NURS 661 Exam 2 Official Exam 2026/2027
Actual Exam Complete Questions and
Answers Detailed Rationales Pass
Guaranteed - A+ Graded
Total Questions: 50 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Advanced Health Assessment Principles | Q1 – Q10
Section 2 | Diagnostic Reasoning and Clinical Decision-Making | Q11 – Q20
Section 3 | Common Acute and Chronic Conditions | Q21 – Q30
Section 4 | Pharmacology and Treatment Modalities | Q31 – Q40
Section 5 | Evidence-Based Practice and Care Management | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: ADVANCED HEALTH ASSESSMENT PRINCIPLES Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 58-year-old man presents to the primary care clinic with progressive exertional
dyspnea and occasional syncope. On cardiac auscultation, you hear a harsh
crescendo-decrescendo systolic ejection murmur at the right upper sternal border that
radiates to both carotid arteries. His carotid pulses are delayed and diminished in
amplitude.
A. Mitral regurgitation with posterior leaflet prolapse
B. Hypertrophic cardiomyopathy with dynamic outflow obstruction
C. Aortic stenosis with calcified trileaflet valve ✓ CORRECT
D. Aortic regurgitation due to root dilation
Correct Answer: C
,Rationale: A harsh systolic ejection murmur radiating to the carotids accompanied by
delayed, diminished carotid pulses (pulsus parvus et tardus) is pathognomonic for
severe aortic stenosis. Choice B is tempting because HCM also produces a systolic
murmur, but it typically radiates to the apex rather than the carotids and is associated
with a brisk bifid pulse, not a delayed upstroke. Advanced cardiac assessment requires
correlating murmur characteristics with peripheral pulse quality to localize the lesion.
Question 2 of 50
A 42-year-old woman presents for her annual wellness visit and points to a new
pigmented lesion on her upper back. It measures 8 mm in diameter, displays irregular
borders with notching, and shows variegated blue-black and tan coloration. She first
noticed it three months ago and believes it has grown slightly since then.
A. Seborrheic keratosis with typical stuck-on appearance and uniform color
B. Melanoma requiring urgent excisional biopsy and staging ✓ CORRECT
C. Basal cell carcinoma with pearly borders and central ulceration
D. Cherry hemangioma with bright red dome-shaped papule
Correct Answer: B
Rationale: An 8 mm pigmented lesion with asymmetry, irregular borders, color
variegation, and evolution over time meets classic ABCDE criteria for melanoma and
warrants prompt excisional biopsy. Choice A is incorrect because seborrheic keratoses
are usually uniform in color, have a waxy stuck-on quality, and grow slowly over years
rather than months. Skin cancer screening is one of the highest-yield preventive
services in primary care, and early melanoma detection dramatically improves survival.
Question 3 of 50
A 35-year-old woman is referred from endocrinology with six months of tremor, heat
intolerance, and 12-pound unintentional weight loss. On examination, you note lid lag,
,brisk deep tendon reflexes, and a smooth, mildly enlarged thyroid gland. Auscultation
over the thyroid reveals a continuous soft bruit.
A. Hashimoto thyroiditis with lymphocytic infiltration and firm gland
B. Toxic multinodular goiter with discrete palpable nodules
C. Graves disease with diffuse toxic goiter and increased vascular flow ✓ CORRECT
D. Subacute granulomatous thyroiditis with tender gland and viral prodrome
Correct Answer: C
Rationale: A diffuse, smooth goiter accompanied by a thyroid bruit reflects the marked
hypervascularity characteristic of Graves disease, while lid lag and brisk reflexes
support thyrotoxicosis. Choice A is incorrect because Hashimoto thyroiditis typically
produces a firm, nodular gland and leads to hypothyroidism rather than
hyperthyroidism. The thyroid bruit is a high-specificity physical finding that helps
distinguish Graves disease from other causes of thyrotoxicosis.
Question 4 of 50
A 67-year-old man with a 40 pack-year smoking history presents with progressive
dyspnea on exertion. Chest inspection reveals an increased anteroposterior diameter.
Palpation shows diminished tactile fremitus, and percussion yields hyperresonance
over the lung fields. Auscultation reveals distant breath sounds and a prolonged
expiratory phase.
A. Acute viral bronchitis with transient wheeze and normal percussion
B. Bronchial asthma with reversible airflow obstruction and allergic triggers
C. Interstitial pulmonary fibrosis with fine bibasilar crackles and clubbing
D. Chronic obstructive pulmonary disease with emphysematous changes ✓ CORRECT
Correct Answer: D
Rationale: The combination of barrel chest, hyperresonant percussion, diminished
breath sounds, and prolonged expiration in a long-term smoker is classic for COPD with
emphysema. Choice B is tempting because asthma also causes wheeze and dyspnea,
, but it typically presents with reversible symptoms, normal percussion, and a younger
age of onset rather than progressive structural changes. Advanced pulmonary
assessment integrates inspection, palpation, percussion, and auscultation to
distinguish obstructive from restrictive disease.
Question 5 of 50
A 48-year-old woman wakes with sudden onset right-sided facial droop. She cannot fully
close her right eye or raise her right eyebrow, but she can smile symmetrically on the left
side. She has no arm weakness, dysarthria, or visual field deficits. Her blood pressure is
128/78 mmHg.
A. Bell palsy involving the peripheral facial nerve with forehead sparing absent ✓
CORRECT
B. Right middle cerebral artery ischemic stroke with central facial palsy
C. Myasthenia gravis with fluctuating bilateral ptosis and diplopia
D. Trigeminal neuralgia with lancinating facial pain and normal motor function
Correct Answer: A
Rationale: Inability to raise the eyebrow or close the eye indicates complete peripheral
facial nerve involvement, which distinguishes Bell palsy from a central lesion that
spares the forehead. Choice B is incorrect because a central stroke typically spares the
upper face due to bilateral cortical innervation of the frontalis muscle. Rapid distinction
between peripheral and central facial weakness prevents unnecessary stroke workups
while ensuring appropriate eye protection for Bell palsy.
Question 6 of 50
A 62-year-old woman complains of bilateral hand stiffness lasting two hours each
morning. Examination reveals symmetric swelling and tenderness of the
metacarpophalangeal and proximal interphalangeal joints with ulnar deviation of the
Actual Exam Complete Questions and
Answers Detailed Rationales Pass
Guaranteed - A+ Graded
Total Questions: 50 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Advanced Health Assessment Principles | Q1 – Q10
Section 2 | Diagnostic Reasoning and Clinical Decision-Making | Q11 – Q20
Section 3 | Common Acute and Chronic Conditions | Q21 – Q30
Section 4 | Pharmacology and Treatment Modalities | Q31 – Q40
Section 5 | Evidence-Based Practice and Care Management | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: ADVANCED HEALTH ASSESSMENT PRINCIPLES Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 58-year-old man presents to the primary care clinic with progressive exertional
dyspnea and occasional syncope. On cardiac auscultation, you hear a harsh
crescendo-decrescendo systolic ejection murmur at the right upper sternal border that
radiates to both carotid arteries. His carotid pulses are delayed and diminished in
amplitude.
A. Mitral regurgitation with posterior leaflet prolapse
B. Hypertrophic cardiomyopathy with dynamic outflow obstruction
C. Aortic stenosis with calcified trileaflet valve ✓ CORRECT
D. Aortic regurgitation due to root dilation
Correct Answer: C
,Rationale: A harsh systolic ejection murmur radiating to the carotids accompanied by
delayed, diminished carotid pulses (pulsus parvus et tardus) is pathognomonic for
severe aortic stenosis. Choice B is tempting because HCM also produces a systolic
murmur, but it typically radiates to the apex rather than the carotids and is associated
with a brisk bifid pulse, not a delayed upstroke. Advanced cardiac assessment requires
correlating murmur characteristics with peripheral pulse quality to localize the lesion.
Question 2 of 50
A 42-year-old woman presents for her annual wellness visit and points to a new
pigmented lesion on her upper back. It measures 8 mm in diameter, displays irregular
borders with notching, and shows variegated blue-black and tan coloration. She first
noticed it three months ago and believes it has grown slightly since then.
A. Seborrheic keratosis with typical stuck-on appearance and uniform color
B. Melanoma requiring urgent excisional biopsy and staging ✓ CORRECT
C. Basal cell carcinoma with pearly borders and central ulceration
D. Cherry hemangioma with bright red dome-shaped papule
Correct Answer: B
Rationale: An 8 mm pigmented lesion with asymmetry, irregular borders, color
variegation, and evolution over time meets classic ABCDE criteria for melanoma and
warrants prompt excisional biopsy. Choice A is incorrect because seborrheic keratoses
are usually uniform in color, have a waxy stuck-on quality, and grow slowly over years
rather than months. Skin cancer screening is one of the highest-yield preventive
services in primary care, and early melanoma detection dramatically improves survival.
Question 3 of 50
A 35-year-old woman is referred from endocrinology with six months of tremor, heat
intolerance, and 12-pound unintentional weight loss. On examination, you note lid lag,
,brisk deep tendon reflexes, and a smooth, mildly enlarged thyroid gland. Auscultation
over the thyroid reveals a continuous soft bruit.
A. Hashimoto thyroiditis with lymphocytic infiltration and firm gland
B. Toxic multinodular goiter with discrete palpable nodules
C. Graves disease with diffuse toxic goiter and increased vascular flow ✓ CORRECT
D. Subacute granulomatous thyroiditis with tender gland and viral prodrome
Correct Answer: C
Rationale: A diffuse, smooth goiter accompanied by a thyroid bruit reflects the marked
hypervascularity characteristic of Graves disease, while lid lag and brisk reflexes
support thyrotoxicosis. Choice A is incorrect because Hashimoto thyroiditis typically
produces a firm, nodular gland and leads to hypothyroidism rather than
hyperthyroidism. The thyroid bruit is a high-specificity physical finding that helps
distinguish Graves disease from other causes of thyrotoxicosis.
Question 4 of 50
A 67-year-old man with a 40 pack-year smoking history presents with progressive
dyspnea on exertion. Chest inspection reveals an increased anteroposterior diameter.
Palpation shows diminished tactile fremitus, and percussion yields hyperresonance
over the lung fields. Auscultation reveals distant breath sounds and a prolonged
expiratory phase.
A. Acute viral bronchitis with transient wheeze and normal percussion
B. Bronchial asthma with reversible airflow obstruction and allergic triggers
C. Interstitial pulmonary fibrosis with fine bibasilar crackles and clubbing
D. Chronic obstructive pulmonary disease with emphysematous changes ✓ CORRECT
Correct Answer: D
Rationale: The combination of barrel chest, hyperresonant percussion, diminished
breath sounds, and prolonged expiration in a long-term smoker is classic for COPD with
emphysema. Choice B is tempting because asthma also causes wheeze and dyspnea,
, but it typically presents with reversible symptoms, normal percussion, and a younger
age of onset rather than progressive structural changes. Advanced pulmonary
assessment integrates inspection, palpation, percussion, and auscultation to
distinguish obstructive from restrictive disease.
Question 5 of 50
A 48-year-old woman wakes with sudden onset right-sided facial droop. She cannot fully
close her right eye or raise her right eyebrow, but she can smile symmetrically on the left
side. She has no arm weakness, dysarthria, or visual field deficits. Her blood pressure is
128/78 mmHg.
A. Bell palsy involving the peripheral facial nerve with forehead sparing absent ✓
CORRECT
B. Right middle cerebral artery ischemic stroke with central facial palsy
C. Myasthenia gravis with fluctuating bilateral ptosis and diplopia
D. Trigeminal neuralgia with lancinating facial pain and normal motor function
Correct Answer: A
Rationale: Inability to raise the eyebrow or close the eye indicates complete peripheral
facial nerve involvement, which distinguishes Bell palsy from a central lesion that
spares the forehead. Choice B is incorrect because a central stroke typically spares the
upper face due to bilateral cortical innervation of the frontalis muscle. Rapid distinction
between peripheral and central facial weakness prevents unnecessary stroke workups
while ensuring appropriate eye protection for Bell palsy.
Question 6 of 50
A 62-year-old woman complains of bilateral hand stiffness lasting two hours each
morning. Examination reveals symmetric swelling and tenderness of the
metacarpophalangeal and proximal interphalangeal joints with ulnar deviation of the
