NUR 5461 EXAM 1 REVIEW
Questions and Answers | 2026 Update | With Complete Solutions
Abstract
This Exam 1 Review assesses NUR 5461 graduate nursing competencies spanning advanced pathophysiology,
evidence-based practice, advanced pharmacology with pharmacogenomics, and nursing leadership with health equity.
The exam comprises 40 multiple-choice questions across four sections aligned with 2026 clinical practice standards,
integrating AI-driven clinical decision support, pharmacogenomic-guided prescribing, health equity frameworks, and
updated regulatory guidelines.
Keywords: Advanced Pathophysiology, EBP, PICO(T), Iowa Model, Johns Hopkins Model, Pharmacogenomics,
CYP2D6, VKORC1, High-Alert Medications, AI Clinical Decision Support, Health Equity, SDOH, 2026 ANA
Standards, HIPAA
Course: NUR 5461 - Advanced Nursing Practice
Assessment: Exam 1 Review - 40 Questions
Date: June 15, 2026
Questions: 40 (Multiple Choice, A-D)
Points: 100 (2.5 points per question)
Passing: 70/100 (70%)
, Section 1: Advanced Pathophysiology & Complex Clinical Assessment
Q1: A 58-year-old patient presents with JVD, hepatomegaly, and bilateral pedal edema. Echo shows LVEF 30%.
Which mechanism drives fluid retention?
A. Increased renal perfusion stimulating diuresis
B. Decreased cardiac output activating RAAS and ADH causing sodium and water retention [CORRECT]
C. Increased oncotic pressure from elevated albumin pulling fluid into vascular space
D. Direct aldosterone suppression reducing potassium excretion
Correct Answer: B
Rationale: Reduced cardiac output triggers RAAS/ADH activation, leading to sodium and water reabsorption in HF.
Q2: A COPD patient has ABG: pH 7.32, PaCO2 58, HCO3- 32. Which acid-base imbalance?
A. Acute respiratory acidosis with no compensation
B. Partially compensated respiratory acidosis with renal bicarbonate retention [CORRECT]
C. Metabolic alkalosis with respiratory compensation
D. Fully compensated respiratory acidosis
Correct Answer: B
Rationale: Low pH + elevated PaCO2 = respiratory acidosis; elevated HCO3- reflects partial renal compensation.
Q3: A 45-year-old with SLE has proteinuria >3.5 g/day, hypoalbuminemia, hyperlipidemia, edema. Biopsy shows
podocyte effacement. Which process?
A. Acute tubular necrosis from nephrotoxic medications
B. GBM thickening with immune complex deposition increasing permeability to plasma proteins [CORRECT]
C. Obstructive uropathy from extrinsic ureteral compression
D. BPH leading to post-renal failure
Correct Answer: B
Rationale: Lupus nephritis causes immune complex deposition and GBM thickening, producing nephrotic syndrome.
Q4: A type 2 diabetic has an 8-week non-healing foot ulcer. A1c 9.8%, loss of protective sensation on
monofilament test. Which mechanisms impair healing?
A. Hyperglycemia-induced microvascular damage and peripheral neuropathy reducing blood flow and
sensation [CORRECT]
B. Autoimmune beta cell destruction eliminating insulin production
C. Elevated cortisol increasing protein catabolism at the wound site
D. Vitamin K deficiency reducing clotting factor synthesis
Correct Answer: A
Rationale: Chronic hyperglycemia causes microangiopathy and neuropathy, both impairing wound healing and increasing
infection risk.
Q5: A 72-year-old with acute right hemiparesis and aphasia. CT shows no hemorrhage. Arrived 90 minutes
post-onset. Per 2026 AHA/ASA guidelines, which intervention?
A. Administer tPA IV within 4.5 hours after confirming no contraindications [CORRECT]
B. Immediate surgical decompression of the left hemisphere
C. Prophylactic heparin to prevent clot propagation
D. Observe for 24 hours before intervention
Correct Answer: A
Rationale: IV tPA is indicated for acute ischemic stroke within 4.5 hours when hemorrhage is excluded.
Q6: A cirrhosis patient with ascites and hepatic encephalopathy has elevated ammonia, prolonged PT/INR,
thrombocytopenia. Which mechanism explains thrombocytopenia?
A. Increased bone marrow platelet production
B. Portal hypertension causing splenomegaly with increased splenic sequestration of platelets [CORRECT]
C. Autoimmune platelet destruction (ITP)
D. Direct ammonia toxicity on megakaryocytes
Questions and Answers | 2026 Update | With Complete Solutions
Abstract
This Exam 1 Review assesses NUR 5461 graduate nursing competencies spanning advanced pathophysiology,
evidence-based practice, advanced pharmacology with pharmacogenomics, and nursing leadership with health equity.
The exam comprises 40 multiple-choice questions across four sections aligned with 2026 clinical practice standards,
integrating AI-driven clinical decision support, pharmacogenomic-guided prescribing, health equity frameworks, and
updated regulatory guidelines.
Keywords: Advanced Pathophysiology, EBP, PICO(T), Iowa Model, Johns Hopkins Model, Pharmacogenomics,
CYP2D6, VKORC1, High-Alert Medications, AI Clinical Decision Support, Health Equity, SDOH, 2026 ANA
Standards, HIPAA
Course: NUR 5461 - Advanced Nursing Practice
Assessment: Exam 1 Review - 40 Questions
Date: June 15, 2026
Questions: 40 (Multiple Choice, A-D)
Points: 100 (2.5 points per question)
Passing: 70/100 (70%)
, Section 1: Advanced Pathophysiology & Complex Clinical Assessment
Q1: A 58-year-old patient presents with JVD, hepatomegaly, and bilateral pedal edema. Echo shows LVEF 30%.
Which mechanism drives fluid retention?
A. Increased renal perfusion stimulating diuresis
B. Decreased cardiac output activating RAAS and ADH causing sodium and water retention [CORRECT]
C. Increased oncotic pressure from elevated albumin pulling fluid into vascular space
D. Direct aldosterone suppression reducing potassium excretion
Correct Answer: B
Rationale: Reduced cardiac output triggers RAAS/ADH activation, leading to sodium and water reabsorption in HF.
Q2: A COPD patient has ABG: pH 7.32, PaCO2 58, HCO3- 32. Which acid-base imbalance?
A. Acute respiratory acidosis with no compensation
B. Partially compensated respiratory acidosis with renal bicarbonate retention [CORRECT]
C. Metabolic alkalosis with respiratory compensation
D. Fully compensated respiratory acidosis
Correct Answer: B
Rationale: Low pH + elevated PaCO2 = respiratory acidosis; elevated HCO3- reflects partial renal compensation.
Q3: A 45-year-old with SLE has proteinuria >3.5 g/day, hypoalbuminemia, hyperlipidemia, edema. Biopsy shows
podocyte effacement. Which process?
A. Acute tubular necrosis from nephrotoxic medications
B. GBM thickening with immune complex deposition increasing permeability to plasma proteins [CORRECT]
C. Obstructive uropathy from extrinsic ureteral compression
D. BPH leading to post-renal failure
Correct Answer: B
Rationale: Lupus nephritis causes immune complex deposition and GBM thickening, producing nephrotic syndrome.
Q4: A type 2 diabetic has an 8-week non-healing foot ulcer. A1c 9.8%, loss of protective sensation on
monofilament test. Which mechanisms impair healing?
A. Hyperglycemia-induced microvascular damage and peripheral neuropathy reducing blood flow and
sensation [CORRECT]
B. Autoimmune beta cell destruction eliminating insulin production
C. Elevated cortisol increasing protein catabolism at the wound site
D. Vitamin K deficiency reducing clotting factor synthesis
Correct Answer: A
Rationale: Chronic hyperglycemia causes microangiopathy and neuropathy, both impairing wound healing and increasing
infection risk.
Q5: A 72-year-old with acute right hemiparesis and aphasia. CT shows no hemorrhage. Arrived 90 minutes
post-onset. Per 2026 AHA/ASA guidelines, which intervention?
A. Administer tPA IV within 4.5 hours after confirming no contraindications [CORRECT]
B. Immediate surgical decompression of the left hemisphere
C. Prophylactic heparin to prevent clot propagation
D. Observe for 24 hours before intervention
Correct Answer: A
Rationale: IV tPA is indicated for acute ischemic stroke within 4.5 hours when hemorrhage is excluded.
Q6: A cirrhosis patient with ascites and hepatic encephalopathy has elevated ammonia, prolonged PT/INR,
thrombocytopenia. Which mechanism explains thrombocytopenia?
A. Increased bone marrow platelet production
B. Portal hypertension causing splenomegaly with increased splenic sequestration of platelets [CORRECT]
C. Autoimmune platelet destruction (ITP)
D. Direct ammonia toxicity on megakaryocytes
