulation of hyaluronic acid and glycosaminoglycans in the
dermis and subcutaneous tissues. This finding, combined with delayed relaxation phase of deep tendon
reflexes, periorbital puffiness, and the biochemical profile of primary hypothyroidism (elevated TSH, low
free T4), confirms the diagnosis. Myxedema represents advanced disease and warrants careful initiation
of levothyroxine replacement with cardiac monitoring. (APRN Competency: Direct Clinical Practice –
Physical Assessment)
Q4. A 71-year-old male with a history of atrial fibrillation on warfarin presents after a fall from standing
height. He is alert and oriented but complains of a severe headache. His INR is 4.2. Which next best
action should the APRN prioritize?
, A. Immediate non-contrast head CT
B. Administration of fresh frozen plasma (FFP)
C. Discontinuation of warfarin and initiation of heparin bridge
D. Administration of vitamin K 10 mg IV
Correct Answer: A
Rationale: In an anticoagulated patient with head trauma and severe headache, immediate non-
contrast head CT is the priority to rapidly identify intracranial hemorrhage, which carries high morbidity
and mortality in this population. The elevated INR of 4.2 increases bleeding risk significantly. While
reversal agents may ultimately be needed, the APRN must first establish whether life-threatening
intracranial bleeding is present before administering potentially unnecessary blood products. Time-
critical neuroimaging aligns with emergency department triage protocols for anticoagulated trauma
patients. (APRN Competency: Direct Clinical Practice – Prioritization & Clinical Decision-Making)
Q5. A 38-year-old female presents with episodic palpitations, heat intolerance, tremor, and a 10-pound
weight loss despite increased appetite. She has a family history of autoimmune thyroid disease. On
exam, she has a fine tremor, warm moist skin, lid lag, and a diffusely enlarged, non-tender thyroid.
Which laboratory pattern is most consistent with her likely diagnosis?
A. Elevated TSH, elevated free T4, positive TSI
B. Suppressed TSH, elevated free T4, positive TSI
C. Elevated TSH, suppressed free T4, positive TPO antibodies
D. Normal TSH, elevated free T4, elevated thyroglobulin
Correct Answer: B
Rationale: Graves' disease, the most common cause of hyperthyroidism, is characterized by a
suppressed TSH with elevated free T4 (or T3) due to thyroid-stimulating immunoglobulins (TSI) acting as
agonists at the TSH receptor. The positive TSI confirms the autoimmune etiology. The clinical
presentation of diffuse goiter, ophthalmopathy (lid lag), and systemic hypermetabolic symptoms in a
patient with family history of autoimmune thyroid disease strongly supports this diagnosis. This pattern
distinguishes Graves' from toxic multinodular goiter or thyroiditis. (APRN Competency: Direct Clinical
Practice – Diagnostic Testing Interpretation)
Q6. A 29-year-old male presents with acute right lower quadrant pain, nausea, and low-grade fever. On
exam, there is localized tenderness at McBurney's point with guarding and rebound. Which diagnostic
finding on imaging would most strongly support the diagnosis of acute appendicitis?
A. Dilated appendix >6 mm diameter with wall enhancement and periappendiceal fat stranding
B. Appendicolith visualized on plain abdominal X-ray
