NR511 Week 4 Midterm Exam – Complete Questions 1-
200
Chamberlain University | 2026 | Verified Answers with Detailed
Rationales
1. A 45-year-old patient with type 2 diabetes and chronic kidney disease (eGFR 35
mL/min/1.73m²) presents with hypertension. Which antihypertensive agent
requires dose adjustment or avoidance due to its renal elimination and risk of
hyperkalemia?
A) Lisinopril
B) Amlodipine
C) Metoprolol tartrate
D) Hydrochlorothiazide
Correct Answer: A) Lisinopril
Rationale: Lisinopril is an ACE inhibitor primarily excreted by the kidneys; in CKD,
accumulation can cause hyperkalemia and acute kidney injury. Amlodipine and
metoprolol are hepatically metabolized; hydrochlorothiazide is less effective at low GFR
and not first-line .
2. Which of the following best explains the mechanism by which metformin
reduces hepatic glucose production?
A) Inhibition of mitochondrial complex I leading to decreased gluconeogenesis
B) Activation of PPAR-γ receptors in adipose tissue
C) Increased pancreatic insulin secretion via sulfonylurea receptor binding
D) Blockade of SGLT2 in the proximal renal tubule
Correct Answer: A) Inhibition of mitochondrial complex I leading to decreased
gluconeogenesis
Rationale: Metformin inhibits mitochondrial complex I, reducing ATP and increasing AMP,
,which suppresses gluconeogenesis and glycogenolysis. Option B describes
thiazolidinediones; C describes sulfonylureas; D describes SGLT2 inhibitors .
3. A patient presents with acute-onset confusion, ataxia, and diplopia. MRI shows
a hyperintense lesion in the cerebellar peduncle. Which of the following is the
most likely diagnosis?
A) Wernicke encephalopathy
B) Multiple sclerosis
C) Acute cerebellar stroke
D) Glioblastoma multiforme
Correct Answer: A) Wernicke encephalopathy
Rationale: Wernicke encephalopathy presents with confusion, ataxia, and oculomotor
abnormalities, and MRI often shows T2 hyperintensities in the periaqueductal gray,
thalamus, and cerebellar peduncles. Multiple sclerosis typically has periventricular plaques;
stroke follows vascular territory; glioblastoma has mass effect .
4. A patient with a history of hypertension and asthma develops acute sinusitis.
Which of the following antibiotics should be avoided due to the risk of drug
interaction with their antihypertensive?
A) Amoxicillin-clavulanate
B) Doxycycline
C) Trimethoprim-sulfamethoxazole
D) Azithromycin
Correct Answer: C) Trimethoprim-sulfamethoxazole
Rationale: Trimethoprim-sulfamethoxazole can increase serum potassium and potentiate
ACE inhibitor/ARB-induced hyperkalemia. It also may cause sulfonamide cross-reactivity
in asthma. Amoxicillin-clavulanate, doxycycline, and azithromycin have no significant
interaction with antihypertensives .
,5. Which of the following findings on a peripheral blood smear is most consistent
with a diagnosis of hemolytic uremic syndrome (HUS) in a child?
A) Schistocytes and thrombocytopenia
B) Spherocytes and elevated bilirubin
C) Basophilic stippling and lead poisoning
D) Target cells and hemoglobin C crystals
Correct Answer: A) Schistocytes and thrombocytopenia
Rationale: HUS is characterized by microangiopathic hemolytic anemia with schistocytes
(fragmented RBCs) and thrombocytopenia. Spherocytes suggest autoimmune hemolytic
anemia; basophilic stippling is seen in lead poisoning; target cells and hemoglobin C
crystals are seen in hemoglobinopathies .
6. A 30-year-old female with no known medical history presents with acute onset
of severe right lower quadrant pain and nausea. Urinalysis shows microscopic
hematuria. Which of the following is the most likely diagnosis?
A) Acute appendicitis
B) Ureteral calculus
C) Ovarian torsion
D) Ectopic pregnancy
Correct Answer: B) Ureteral calculus
Rationale: Microscopic hematuria strongly suggests a ureteral stone, which often presents
with colicky pain radiating to the groin. Appendicitis typically has fever and leukocytosis
without hematuria; ovarian torsion presents with adnexal mass; ectopic pregnancy
requires positive hCG .
7. Which of the following lipid-lowering medications is most likely to increase the
risk of new-onset diabetes mellitus?
A) Atorvastatin
B) Fenofibrate
C) Ezetimibe
D) Niacin
, Correct Answer: A) Atorvastatin
Rationale: Statins, particularly high-potency ones like atorvastatin, are associated with a
modest increase in new-onset diabetes risk. Fenofibrate can increase creatinine but has
less diabetes risk; ezetimibe has no significant diabetes risk; niacin can worsen insulin
resistance .
8. A patient undergoing evaluation for recurrent stones has a 24-hour urine
demonstrating hyperuricosuria (>800 mg/day in men). Serum uric acid is normal.
Which of the following is the most appropriate pharmacotherapy to reduce stone
recurrence?
A) Allopurinol 300 mg daily
B) Potassium citrate 20 mEq twice daily
C) Hydrochlorothiazide 25 mg daily
D) Tiopronin 800 mg daily
Correct Answer: A) Allopurinol 300 mg daily
Rationale: Hyperuricosuric calcium oxalate nephrolithiasis (with normal serum uric acid) is
treated with allopurinol to reduce urinary uric acid, which can otherwise promote calcium
oxalate crystallization via salting out. Potassium citrate is for hypocitraturia; thiazides for
hypercalciuria; tiopronin for cystinuria .
9. A patient with bilateral staghorn calculi and recurrent urinary tract infections
with Proteus mirabilis undergoes complete stone removal. Stone analysis reveals
100% struvite. Which of the following postoperative regimens has been shown to
reduce recurrence most effectively?
A) Long-term suppressive antibiotics with low-dose nitrofurantoin
B) Acetohydroxamic acid (AHA) therapy
C) Urinary acidification with ascorbic acid
D) Monthly urine cultures and treat only when symptomatic
Correct Answer: B) Acetohydroxamic acid (AHA) therapy
Rationale: Acetohydroxamic acid is a urease inhibitor that reduces stone growth and
recurrence in struvite nephrolithiasis, especially when residual fragments are present.
200
Chamberlain University | 2026 | Verified Answers with Detailed
Rationales
1. A 45-year-old patient with type 2 diabetes and chronic kidney disease (eGFR 35
mL/min/1.73m²) presents with hypertension. Which antihypertensive agent
requires dose adjustment or avoidance due to its renal elimination and risk of
hyperkalemia?
A) Lisinopril
B) Amlodipine
C) Metoprolol tartrate
D) Hydrochlorothiazide
Correct Answer: A) Lisinopril
Rationale: Lisinopril is an ACE inhibitor primarily excreted by the kidneys; in CKD,
accumulation can cause hyperkalemia and acute kidney injury. Amlodipine and
metoprolol are hepatically metabolized; hydrochlorothiazide is less effective at low GFR
and not first-line .
2. Which of the following best explains the mechanism by which metformin
reduces hepatic glucose production?
A) Inhibition of mitochondrial complex I leading to decreased gluconeogenesis
B) Activation of PPAR-γ receptors in adipose tissue
C) Increased pancreatic insulin secretion via sulfonylurea receptor binding
D) Blockade of SGLT2 in the proximal renal tubule
Correct Answer: A) Inhibition of mitochondrial complex I leading to decreased
gluconeogenesis
Rationale: Metformin inhibits mitochondrial complex I, reducing ATP and increasing AMP,
,which suppresses gluconeogenesis and glycogenolysis. Option B describes
thiazolidinediones; C describes sulfonylureas; D describes SGLT2 inhibitors .
3. A patient presents with acute-onset confusion, ataxia, and diplopia. MRI shows
a hyperintense lesion in the cerebellar peduncle. Which of the following is the
most likely diagnosis?
A) Wernicke encephalopathy
B) Multiple sclerosis
C) Acute cerebellar stroke
D) Glioblastoma multiforme
Correct Answer: A) Wernicke encephalopathy
Rationale: Wernicke encephalopathy presents with confusion, ataxia, and oculomotor
abnormalities, and MRI often shows T2 hyperintensities in the periaqueductal gray,
thalamus, and cerebellar peduncles. Multiple sclerosis typically has periventricular plaques;
stroke follows vascular territory; glioblastoma has mass effect .
4. A patient with a history of hypertension and asthma develops acute sinusitis.
Which of the following antibiotics should be avoided due to the risk of drug
interaction with their antihypertensive?
A) Amoxicillin-clavulanate
B) Doxycycline
C) Trimethoprim-sulfamethoxazole
D) Azithromycin
Correct Answer: C) Trimethoprim-sulfamethoxazole
Rationale: Trimethoprim-sulfamethoxazole can increase serum potassium and potentiate
ACE inhibitor/ARB-induced hyperkalemia. It also may cause sulfonamide cross-reactivity
in asthma. Amoxicillin-clavulanate, doxycycline, and azithromycin have no significant
interaction with antihypertensives .
,5. Which of the following findings on a peripheral blood smear is most consistent
with a diagnosis of hemolytic uremic syndrome (HUS) in a child?
A) Schistocytes and thrombocytopenia
B) Spherocytes and elevated bilirubin
C) Basophilic stippling and lead poisoning
D) Target cells and hemoglobin C crystals
Correct Answer: A) Schistocytes and thrombocytopenia
Rationale: HUS is characterized by microangiopathic hemolytic anemia with schistocytes
(fragmented RBCs) and thrombocytopenia. Spherocytes suggest autoimmune hemolytic
anemia; basophilic stippling is seen in lead poisoning; target cells and hemoglobin C
crystals are seen in hemoglobinopathies .
6. A 30-year-old female with no known medical history presents with acute onset
of severe right lower quadrant pain and nausea. Urinalysis shows microscopic
hematuria. Which of the following is the most likely diagnosis?
A) Acute appendicitis
B) Ureteral calculus
C) Ovarian torsion
D) Ectopic pregnancy
Correct Answer: B) Ureteral calculus
Rationale: Microscopic hematuria strongly suggests a ureteral stone, which often presents
with colicky pain radiating to the groin. Appendicitis typically has fever and leukocytosis
without hematuria; ovarian torsion presents with adnexal mass; ectopic pregnancy
requires positive hCG .
7. Which of the following lipid-lowering medications is most likely to increase the
risk of new-onset diabetes mellitus?
A) Atorvastatin
B) Fenofibrate
C) Ezetimibe
D) Niacin
, Correct Answer: A) Atorvastatin
Rationale: Statins, particularly high-potency ones like atorvastatin, are associated with a
modest increase in new-onset diabetes risk. Fenofibrate can increase creatinine but has
less diabetes risk; ezetimibe has no significant diabetes risk; niacin can worsen insulin
resistance .
8. A patient undergoing evaluation for recurrent stones has a 24-hour urine
demonstrating hyperuricosuria (>800 mg/day in men). Serum uric acid is normal.
Which of the following is the most appropriate pharmacotherapy to reduce stone
recurrence?
A) Allopurinol 300 mg daily
B) Potassium citrate 20 mEq twice daily
C) Hydrochlorothiazide 25 mg daily
D) Tiopronin 800 mg daily
Correct Answer: A) Allopurinol 300 mg daily
Rationale: Hyperuricosuric calcium oxalate nephrolithiasis (with normal serum uric acid) is
treated with allopurinol to reduce urinary uric acid, which can otherwise promote calcium
oxalate crystallization via salting out. Potassium citrate is for hypocitraturia; thiazides for
hypercalciuria; tiopronin for cystinuria .
9. A patient with bilateral staghorn calculi and recurrent urinary tract infections
with Proteus mirabilis undergoes complete stone removal. Stone analysis reveals
100% struvite. Which of the following postoperative regimens has been shown to
reduce recurrence most effectively?
A) Long-term suppressive antibiotics with low-dose nitrofurantoin
B) Acetohydroxamic acid (AHA) therapy
C) Urinary acidification with ascorbic acid
D) Monthly urine cultures and treat only when symptomatic
Correct Answer: B) Acetohydroxamic acid (AHA) therapy
Rationale: Acetohydroxamic acid is a urease inhibitor that reduces stone growth and
recurrence in struvite nephrolithiasis, especially when residual fragments are present.
