NURS 6015 Exam 3
Advanced Graduate Clinical Practice Examination
50 Questions with Complete Answers
April 6, 2026
This examination assesses competency in advanced clinical practice including advanced assessment,
diagnostic reasoning, pharmacotherapeutics, complex comorbidity management, care coordination,
ethical/legal practice, and evidence-based quality improvement.
Alignment: AACN Essentials | NCSBN NCJMM | Specialty Board Standards | 2026/2027 Clinical Practice
Guidelines
,Section 1: Advanced Assessment & Diagnostic Reasoning
Q1: According to the 2026 AHA/ACC guidelines, which diagnostic modality is considered the gold
standard for evaluating hemodynamically significant coronary artery disease (CAD)?
A. Exercise stress echocardiography
B. Coronary computed tomography angiography (CCTA)
C. Invasive coronary angiography with fractional flow reserve (FFR) [CORRECT]
D. Cardiac magnetic resonance imaging (CMR)
Correct Answer: C
Rationale: Invasive coronary angiography with fractional flow reserve (FFR) remains the gold
standard for evaluating hemodynamically significant CAD, as it provides both anatomic and
functional assessment. Exercise stress echocardiography is a functional test but has lower
sensitivity. CCTA provides anatomic data only and does not assess lesion-specific ischemia. CMR is
excellent for myocardial viability and structural assessment but is not the primary tool for CAD
evaluation (AHA/ACC 2026 Guidelines).
Q2: A 68-year-old woman presents to the clinic with progressive dyspnea on exertion, bilateral
lower extremity edema, and a new systolic murmur heard best at the right upper sternal border
radiating to the carotids. Her BNP is 680 pg/mL and ECG shows left ventricular hypertrophy. Which
diagnostic test should the nurse practitioner order FIRST to determine the etiology?
A. Cardiac catheterization
B. Transthoracic echocardiogram (TTE) [CORRECT]
C. Chest CT with contrast
D. Pulmonary function testing
Correct Answer: B
Rationale: A transthoracic echocardiogram (TTE) is the most appropriate initial diagnostic test.
The clinical presentation (dyspnea, edema, systolic murmur at right upper sternal border radiating
to carotids, elevated BNP, LVH on ECG) strongly suggests aortic stenosis. TTE provides immediate
information about valve morphology, gradient severity, LV function, and pulmonary pressures.
Cardiac catheterization is invasive and reserved for definitive anatomic assessment. Chest CT does
not evaluate valve pathology. PFTs are not indicated for this cardiac presentation.
Q3: A 55-year-old man with a history of hypertension and type 2 diabetes presents with acute onset
severe tearing chest pain radiating to the back. Blood pressure is 180/110 mmHg in the right arm
and 140/90 mmHg in the left arm. A widened mediastinum is noted on chest X-ray. Which condition
must be ruled out emergently, and what is the definitive diagnostic test?
A. Acute myocardial infarction; cardiac enzymes and ECG
B. Acute aortic dissection; CT angiography of the chest and abdomen [CORRECT]
C. Pulmonary embolism; D-dimer and ventilation-perfusion scan
D. Esophageal rupture; barium esophagram
Correct Answer: B
Rationale: The presentation of severe tearing chest pain radiating to the back, blood pressure
differential between arms (>20 mmHg), and widened mediastinum on chest X-ray is classic for acute
aortic dissection. CT angiography of the chest and abdomen is the definitive diagnostic test with
>95% sensitivity and specificity (AHA 2026 guidelines). While AMI must also be considered, the
Page 1
, clinical picture is most consistent with dissection. D-dimer lacks specificity, and barium
esophagram does not address the life-threatening vascular emergency.
Q4: Which clinical decision rule is recommended by the American College of Emergency Physicians
(ACEP) to risk-stratify patients with suspected pulmonary embolism and reduce unnecessary CT
imaging?
A. CHA2DS2-VASc score
B. Wells Criteria for PE [CORRECT]
C. CURB-65 score
D. HEART score
Correct Answer: B
Rationale: The Wells Criteria for PE is the validated clinical decision rule for risk-stratifying
patients with suspected pulmonary embolism. It categorizes patients as low, moderate, or high
probability to guide the need for D-dimer testing versus direct imaging with CT pulmonary
angiography. CHA2DS2-VASc is for stroke risk in atrial fibrillation. CURB-65 is for CAP severity.
The HEART score evaluates chest pain for ACS risk.
Q5: A 72-year-old patient presents with syncope. On ECG, you note a short PR interval (<120 ms), a
delta wave, and a widened QRS complex. The patient reports no prior cardiac history. What is the
most likely diagnosis, and what is the recommended management per 2026 AHA/HRS guidelines?
A. First-degree AV block; outpatient Holter monitoring in 4 weeks
B. Wolff-Parkinson-White (WPW) syndrome; referral for electrophysiology study and possible
ablation [CORRECT]
C. Bundle branch block; start beta-blocker and reassess in 3 months
D. Brugada syndrome; immediate ICD implantation
Correct Answer: B
Rationale: The ECG findings of a short PR interval, delta wave, and widened QRS are diagnostic of
Wolff-Parkinson-White (WPW) syndrome. Given the presentation with syncope, which may indicate
life-threatening arrhythmias (e.g., atrial fibrillation conducting over the accessory pathway),
referral for electrophysiology study with possible catheter ablation is recommended (AHA/HRS 2026
guidelines). First-degree AV block shows only prolonged PR. Bundle branch block does not have a
delta wave. Brugada syndrome has a characteristic coved ST elevation in V1-V3, not a delta wave.
Q6: A 45-year-old woman presents with fatigue, arthralgias, and a malar rash. Laboratory results
reveal ANA positive at 1:640, anti-dsDNA positive, low C3 and C4, hemoglobin 9.8 g/dL, WBC
2,800/microL, platelets 95,000/microL, creatinine 2.1 mg/dL (baseline 0.9), and urinalysis with 3+
protein and RBC casts. How should the nurse practitioner synthesize these findings, and what is the
priority intervention?
A. Diagnose systemic lupus erythematosus with Class IV lupus nephritis; initiate high-dose
corticosteroids and mycophenolate mofetil with nephrology referral [CORRECT]
B. Diagnose drug-induced lupus; discontinue all medications and monitor renal function in 4
weeks
C. Diagnose rheumatoid arthritis with secondary anemia; start methotrexate and refer to
rheumatology in 6 weeks
D. Diagnose fibromyalgia with comorbid depression; initiate SNRI and cognitive behavioral
therapy
Correct Answer: A
Page 2
Advanced Graduate Clinical Practice Examination
50 Questions with Complete Answers
April 6, 2026
This examination assesses competency in advanced clinical practice including advanced assessment,
diagnostic reasoning, pharmacotherapeutics, complex comorbidity management, care coordination,
ethical/legal practice, and evidence-based quality improvement.
Alignment: AACN Essentials | NCSBN NCJMM | Specialty Board Standards | 2026/2027 Clinical Practice
Guidelines
,Section 1: Advanced Assessment & Diagnostic Reasoning
Q1: According to the 2026 AHA/ACC guidelines, which diagnostic modality is considered the gold
standard for evaluating hemodynamically significant coronary artery disease (CAD)?
A. Exercise stress echocardiography
B. Coronary computed tomography angiography (CCTA)
C. Invasive coronary angiography with fractional flow reserve (FFR) [CORRECT]
D. Cardiac magnetic resonance imaging (CMR)
Correct Answer: C
Rationale: Invasive coronary angiography with fractional flow reserve (FFR) remains the gold
standard for evaluating hemodynamically significant CAD, as it provides both anatomic and
functional assessment. Exercise stress echocardiography is a functional test but has lower
sensitivity. CCTA provides anatomic data only and does not assess lesion-specific ischemia. CMR is
excellent for myocardial viability and structural assessment but is not the primary tool for CAD
evaluation (AHA/ACC 2026 Guidelines).
Q2: A 68-year-old woman presents to the clinic with progressive dyspnea on exertion, bilateral
lower extremity edema, and a new systolic murmur heard best at the right upper sternal border
radiating to the carotids. Her BNP is 680 pg/mL and ECG shows left ventricular hypertrophy. Which
diagnostic test should the nurse practitioner order FIRST to determine the etiology?
A. Cardiac catheterization
B. Transthoracic echocardiogram (TTE) [CORRECT]
C. Chest CT with contrast
D. Pulmonary function testing
Correct Answer: B
Rationale: A transthoracic echocardiogram (TTE) is the most appropriate initial diagnostic test.
The clinical presentation (dyspnea, edema, systolic murmur at right upper sternal border radiating
to carotids, elevated BNP, LVH on ECG) strongly suggests aortic stenosis. TTE provides immediate
information about valve morphology, gradient severity, LV function, and pulmonary pressures.
Cardiac catheterization is invasive and reserved for definitive anatomic assessment. Chest CT does
not evaluate valve pathology. PFTs are not indicated for this cardiac presentation.
Q3: A 55-year-old man with a history of hypertension and type 2 diabetes presents with acute onset
severe tearing chest pain radiating to the back. Blood pressure is 180/110 mmHg in the right arm
and 140/90 mmHg in the left arm. A widened mediastinum is noted on chest X-ray. Which condition
must be ruled out emergently, and what is the definitive diagnostic test?
A. Acute myocardial infarction; cardiac enzymes and ECG
B. Acute aortic dissection; CT angiography of the chest and abdomen [CORRECT]
C. Pulmonary embolism; D-dimer and ventilation-perfusion scan
D. Esophageal rupture; barium esophagram
Correct Answer: B
Rationale: The presentation of severe tearing chest pain radiating to the back, blood pressure
differential between arms (>20 mmHg), and widened mediastinum on chest X-ray is classic for acute
aortic dissection. CT angiography of the chest and abdomen is the definitive diagnostic test with
>95% sensitivity and specificity (AHA 2026 guidelines). While AMI must also be considered, the
Page 1
, clinical picture is most consistent with dissection. D-dimer lacks specificity, and barium
esophagram does not address the life-threatening vascular emergency.
Q4: Which clinical decision rule is recommended by the American College of Emergency Physicians
(ACEP) to risk-stratify patients with suspected pulmonary embolism and reduce unnecessary CT
imaging?
A. CHA2DS2-VASc score
B. Wells Criteria for PE [CORRECT]
C. CURB-65 score
D. HEART score
Correct Answer: B
Rationale: The Wells Criteria for PE is the validated clinical decision rule for risk-stratifying
patients with suspected pulmonary embolism. It categorizes patients as low, moderate, or high
probability to guide the need for D-dimer testing versus direct imaging with CT pulmonary
angiography. CHA2DS2-VASc is for stroke risk in atrial fibrillation. CURB-65 is for CAP severity.
The HEART score evaluates chest pain for ACS risk.
Q5: A 72-year-old patient presents with syncope. On ECG, you note a short PR interval (<120 ms), a
delta wave, and a widened QRS complex. The patient reports no prior cardiac history. What is the
most likely diagnosis, and what is the recommended management per 2026 AHA/HRS guidelines?
A. First-degree AV block; outpatient Holter monitoring in 4 weeks
B. Wolff-Parkinson-White (WPW) syndrome; referral for electrophysiology study and possible
ablation [CORRECT]
C. Bundle branch block; start beta-blocker and reassess in 3 months
D. Brugada syndrome; immediate ICD implantation
Correct Answer: B
Rationale: The ECG findings of a short PR interval, delta wave, and widened QRS are diagnostic of
Wolff-Parkinson-White (WPW) syndrome. Given the presentation with syncope, which may indicate
life-threatening arrhythmias (e.g., atrial fibrillation conducting over the accessory pathway),
referral for electrophysiology study with possible catheter ablation is recommended (AHA/HRS 2026
guidelines). First-degree AV block shows only prolonged PR. Bundle branch block does not have a
delta wave. Brugada syndrome has a characteristic coved ST elevation in V1-V3, not a delta wave.
Q6: A 45-year-old woman presents with fatigue, arthralgias, and a malar rash. Laboratory results
reveal ANA positive at 1:640, anti-dsDNA positive, low C3 and C4, hemoglobin 9.8 g/dL, WBC
2,800/microL, platelets 95,000/microL, creatinine 2.1 mg/dL (baseline 0.9), and urinalysis with 3+
protein and RBC casts. How should the nurse practitioner synthesize these findings, and what is the
priority intervention?
A. Diagnose systemic lupus erythematosus with Class IV lupus nephritis; initiate high-dose
corticosteroids and mycophenolate mofetil with nephrology referral [CORRECT]
B. Diagnose drug-induced lupus; discontinue all medications and monitor renal function in 4
weeks
C. Diagnose rheumatoid arthritis with secondary anemia; start methotrexate and refer to
rheumatology in 6 weeks
D. Diagnose fibromyalgia with comorbid depression; initiate SNRI and cognitive behavioral
therapy
Correct Answer: A
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