NURS6531 Final Exam LATEST 2026 UPDATE 100
QUESTIONS AND DETAILED VERIFIED ANSWERS
FROM ACTUAL EXAMS TEST GRADE A+
Question 1
A 72-year-old male with a history of hypertension presents with acute onset of
right-sided hemiplegia and aphasia. His symptoms began 90 minutes ago. A non-
contrast head CT shows no evidence of hemorrhage. What is the most
appropriate next step?
A) Administer aspirin 325 mg orally
B) Start intravenous recombinant tissue plasminogen activator (rtPA)
C) Obtain an MRI of the brain
D) Start heparin drip for presumed stroke
Correct Answer: B
*Explanation: Intravenous rtPA is indicated for acute ischemic stroke within 3
hours of symptom onset in eligible patients without hemorrhage on CT. The
patient presents within 90 minutes with no contraindications, making rtPA the
standard of care. Aspirin is secondary prevention, MRI would delay treatment, and
heparin is not first-line for acute ischemic stroke.*
Question 2
A 45-year-old female presents with palpitations, weight loss despite increased
appetite, heat intolerance, and tremor. Her heart rate is 110 bpm and irregular.
Which laboratory finding is most consistent with her suspected diagnosis?
A) Elevated TSH with low free T4
B) Low TSH with elevated free T4
C) Normal TSH with elevated free T3
D) Low TSH with low free T4
Correct Answer: B
*Explanation: Primary hyperthyroidism is characterized by a low TSH (from
negative feedback) and elevated free T4. Option A suggests hypothyroidism, C
,suggests T3 toxicosis but less common, and D suggests central hypothyroidism or
non-thyroidal illness.*
Question 3
A 60-year-old male with type 2 diabetes mellitus has a serum creatinine of 1.8
mg/dL and an eGFR of 42 mL/min/1.73m². Which antihypertensive class is
recommended first-line to reduce progression of nephropathy?
A) Beta-blocker
B) Thiazide diuretic
C) ACE inhibitor
D) Direct vasodilator
Correct Answer: C
Explanation: ACE inhibitors (or ARBs) are first-line for diabetic kidney disease due
to their reno-protective effects independent of blood pressure lowering. Beta-
blockers and thiazides are not first-line for renal protection, and direct vasodilators
lack evidence for slowing nephropathy progression.
Question 4
A 28-year-old pregnant female at 32 weeks gestation presents with new-onset
headache, blurred vision, and epigastric pain. Her blood pressure is 165/105
mmHg. Urinalysis shows 3+ protein. Which medication is contraindicated for acute
blood pressure management here?
A) Labetalol
B) Hydralazine
C) Nifedipine
D) Lisinopril
Correct Answer: D
Explanation: ACE inhibitors like lisinopril are teratogenic and contraindicated in
pregnancy, especially during the second and third trimesters due to risk of fetal
renal agenesis and oligohydramnios. Labetalol, hydralazine, and nifedipine are
safe options for acute hypertension in pregnancy.
Question 5
A 55-year-old with chronic obstructive pulmonary disease (COPD) presents with
,increased dyspnea, purulent sputum, and fever. On exam, he has diffuse
wheezing. Which outpatient antibiotic regimen is most appropriate?
A) Amoxicillin-clavulanate
B) Doxycycline
C) Ciprofloxacin alone
D) Trimethoprim-sulfamethoxazole
Correct Answer: B
Explanation: For acute exacerbation of COPD without severe comorbidities,
doxycycline is recommended due to coverage of common pathogens (H.
influenzae, S. pneumoniae, M. catarrhalis). Amoxicillin-clavulanate is an option but
broader; ciprofloxacin alone misses some respiratory pathogens; TMP-SMX has
resistance issues.
Question 6
A 30-year-old male has a serum potassium of 6.2 mEq/L and an ECG showing
peaked T waves. He takes lisinopril and spironolactone for heart failure. Which
immediate intervention is most appropriate?
A) Oral sodium polystyrene sulfonate
B) Intravenous calcium gluconate
C) Intravenous furosemide
D) Oral albuterol
Correct Answer: B
Explanation: Intravenous calcium gluconate stabilizes cardiac membranes in
severe hyperkalemia with ECG changes, preventing arrhythmias. It does not lower
potassium but is first-line for cardioprotection. Other options lower potassium but
are not the immediate priority given ECG changes.
Question 7
A 65-year-old female presents with acute shortness of breath, pleuritic chest pain,
and tachycardia. She returned from a long flight 3 days ago. Her D-dimer is
elevated. Which diagnostic test is most definitive for suspected pulmonary
embolism?
A) Chest x-ray
B) Ventilation-perfusion (V/Q) scan
, C) Computed tomography pulmonary angiography (CTPA)
D) Lower extremity venous duplex
Correct Answer: C
Explanation: CTPA is the gold standard for diagnosing pulmonary embolism,
offering high sensitivity and specificity. V/Q scan is used if CTPA contraindicated;
chest x-ray is nonspecific; venous duplex confirms DVT but not PE.
Question 8
A 50-year-old male with chronic hepatitis C presents with ascites and jaundice.
Paracentesis reveals a serum-ascites albumin gradient (SAAG) of 1.2 g/dL, total
protein of 2.5 g/dL, and neutrophil count of 750/mm³. What is the most likely
diagnosis?
A) Spontaneous bacterial peritonitis (SBP)
B) Malignant ascites
C) Tuberculous peritonitis
D) Pancreatic ascites
Correct Answer: A
*Explanation: A high SAAG (>1.1) indicates portal hypertension; ascitic fluid
neutrophil count >250/mm³ diagnoses SBP even with normal total protein.
Cirrhosis with low protein can still have SBP. Malignant ascites typically has low
SAAG; TB and pancreatic ascites have different profiles.*
Question 9
A 35-year-old female presents with fatigue, joint pain, malar rash, and oral ulcers.
Laboratory findings: ANA positive, anti-dsDNA positive, low C3 and C4. Which
medication is first-line for preventing disease flares in systemic lupus
erythematosus (SLE)?
A) Prednisone
B) Hydroxychloroquine
C) Azathioprine
D) Cyclophosphamide
Correct Answer: B
Explanation: Hydroxychloroquine is used in all SLE patients to reduce disease
activity and prevent flares, with immunomodulatory effects. Prednisone treats
QUESTIONS AND DETAILED VERIFIED ANSWERS
FROM ACTUAL EXAMS TEST GRADE A+
Question 1
A 72-year-old male with a history of hypertension presents with acute onset of
right-sided hemiplegia and aphasia. His symptoms began 90 minutes ago. A non-
contrast head CT shows no evidence of hemorrhage. What is the most
appropriate next step?
A) Administer aspirin 325 mg orally
B) Start intravenous recombinant tissue plasminogen activator (rtPA)
C) Obtain an MRI of the brain
D) Start heparin drip for presumed stroke
Correct Answer: B
*Explanation: Intravenous rtPA is indicated for acute ischemic stroke within 3
hours of symptom onset in eligible patients without hemorrhage on CT. The
patient presents within 90 minutes with no contraindications, making rtPA the
standard of care. Aspirin is secondary prevention, MRI would delay treatment, and
heparin is not first-line for acute ischemic stroke.*
Question 2
A 45-year-old female presents with palpitations, weight loss despite increased
appetite, heat intolerance, and tremor. Her heart rate is 110 bpm and irregular.
Which laboratory finding is most consistent with her suspected diagnosis?
A) Elevated TSH with low free T4
B) Low TSH with elevated free T4
C) Normal TSH with elevated free T3
D) Low TSH with low free T4
Correct Answer: B
*Explanation: Primary hyperthyroidism is characterized by a low TSH (from
negative feedback) and elevated free T4. Option A suggests hypothyroidism, C
,suggests T3 toxicosis but less common, and D suggests central hypothyroidism or
non-thyroidal illness.*
Question 3
A 60-year-old male with type 2 diabetes mellitus has a serum creatinine of 1.8
mg/dL and an eGFR of 42 mL/min/1.73m². Which antihypertensive class is
recommended first-line to reduce progression of nephropathy?
A) Beta-blocker
B) Thiazide diuretic
C) ACE inhibitor
D) Direct vasodilator
Correct Answer: C
Explanation: ACE inhibitors (or ARBs) are first-line for diabetic kidney disease due
to their reno-protective effects independent of blood pressure lowering. Beta-
blockers and thiazides are not first-line for renal protection, and direct vasodilators
lack evidence for slowing nephropathy progression.
Question 4
A 28-year-old pregnant female at 32 weeks gestation presents with new-onset
headache, blurred vision, and epigastric pain. Her blood pressure is 165/105
mmHg. Urinalysis shows 3+ protein. Which medication is contraindicated for acute
blood pressure management here?
A) Labetalol
B) Hydralazine
C) Nifedipine
D) Lisinopril
Correct Answer: D
Explanation: ACE inhibitors like lisinopril are teratogenic and contraindicated in
pregnancy, especially during the second and third trimesters due to risk of fetal
renal agenesis and oligohydramnios. Labetalol, hydralazine, and nifedipine are
safe options for acute hypertension in pregnancy.
Question 5
A 55-year-old with chronic obstructive pulmonary disease (COPD) presents with
,increased dyspnea, purulent sputum, and fever. On exam, he has diffuse
wheezing. Which outpatient antibiotic regimen is most appropriate?
A) Amoxicillin-clavulanate
B) Doxycycline
C) Ciprofloxacin alone
D) Trimethoprim-sulfamethoxazole
Correct Answer: B
Explanation: For acute exacerbation of COPD without severe comorbidities,
doxycycline is recommended due to coverage of common pathogens (H.
influenzae, S. pneumoniae, M. catarrhalis). Amoxicillin-clavulanate is an option but
broader; ciprofloxacin alone misses some respiratory pathogens; TMP-SMX has
resistance issues.
Question 6
A 30-year-old male has a serum potassium of 6.2 mEq/L and an ECG showing
peaked T waves. He takes lisinopril and spironolactone for heart failure. Which
immediate intervention is most appropriate?
A) Oral sodium polystyrene sulfonate
B) Intravenous calcium gluconate
C) Intravenous furosemide
D) Oral albuterol
Correct Answer: B
Explanation: Intravenous calcium gluconate stabilizes cardiac membranes in
severe hyperkalemia with ECG changes, preventing arrhythmias. It does not lower
potassium but is first-line for cardioprotection. Other options lower potassium but
are not the immediate priority given ECG changes.
Question 7
A 65-year-old female presents with acute shortness of breath, pleuritic chest pain,
and tachycardia. She returned from a long flight 3 days ago. Her D-dimer is
elevated. Which diagnostic test is most definitive for suspected pulmonary
embolism?
A) Chest x-ray
B) Ventilation-perfusion (V/Q) scan
, C) Computed tomography pulmonary angiography (CTPA)
D) Lower extremity venous duplex
Correct Answer: C
Explanation: CTPA is the gold standard for diagnosing pulmonary embolism,
offering high sensitivity and specificity. V/Q scan is used if CTPA contraindicated;
chest x-ray is nonspecific; venous duplex confirms DVT but not PE.
Question 8
A 50-year-old male with chronic hepatitis C presents with ascites and jaundice.
Paracentesis reveals a serum-ascites albumin gradient (SAAG) of 1.2 g/dL, total
protein of 2.5 g/dL, and neutrophil count of 750/mm³. What is the most likely
diagnosis?
A) Spontaneous bacterial peritonitis (SBP)
B) Malignant ascites
C) Tuberculous peritonitis
D) Pancreatic ascites
Correct Answer: A
*Explanation: A high SAAG (>1.1) indicates portal hypertension; ascitic fluid
neutrophil count >250/mm³ diagnoses SBP even with normal total protein.
Cirrhosis with low protein can still have SBP. Malignant ascites typically has low
SAAG; TB and pancreatic ascites have different profiles.*
Question 9
A 35-year-old female presents with fatigue, joint pain, malar rash, and oral ulcers.
Laboratory findings: ANA positive, anti-dsDNA positive, low C3 and C4. Which
medication is first-line for preventing disease flares in systemic lupus
erythematosus (SLE)?
A) Prednisone
B) Hydroxychloroquine
C) Azathioprine
D) Cyclophosphamide
Correct Answer: B
Explanation: Hydroxychloroquine is used in all SLE patients to reduce disease
activity and prevent flares, with immunomodulatory effects. Prednisone treats
