2026 GRADED A+ EXAM
NURS 346 MIDTERM EXAM ACTUAL QUESTIONS AND WELL REVISED
ANSWERS - LATEST AND COMPLETE UPDATE WITH VERIFIED SOLUTIONS
2026
1. What is the primary difference between dysplasia and carcinoma in situ?
A) Dysplasia involves cell death, while carcinoma in situ does not.
B) Carcinoma in situ is an early-stage cancer that has not broken through
the basement membrane.
C) Dysplasia is always cancerous; carcinoma in situ is always benign.
D) There is no difference between the two terms.
Answer: B
Rationale: Dysplasia refers to abnormal changes in size/shape, whereas
carcinoma in situ is a pre-invasive epithelial tumor.
2. Which technique is performed FIRST during a physical assessment of the
abdomen?
A) Palpation
B) Percussion
C) Inspection
D) Auscultation
Answer: C
Rationale: Inspection always comes first to observe symmetry and skin
characteristics before any contact is made.
3. In the evidence-based practice hierarchy, which represents Level I
evidence?
A) A single randomized controlled trial (RCT)
B) A systematic review or meta-analysis of all relevant RCTs
C) Expert opinion or committee reports
D) Case-control studies
Answer: B
,2026 GRADED A+ EXAM
Rationale: Meta-analyses of RCTs are the "gold standard" and provide the
highest level of clinical evidence.
4. A patient with Parkinson’s disease displays "bradykinesia." The nurse
expects to see:
A) Rapid, jerky movements
B) Extreme slowness of movement
C) Inability to speak
D) Excessive muscle flaccidity
Answer: B
Rationale: Bradykinesia is a hallmark of Parkinson's, caused by depleted
dopamine in the basal ganglia.
5. Which genetic disorder is characterized by a deficiency in Factor VIII?
A) Sickle Cell Anemia
B) Hemophilia A
C) Thalassemia
D) Cystic Fibrosis
Answer: B
Rationale: Hemophilia A is an X-linked recessive disorder resulting in a lack of
clotting Factor VIII.
6. Decreased serum albumin levels in a patient with liver failure lead to:
A) Increased osmotic pressure
B) Decreased osmotic pressure and peripheral edema
C) Dehydration of the tissues
D) Hypertension
Answer: B
Rationale: Albumin maintains oncotic pressure; when it is low, fluid leaks from
the intravascular space into the interstitial space (edema).
7. The primary goal of the "Chief Complaint" section of a health history is to:
A) Diagnose the patient
B) Identify the patient's reason for seeking care in their own words
C) Review all body systems
D) Document the family medical history
Answer: B
,2026 GRADED A+ EXAM
Rationale: The chief complaint is a brief statement describing the symptom or
problem that brought the patient in.
8. Which electrolyte imbalance is most commonly associated with a positive
Chvostek’s sign?
A) Hyperkalemia
B) Hyponatremia
C) Hypocalcemia
D) Hypercalcemia
Answer: C
Rationale: Low calcium increases neuromuscular excitability, causing facial
twitching when the facial nerve is tapped.
9. In asthma, the primary underlying Pathophysiological mechanism is:
A) Irreversible alveolar destruction
B) Chronic airway inflammation with reversible bronchospasm
C) Permanent thickening of the pleura
D) Infection of the lower lobes
Answer: B
Rationale: Asthma is an obstructive disease characterized by
hyperresponsiveness and inflammation.
10. A patient with "Atelectasis" is experiencing:
A) Fluid in the pleural space
B) Collapse of the alveoli
C) Excessive mucus in the bronchi
D) A hole in the lung wall
Answer: B
Rationale: Atelectasis prevents gas exchange and often occurs post-operatively
due to shallow breathing.
11. Which cranial nerve is tested by asking the patient to stick out their
tongue?
A) CN IX (Glossopharyngeal)
B) CN X (Vagus)
C) CN XII (Hypoglossal)
D) CN VII (Facial)
, 2026 GRADED A+ EXAM
Answer: C
Rationale: CN XII controls the motor movement of the tongue.
12. The "TNM" system for cancer staging stands for:
A) Tissue, Nodes, Metastasis
B) Tumor size, Node involvement, Metastasis
C) Type, Number, Morphology
D) Time, Nature, Mutation
Answer: B
Rationale: This is the international standard for determining the extent of cancer
spread.
13. Type 1 Diabetes Mellitus is primarily caused by:
A) Insulin resistance in peripheral tissues
B) Autoimmune destruction of pancreatic beta cells
C) Excessive intake of dietary glucose
D) Obesity and sedentary lifestyle
Answer: B
Rationale: Type 1 is an absolute insulin deficiency due to beta-cell failure.
14. Which breath sound is normal when heard over the majority of the
peripheral lung fields?
A) Bronchial
B) Vesicular
C) Bronchovesicular
D) Tracheal
Answer: B
Rationale: Vesicular sounds are soft, low-pitched, and heard over healthy lung
tissue.
15. A patient with a blood pressure of 145/95 mmHg is classified as having:
A) Elevated BP
B) Stage 2 Hypertension
C) Stage 1 Hypertension
D) Normal BP
Answer: B
Rationale: Per current AHA guidelines, a systolic ≥140 or diastolic ≥90 is Stage
2.
NURS 346 MIDTERM EXAM ACTUAL QUESTIONS AND WELL REVISED
ANSWERS - LATEST AND COMPLETE UPDATE WITH VERIFIED SOLUTIONS
2026
1. What is the primary difference between dysplasia and carcinoma in situ?
A) Dysplasia involves cell death, while carcinoma in situ does not.
B) Carcinoma in situ is an early-stage cancer that has not broken through
the basement membrane.
C) Dysplasia is always cancerous; carcinoma in situ is always benign.
D) There is no difference between the two terms.
Answer: B
Rationale: Dysplasia refers to abnormal changes in size/shape, whereas
carcinoma in situ is a pre-invasive epithelial tumor.
2. Which technique is performed FIRST during a physical assessment of the
abdomen?
A) Palpation
B) Percussion
C) Inspection
D) Auscultation
Answer: C
Rationale: Inspection always comes first to observe symmetry and skin
characteristics before any contact is made.
3. In the evidence-based practice hierarchy, which represents Level I
evidence?
A) A single randomized controlled trial (RCT)
B) A systematic review or meta-analysis of all relevant RCTs
C) Expert opinion or committee reports
D) Case-control studies
Answer: B
,2026 GRADED A+ EXAM
Rationale: Meta-analyses of RCTs are the "gold standard" and provide the
highest level of clinical evidence.
4. A patient with Parkinson’s disease displays "bradykinesia." The nurse
expects to see:
A) Rapid, jerky movements
B) Extreme slowness of movement
C) Inability to speak
D) Excessive muscle flaccidity
Answer: B
Rationale: Bradykinesia is a hallmark of Parkinson's, caused by depleted
dopamine in the basal ganglia.
5. Which genetic disorder is characterized by a deficiency in Factor VIII?
A) Sickle Cell Anemia
B) Hemophilia A
C) Thalassemia
D) Cystic Fibrosis
Answer: B
Rationale: Hemophilia A is an X-linked recessive disorder resulting in a lack of
clotting Factor VIII.
6. Decreased serum albumin levels in a patient with liver failure lead to:
A) Increased osmotic pressure
B) Decreased osmotic pressure and peripheral edema
C) Dehydration of the tissues
D) Hypertension
Answer: B
Rationale: Albumin maintains oncotic pressure; when it is low, fluid leaks from
the intravascular space into the interstitial space (edema).
7. The primary goal of the "Chief Complaint" section of a health history is to:
A) Diagnose the patient
B) Identify the patient's reason for seeking care in their own words
C) Review all body systems
D) Document the family medical history
Answer: B
,2026 GRADED A+ EXAM
Rationale: The chief complaint is a brief statement describing the symptom or
problem that brought the patient in.
8. Which electrolyte imbalance is most commonly associated with a positive
Chvostek’s sign?
A) Hyperkalemia
B) Hyponatremia
C) Hypocalcemia
D) Hypercalcemia
Answer: C
Rationale: Low calcium increases neuromuscular excitability, causing facial
twitching when the facial nerve is tapped.
9. In asthma, the primary underlying Pathophysiological mechanism is:
A) Irreversible alveolar destruction
B) Chronic airway inflammation with reversible bronchospasm
C) Permanent thickening of the pleura
D) Infection of the lower lobes
Answer: B
Rationale: Asthma is an obstructive disease characterized by
hyperresponsiveness and inflammation.
10. A patient with "Atelectasis" is experiencing:
A) Fluid in the pleural space
B) Collapse of the alveoli
C) Excessive mucus in the bronchi
D) A hole in the lung wall
Answer: B
Rationale: Atelectasis prevents gas exchange and often occurs post-operatively
due to shallow breathing.
11. Which cranial nerve is tested by asking the patient to stick out their
tongue?
A) CN IX (Glossopharyngeal)
B) CN X (Vagus)
C) CN XII (Hypoglossal)
D) CN VII (Facial)
, 2026 GRADED A+ EXAM
Answer: C
Rationale: CN XII controls the motor movement of the tongue.
12. The "TNM" system for cancer staging stands for:
A) Tissue, Nodes, Metastasis
B) Tumor size, Node involvement, Metastasis
C) Type, Number, Morphology
D) Time, Nature, Mutation
Answer: B
Rationale: This is the international standard for determining the extent of cancer
spread.
13. Type 1 Diabetes Mellitus is primarily caused by:
A) Insulin resistance in peripheral tissues
B) Autoimmune destruction of pancreatic beta cells
C) Excessive intake of dietary glucose
D) Obesity and sedentary lifestyle
Answer: B
Rationale: Type 1 is an absolute insulin deficiency due to beta-cell failure.
14. Which breath sound is normal when heard over the majority of the
peripheral lung fields?
A) Bronchial
B) Vesicular
C) Bronchovesicular
D) Tracheal
Answer: B
Rationale: Vesicular sounds are soft, low-pitched, and heard over healthy lung
tissue.
15. A patient with a blood pressure of 145/95 mmHg is classified as having:
A) Elevated BP
B) Stage 2 Hypertension
C) Stage 1 Hypertension
D) Normal BP
Answer: B
Rationale: Per current AHA guidelines, a systolic ≥140 or diastolic ≥90 is Stage
2.
