NUR 641E Midterm Study Guide Questions
With Complete Solutions
Course
Nursing NUR 641
1. Question: Differential Diagnosis of Cough
Q: A 65-year-old male presents with a persistent cough, wheezing, and a history of smoking.
What is the most likely diagnosis?
A. Acute bronchitis
B. Chronic obstructive pulmonary disease (COPD)
C. Pneumonia
D. Asthma
Answer: B
Rationale: The patient’s history of smoking and wheezing suggests COPD, a chronic lung
disease. Acute bronchitis could also present with coughing, but wheezing and a smoking history
point more strongly to COPD.
2. Question: Asthma Management
Q: Which of the following is a first-line treatment for a patient diagnosed with asthma?
A. Short-acting beta-agonist (SABA)
B. Inhaled corticosteroid (ICS)
C. Oral prednisone
D. Leukotriene receptor antagonist
Answer: B
Rationale: Inhaled corticosteroids (ICS) are considered the first-line treatment for persistent
asthma to reduce inflammation and prevent exacerbations. SABAs are used for acute relief,
while prednisone is reserved for exacerbations.
3. Question: Diabetes Management
Q: A 45-year-old diabetic patient’s HbA1c is 8.5%. What is the best next step in management?
A. Add metformin
B. Increase the current insulin dose
,C. Initiate a statin
D. Initiate lifestyle modifications
Answer: A
Rationale: With an HbA1c of 8.5%, the patient’s blood sugar is not well-controlled, and
metformin should be considered as it is the first-line medication for type 2 diabetes.
4. Question: Heart Failure Management
Q: A 70-year-old patient presents with fatigue, edema, and shortness of breath. An
echocardiogram shows a reduced ejection fraction. Which medication should be started
immediately?
A. Beta-blocker
B. Diuretic
C. ACE inhibitor
D. Calcium channel blocker
Answer: B
Rationale: In heart failure with reduced ejection fraction (HFrEF), diuretics are used to
manage fluid retention, improving symptoms like edema and shortness of breath. ACE
inhibitors and beta-blockers are important in long-term management, but diuretics are typically
initiated first.
5. Question: Hypertension in Pregnancy
Q: A 28-year-old pregnant woman at 32 weeks gestation presents with high blood pressure
(160/110 mmHg), proteinuria, and swelling. What is the most likely diagnosis?
A. Gestational hypertension
B. Pre-eclampsia
C. Chronic hypertension
D. Preeclampsia with severe features
Answer: D
Rationale: Preeclampsia with severe features is indicated by high blood pressure,
proteinuria, and swelling after 20 weeks of gestation. The severe features include BP readings
above 160/110 mmHg, as seen in this case.
6. Question: Rheumatoid Arthritis
,Q: A 55-year-old woman presents with joint pain, morning stiffness, and bilateral swelling in the
small joints of her hands. Which laboratory finding would most likely confirm a diagnosis of
rheumatoid arthritis?
A. Elevated C-reactive protein (CRP)
B. Positive antinuclear antibody (ANA)
C. Positive rheumatoid factor (RF)
D. Elevated erythrocyte sedimentation rate (ESR)
Answer: C
Rationale: Rheumatoid factor (RF) is a diagnostic marker for rheumatoid arthritis,
especially when combined with clinical findings like joint pain and morning stiffness. CRP and
ESR are nonspecific markers of inflammation, and ANA is more commonly associated with
lupus.
7. Question: Acute Abdominal Pain
Q: A 40-year-old male presents with sharp, intermittent abdominal pain in the right lower
quadrant, nausea, and fever. What is the most likely diagnosis?
A. Gastroenteritis
B. Appendicitis
C. Gallbladder disease
D. Peptic ulcer disease
Answer: B
Rationale: Appendicitis typically presents with right lower quadrant pain, nausea, and fever,
often preceded by abdominal discomfort. The sharp pain and associated fever make this the
most likely diagnosis.
8. Question: Urinary Tract Infection (UTI) in Older Adults
Q: An elderly patient presents with confusion and fever. Urine analysis shows cloudy urine with
increased white blood cells. What is the most appropriate treatment?
A. Start a broad-spectrum antibiotic
B. Increase fluid intake only
C. Provide acetaminophen for fever
D. Start antiviral therapy
Answer: A
Rationale: Urinary tract infections (UTIs) are common in older adults and can present with
, non-specific symptoms like confusion. A broad-spectrum antibiotic is the first step in treating
the infection while awaiting culture results.
9. Question: COPD Exacerbation
Q: A patient with chronic obstructive pulmonary disease (COPD) presents with increased
shortness of breath, wheezing, and productive cough. What is the first-line management for an
acute COPD exacerbation?
A. Intravenous corticosteroids
B. Antibiotics
C. Oxygen therapy and nebulized bronchodilators
D. Long-acting anticholinergics
Answer: C
Rationale: Oxygen therapy and nebulized bronchodilators (such as albuterol) are first-line
treatments for an acute COPD exacerbation to help relieve symptoms like shortness of breath
and wheezing.
10. Question: Type 2 Diabetes Screening
Q: Which of the following patients should be screened for type 2 diabetes according to current
guidelines?
A. A 25-year-old woman with no symptoms and a BMI of 22
B. A 40-year-old male with a BMI of 28, family history of diabetes, and hypertension
C. A 60-year-old man with no risk factors and normal BMI
D. A 35-year-old woman with gestational diabetes in her history
Answer: B
Rationale: The 40-year-old male with risk factors (e.g., BMI of 28, family history, and
hypertension) is the most appropriate candidate for diabetes screening as he meets the
screening criteria based on age and risk factors.
11. Question: Management of Stroke
Q: A 70-year-old woman is admitted with left-sided weakness, facial drooping, and difficulty
speaking. Which of the following is the most critical first intervention?
A. Administer aspirin
B. Obtain a CT scan of the brain
With Complete Solutions
Course
Nursing NUR 641
1. Question: Differential Diagnosis of Cough
Q: A 65-year-old male presents with a persistent cough, wheezing, and a history of smoking.
What is the most likely diagnosis?
A. Acute bronchitis
B. Chronic obstructive pulmonary disease (COPD)
C. Pneumonia
D. Asthma
Answer: B
Rationale: The patient’s history of smoking and wheezing suggests COPD, a chronic lung
disease. Acute bronchitis could also present with coughing, but wheezing and a smoking history
point more strongly to COPD.
2. Question: Asthma Management
Q: Which of the following is a first-line treatment for a patient diagnosed with asthma?
A. Short-acting beta-agonist (SABA)
B. Inhaled corticosteroid (ICS)
C. Oral prednisone
D. Leukotriene receptor antagonist
Answer: B
Rationale: Inhaled corticosteroids (ICS) are considered the first-line treatment for persistent
asthma to reduce inflammation and prevent exacerbations. SABAs are used for acute relief,
while prednisone is reserved for exacerbations.
3. Question: Diabetes Management
Q: A 45-year-old diabetic patient’s HbA1c is 8.5%. What is the best next step in management?
A. Add metformin
B. Increase the current insulin dose
,C. Initiate a statin
D. Initiate lifestyle modifications
Answer: A
Rationale: With an HbA1c of 8.5%, the patient’s blood sugar is not well-controlled, and
metformin should be considered as it is the first-line medication for type 2 diabetes.
4. Question: Heart Failure Management
Q: A 70-year-old patient presents with fatigue, edema, and shortness of breath. An
echocardiogram shows a reduced ejection fraction. Which medication should be started
immediately?
A. Beta-blocker
B. Diuretic
C. ACE inhibitor
D. Calcium channel blocker
Answer: B
Rationale: In heart failure with reduced ejection fraction (HFrEF), diuretics are used to
manage fluid retention, improving symptoms like edema and shortness of breath. ACE
inhibitors and beta-blockers are important in long-term management, but diuretics are typically
initiated first.
5. Question: Hypertension in Pregnancy
Q: A 28-year-old pregnant woman at 32 weeks gestation presents with high blood pressure
(160/110 mmHg), proteinuria, and swelling. What is the most likely diagnosis?
A. Gestational hypertension
B. Pre-eclampsia
C. Chronic hypertension
D. Preeclampsia with severe features
Answer: D
Rationale: Preeclampsia with severe features is indicated by high blood pressure,
proteinuria, and swelling after 20 weeks of gestation. The severe features include BP readings
above 160/110 mmHg, as seen in this case.
6. Question: Rheumatoid Arthritis
,Q: A 55-year-old woman presents with joint pain, morning stiffness, and bilateral swelling in the
small joints of her hands. Which laboratory finding would most likely confirm a diagnosis of
rheumatoid arthritis?
A. Elevated C-reactive protein (CRP)
B. Positive antinuclear antibody (ANA)
C. Positive rheumatoid factor (RF)
D. Elevated erythrocyte sedimentation rate (ESR)
Answer: C
Rationale: Rheumatoid factor (RF) is a diagnostic marker for rheumatoid arthritis,
especially when combined with clinical findings like joint pain and morning stiffness. CRP and
ESR are nonspecific markers of inflammation, and ANA is more commonly associated with
lupus.
7. Question: Acute Abdominal Pain
Q: A 40-year-old male presents with sharp, intermittent abdominal pain in the right lower
quadrant, nausea, and fever. What is the most likely diagnosis?
A. Gastroenteritis
B. Appendicitis
C. Gallbladder disease
D. Peptic ulcer disease
Answer: B
Rationale: Appendicitis typically presents with right lower quadrant pain, nausea, and fever,
often preceded by abdominal discomfort. The sharp pain and associated fever make this the
most likely diagnosis.
8. Question: Urinary Tract Infection (UTI) in Older Adults
Q: An elderly patient presents with confusion and fever. Urine analysis shows cloudy urine with
increased white blood cells. What is the most appropriate treatment?
A. Start a broad-spectrum antibiotic
B. Increase fluid intake only
C. Provide acetaminophen for fever
D. Start antiviral therapy
Answer: A
Rationale: Urinary tract infections (UTIs) are common in older adults and can present with
, non-specific symptoms like confusion. A broad-spectrum antibiotic is the first step in treating
the infection while awaiting culture results.
9. Question: COPD Exacerbation
Q: A patient with chronic obstructive pulmonary disease (COPD) presents with increased
shortness of breath, wheezing, and productive cough. What is the first-line management for an
acute COPD exacerbation?
A. Intravenous corticosteroids
B. Antibiotics
C. Oxygen therapy and nebulized bronchodilators
D. Long-acting anticholinergics
Answer: C
Rationale: Oxygen therapy and nebulized bronchodilators (such as albuterol) are first-line
treatments for an acute COPD exacerbation to help relieve symptoms like shortness of breath
and wheezing.
10. Question: Type 2 Diabetes Screening
Q: Which of the following patients should be screened for type 2 diabetes according to current
guidelines?
A. A 25-year-old woman with no symptoms and a BMI of 22
B. A 40-year-old male with a BMI of 28, family history of diabetes, and hypertension
C. A 60-year-old man with no risk factors and normal BMI
D. A 35-year-old woman with gestational diabetes in her history
Answer: B
Rationale: The 40-year-old male with risk factors (e.g., BMI of 28, family history, and
hypertension) is the most appropriate candidate for diabetes screening as he meets the
screening criteria based on age and risk factors.
11. Question: Management of Stroke
Q: A 70-year-old woman is admitted with left-sided weakness, facial drooping, and difficulty
speaking. Which of the following is the most critical first intervention?
A. Administer aspirin
B. Obtain a CT scan of the brain
