NRNP 6665-01 | WEEK 11 FINAL EXAM /
ACTUAL EXAM QUESTIONS AND 100%
VERIFIED ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A 68-year-old patient presents with acute onset of dyspnea, productive cough
with green sputum, and fever of 101.8°F. The patient has a history of COPD and
type 2 diabetes. Which empiric antibiotic therapy is most appropriate initially?
A. Amoxicillin
B. Levofloxacin
C. Azithromycin
D. Doxycycline
Answer: B. Levofloxacin
Rationale: For elderly patients with COPD exacerbation and comorbidities,
fluoroquinolones like levofloxacin provide broad coverage against typical and
atypical pathogens. Amoxicillin may not cover resistant strains; azithromycin and
doxycycline are alternatives but less ideal in severe exacerbations with
comorbidities.
2. A patient with atrial fibrillation is being considered for anticoagulation. Which
lab test is essential before initiating warfarin therapy?
A. PT/INR
B. aPTT
C. Platelet count
D. D-dimer
Answer: A. PT/INR
Rationale: Warfarin acts on vitamin K-dependent clotting factors. PT/INR is used
to monitor anticoagulation levels and adjust dosage to reduce bleeding risk. aPTT
is for heparin monitoring.
,3. A 55-year-old patient presents with sudden, severe chest pain radiating to the
back. BP is 180/100 mmHg in the right arm and 140/90 mmHg in the left arm.
What is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
Rationale: Acute onset of tearing chest pain with unequal blood pressures between
arms is classic for aortic dissection. Rapid recognition is critical for surgical
intervention.
4. A patient presents with severe hypercalcemia (Ca 14 mg/dL) secondary to
malignancy. Which is the first-line management?
A. Loop diuretics
B. IV hydration with normal saline
C. Oral calcium restriction
D. Bisphosphonate therapy only
Answer: B. IV hydration with normal saline
Rationale: Initial management of severe hypercalcemia includes aggressive IV
hydration to promote renal calcium excretion. Bisphosphonates are adjunctive
therapy for long-term control. Loop diuretics are used only after adequate
hydration.
5. Which medication is contraindicated in a patient with acute decompensated
heart failure presenting with hypotension (BP 85/50 mmHg)?
A. Furosemide
B. Dobutamine
C. Metoprolol
D. Nitroglycerin
Answer: C. Metoprolol
,Rationale: Beta-blockers are contraindicated in acute decompensated heart failure
with hypotension because they reduce cardiac contractility. Dobutamine supports
contractility, and furosemide reduces volume overload cautiously.
6. A patient with sepsis secondary to a urinary tract infection has hypotension
despite IV fluids. Which is the first-line vasopressor?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Phenylephrine
Answer: B. Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock as it
increases systemic vascular resistance while maintaining perfusion. Dopamine is
reserved for bradycardic patients.
7. A 70-year-old patient presents with acute confusion, fever, and neck stiffness.
Which empiric therapy should be started immediately after blood cultures are
obtained?
A. Ceftriaxone + Vancomycin + Dexamethasone
B. Ampicillin alone
C. Vancomycin alone
D. Cefepime only
Answer: A. Ceftriaxone + Vancomycin + Dexamethasone
Rationale: Empiric therapy for bacterial meningitis in older adults includes broad-
spectrum antibiotics covering common pathogens (Streptococcus pneumoniae,
Neisseria meningitidis) plus dexamethasone to reduce inflammation and
neurologic complications.
, 8. Which electrolyte abnormality is most commonly associated with prolonged QT
interval and risk of Torsades de Pointes?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B. Hypokalemia
Rationale: Low potassium prolongs repolarization, increasing risk for Torsades de
Pointes. Magnesium and calcium also affect cardiac conduction, but hypokalemia
is most frequently implicated.
9. A patient on long-term corticosteroid therapy develops new-onset hypertension,
moon face, and central obesity. What is the most likely diagnosis?
A. Addison’s disease
B. Cushing’s syndrome
C. Conn’s syndrome
D. Hypothyroidism
Answer: B. Cushing’s syndrome
Rationale: Chronic corticosteroid therapy can induce iatrogenic Cushing’s
syndrome, characterized by hypercortisolism, weight redistribution, hypertension,
and metabolic complications.
10. A patient with chronic kidney disease has persistent hyperphosphatemia.
Which medication class is most appropriate to manage this condition?
A. Calcium channel blockers
B. Phosphate binders
C. Loop diuretics
D. ACE inhibitors
Answer: B. Phosphate binders
Rationale: Phosphate binders (e.g., sevelamer, calcium acetate) reduce phosphate
absorption in the gut, managing hyperphosphatemia in CKD.
ACTUAL EXAM QUESTIONS AND 100%
VERIFIED ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A 68-year-old patient presents with acute onset of dyspnea, productive cough
with green sputum, and fever of 101.8°F. The patient has a history of COPD and
type 2 diabetes. Which empiric antibiotic therapy is most appropriate initially?
A. Amoxicillin
B. Levofloxacin
C. Azithromycin
D. Doxycycline
Answer: B. Levofloxacin
Rationale: For elderly patients with COPD exacerbation and comorbidities,
fluoroquinolones like levofloxacin provide broad coverage against typical and
atypical pathogens. Amoxicillin may not cover resistant strains; azithromycin and
doxycycline are alternatives but less ideal in severe exacerbations with
comorbidities.
2. A patient with atrial fibrillation is being considered for anticoagulation. Which
lab test is essential before initiating warfarin therapy?
A. PT/INR
B. aPTT
C. Platelet count
D. D-dimer
Answer: A. PT/INR
Rationale: Warfarin acts on vitamin K-dependent clotting factors. PT/INR is used
to monitor anticoagulation levels and adjust dosage to reduce bleeding risk. aPTT
is for heparin monitoring.
,3. A 55-year-old patient presents with sudden, severe chest pain radiating to the
back. BP is 180/100 mmHg in the right arm and 140/90 mmHg in the left arm.
What is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
Rationale: Acute onset of tearing chest pain with unequal blood pressures between
arms is classic for aortic dissection. Rapid recognition is critical for surgical
intervention.
4. A patient presents with severe hypercalcemia (Ca 14 mg/dL) secondary to
malignancy. Which is the first-line management?
A. Loop diuretics
B. IV hydration with normal saline
C. Oral calcium restriction
D. Bisphosphonate therapy only
Answer: B. IV hydration with normal saline
Rationale: Initial management of severe hypercalcemia includes aggressive IV
hydration to promote renal calcium excretion. Bisphosphonates are adjunctive
therapy for long-term control. Loop diuretics are used only after adequate
hydration.
5. Which medication is contraindicated in a patient with acute decompensated
heart failure presenting with hypotension (BP 85/50 mmHg)?
A. Furosemide
B. Dobutamine
C. Metoprolol
D. Nitroglycerin
Answer: C. Metoprolol
,Rationale: Beta-blockers are contraindicated in acute decompensated heart failure
with hypotension because they reduce cardiac contractility. Dobutamine supports
contractility, and furosemide reduces volume overload cautiously.
6. A patient with sepsis secondary to a urinary tract infection has hypotension
despite IV fluids. Which is the first-line vasopressor?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Phenylephrine
Answer: B. Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock as it
increases systemic vascular resistance while maintaining perfusion. Dopamine is
reserved for bradycardic patients.
7. A 70-year-old patient presents with acute confusion, fever, and neck stiffness.
Which empiric therapy should be started immediately after blood cultures are
obtained?
A. Ceftriaxone + Vancomycin + Dexamethasone
B. Ampicillin alone
C. Vancomycin alone
D. Cefepime only
Answer: A. Ceftriaxone + Vancomycin + Dexamethasone
Rationale: Empiric therapy for bacterial meningitis in older adults includes broad-
spectrum antibiotics covering common pathogens (Streptococcus pneumoniae,
Neisseria meningitidis) plus dexamethasone to reduce inflammation and
neurologic complications.
, 8. Which electrolyte abnormality is most commonly associated with prolonged QT
interval and risk of Torsades de Pointes?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B. Hypokalemia
Rationale: Low potassium prolongs repolarization, increasing risk for Torsades de
Pointes. Magnesium and calcium also affect cardiac conduction, but hypokalemia
is most frequently implicated.
9. A patient on long-term corticosteroid therapy develops new-onset hypertension,
moon face, and central obesity. What is the most likely diagnosis?
A. Addison’s disease
B. Cushing’s syndrome
C. Conn’s syndrome
D. Hypothyroidism
Answer: B. Cushing’s syndrome
Rationale: Chronic corticosteroid therapy can induce iatrogenic Cushing’s
syndrome, characterized by hypercortisolism, weight redistribution, hypertension,
and metabolic complications.
10. A patient with chronic kidney disease has persistent hyperphosphatemia.
Which medication class is most appropriate to manage this condition?
A. Calcium channel blockers
B. Phosphate binders
C. Loop diuretics
D. ACE inhibitors
Answer: B. Phosphate binders
Rationale: Phosphate binders (e.g., sevelamer, calcium acetate) reduce phosphate
absorption in the gut, managing hyperphosphatemia in CKD.
