NUR 753/753 NUR MIDTERM EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS A NEW UPDATED VERSION
LATEST 2026-2027 100% CORRECT VERIFIED ANSWERS)
WITH RATIONALES/ ALREADY GRADED A+
1. A patient with heart failure presents with dyspnea on exertion, orthopnea, and bilateral pedal edema.
Which medication is most appropriate to reduce preload?
a) Digoxin
b) Metoprolol
c) Furosemide
d) Spironolactone
Rationale: Furosemide is a loop diuretic that reduces preload by promoting excretion of sodium and
water, decreasing venous return and relieving symptoms of fluid overload.
2. A nurse is assessing a patient with suspected diabetic ketoacidosis (DKA). Which finding is most
consistent with this diagnosis?
a) Blood glucose 60 mg/dL
b) Serum bicarbonate 18 mEq/L
c) *Anion gap 22 mEq/L*
d) pH 7.45
Rationale: DKA typically presents with an elevated anion gap metabolic acidosis (anion gap >12) due
to accumulation of ketones.
3. A patient on mechanical ventilation has a sudden drop in oxygen saturation. The nurse notes absent
breath sounds on the right side and tracheal deviation to the left. What is the priority action?
a) Increase FiO2
b) Prepare for needle decompression
c) Suction the endotracheal tube
d) Reposition the patient
,Rationale: These findings indicate tension pneumothorax, which requires immediate needle
decompression to relieve intrapleural pressure.
4. Which laboratory value is most concerning in a patient receiving gentamicin for sepsis?
a) White blood cell count 12,000/mm³
b) *Serum creatinine 2.5 mg/dL*
c) Hemoglobin 11 g/dL
d) Platelets 150,000/mm³
Rationale: Gentamicin is nephrotoxic; a rising serum creatinine suggests acute kidney injury, requiring
dose adjustment or discontinuation.
5. A patient with chronic obstructive pulmonary disease (COPD) has a PaO2 of 55 mmHg and PaCO2
of 65 mmHg on room air. Which oxygen delivery method is safest?
a) Non-rebreather mask at 15 L/min
b) *Nasal cannula at 2 L/min*
c) Simple face mask at 8 L/min
d) Venturi mask at 50% FiO2
*Rationale: In COPD with hypercapnia, low-flow oxygen (nasal cannula 1–3 L/min) is used to avoid
suppressing the hypoxic drive.*
6. A patient post-cardiac arrest has a Glasgow Coma Scale score of 7. Which intervention should the
nurse anticipate?
a) Administer naloxone
b) Initiate targeted temperature management
c) Prepare for thrombolytics
d) Increase vasopressor infusion
Rationale: Targeted temperature management (32–36°C) improves neurological outcomes after
cardiac arrest in comatose patients.
7. Which finding in a patient with cirrhosis indicates worsening hepatic encephalopathy?
a) Asterixis
b) Altered mental status with hyperreflexia
c) Jaundice
d) Spider angiomas
, Rationale: Hepatic encephalopathy progresses from confusion to coma; hyperreflexia and asterixis are
early signs, but altered mental status with hyperreflexia indicates moderate severity.
8. A patient with septic shock has a mean arterial pressure (MAP) of 55 mmHg despite fluid
resuscitation. The nurse should prepare to administer:
a) Furosemide
b) Norepinephrine
c) Dobutamine
d) Nitroprusside
*Rationale: Norepinephrine is first-line vasopressor in septic shock to maintain MAP ≥65 mmHg after
fluid resuscitation.*
9. A patient is admitted with acute pancreatitis. Which laboratory finding is most specific to this
diagnosis?
a) Elevated aspartate aminotransferase (AST)
b) Lipase >3 times upper limit of normal
c) Hypercalcemia
d) Elevated bilirubin
Rationale: Lipase is the most sensitive and specific marker for acute pancreatitis, remaining elevated
longer than amylase.
10. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS). Which ventilator
setting is most protective?
a) Tidal volume 10 mL/kg ideal body weight
b) *Tidal volume 6 mL/kg ideal body weight*
c) Plateau pressure 35 cm H2O
d) Respiratory rate 10 breaths/min
*Rationale: Low tidal volume (6 mL/kg) ventilation reduces volutrauma and mortality in ARDS.*
11. A patient with a history of cocaine use presents with chest pain, hypertension, and diaphoresis.
ECG shows ST elevation. Which medication is contraindicated?
a) Aspirin
b) Labetalol
c) Nitroglycerin
d) Morphine
CORRECT DETAILED ANSWERS A NEW UPDATED VERSION
LATEST 2026-2027 100% CORRECT VERIFIED ANSWERS)
WITH RATIONALES/ ALREADY GRADED A+
1. A patient with heart failure presents with dyspnea on exertion, orthopnea, and bilateral pedal edema.
Which medication is most appropriate to reduce preload?
a) Digoxin
b) Metoprolol
c) Furosemide
d) Spironolactone
Rationale: Furosemide is a loop diuretic that reduces preload by promoting excretion of sodium and
water, decreasing venous return and relieving symptoms of fluid overload.
2. A nurse is assessing a patient with suspected diabetic ketoacidosis (DKA). Which finding is most
consistent with this diagnosis?
a) Blood glucose 60 mg/dL
b) Serum bicarbonate 18 mEq/L
c) *Anion gap 22 mEq/L*
d) pH 7.45
Rationale: DKA typically presents with an elevated anion gap metabolic acidosis (anion gap >12) due
to accumulation of ketones.
3. A patient on mechanical ventilation has a sudden drop in oxygen saturation. The nurse notes absent
breath sounds on the right side and tracheal deviation to the left. What is the priority action?
a) Increase FiO2
b) Prepare for needle decompression
c) Suction the endotracheal tube
d) Reposition the patient
,Rationale: These findings indicate tension pneumothorax, which requires immediate needle
decompression to relieve intrapleural pressure.
4. Which laboratory value is most concerning in a patient receiving gentamicin for sepsis?
a) White blood cell count 12,000/mm³
b) *Serum creatinine 2.5 mg/dL*
c) Hemoglobin 11 g/dL
d) Platelets 150,000/mm³
Rationale: Gentamicin is nephrotoxic; a rising serum creatinine suggests acute kidney injury, requiring
dose adjustment or discontinuation.
5. A patient with chronic obstructive pulmonary disease (COPD) has a PaO2 of 55 mmHg and PaCO2
of 65 mmHg on room air. Which oxygen delivery method is safest?
a) Non-rebreather mask at 15 L/min
b) *Nasal cannula at 2 L/min*
c) Simple face mask at 8 L/min
d) Venturi mask at 50% FiO2
*Rationale: In COPD with hypercapnia, low-flow oxygen (nasal cannula 1–3 L/min) is used to avoid
suppressing the hypoxic drive.*
6. A patient post-cardiac arrest has a Glasgow Coma Scale score of 7. Which intervention should the
nurse anticipate?
a) Administer naloxone
b) Initiate targeted temperature management
c) Prepare for thrombolytics
d) Increase vasopressor infusion
Rationale: Targeted temperature management (32–36°C) improves neurological outcomes after
cardiac arrest in comatose patients.
7. Which finding in a patient with cirrhosis indicates worsening hepatic encephalopathy?
a) Asterixis
b) Altered mental status with hyperreflexia
c) Jaundice
d) Spider angiomas
, Rationale: Hepatic encephalopathy progresses from confusion to coma; hyperreflexia and asterixis are
early signs, but altered mental status with hyperreflexia indicates moderate severity.
8. A patient with septic shock has a mean arterial pressure (MAP) of 55 mmHg despite fluid
resuscitation. The nurse should prepare to administer:
a) Furosemide
b) Norepinephrine
c) Dobutamine
d) Nitroprusside
*Rationale: Norepinephrine is first-line vasopressor in septic shock to maintain MAP ≥65 mmHg after
fluid resuscitation.*
9. A patient is admitted with acute pancreatitis. Which laboratory finding is most specific to this
diagnosis?
a) Elevated aspartate aminotransferase (AST)
b) Lipase >3 times upper limit of normal
c) Hypercalcemia
d) Elevated bilirubin
Rationale: Lipase is the most sensitive and specific marker for acute pancreatitis, remaining elevated
longer than amylase.
10. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS). Which ventilator
setting is most protective?
a) Tidal volume 10 mL/kg ideal body weight
b) *Tidal volume 6 mL/kg ideal body weight*
c) Plateau pressure 35 cm H2O
d) Respiratory rate 10 breaths/min
*Rationale: Low tidal volume (6 mL/kg) ventilation reduces volutrauma and mortality in ARDS.*
11. A patient with a history of cocaine use presents with chest pain, hypertension, and diaphoresis.
ECG shows ST elevation. Which medication is contraindicated?
a) Aspirin
b) Labetalol
c) Nitroglycerin
d) Morphine
