[NR507 MIDTERM EXAM] – EXAM-STYLE
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE |
EXAM PREP | STUDY GUIDE | PRACTICE TEST
SECTION ONE: QUESTIONS 1-50
1. A 68-year-old male with a 45-pack-year smoking history presents with
progressive dyspnea on exertion and a chronic productive cough. Pulmonary
function testing reveals a forced expiratory volume in 1 second (FEV1) of 52% of
predicted, FEV1/FVC ratio of 0.62, and a markedly reduced diffusing capacity of
the lungs for carbon monoxide (DLCO). Which of the following
pathophysiological mechanisms best explains this patient's clinical
presentation?
A. Destruction of alveolar septa with loss of elastic recoil and impaired gas
exchange
B. Chronic inflammation of the bronchial walls with excessive mucus production
and airway narrowing
C. Fibrotic thickening of the alveolar-capillary membrane with restrictive
ventilatory defect
D. Reversible bronchoconstriction mediated by type I hypersensitivity reaction
,Correct Answer: A. Destruction of alveolar septa with loss of elastic recoil and
impaired gas exchange
Rationale: This patient presents with classic features of emphysema, a subtype of
chronic obstructive pulmonary disease (COPD). The reduced DLCO indicates
alveolar-capillary membrane destruction, which is the hallmark of emphysema. The
airflow obstruction in emphysema results from loss of elastic recoil rather than
airway inflammation alone. Option B describes chronic bronchitis, which would
present with FEV1/FVC reduction but typically preserved DLCO. Option C describes
interstitial lung disease, which would show restrictive pattern with reduced FVC.
Option D describes asthma, which demonstrates reversible airway obstruction with
normal DLCO.
2. A 45-year-old female with a history of systemic lupus erythematosus
develops sudden-onset pleuritic chest pain, dyspnea, and a pericardial friction
rub on auscultation. ECG reveals diffuse ST-segment elevation with PR-
segment depression. Which of the following medications is most appropriate
for initial management of this patient's acute condition?
A. Colchicine 0.6 mg twice daily
B. Prednisone 60 mg daily
C. Ibuprofen 600 mg every 8 hours
D. Hydroxychloroquine 200 mg twice daily
Correct Answer: C. Ibuprofen 600 mg every 8 hours
Rationale: This patient has acute pericarditis as a manifestation of her systemic
lupus erythematosus. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
,ibuprofen are first-line therapy for acute pericarditis without high-risk features.
Colchicine (Option A) is used as adjunctive therapy, not monotherapy. Prednisone
(Option B) is reserved for refractory cases or specific autoimmune conditions but
should be avoided in initial treatment due to potential for chronic relapsing
pericarditis. Hydroxychloroquine (Option D) is a disease-modifying antirheumatic
drug for SLE maintenance but provides no acute anti-inflammatory effect for
pericarditis.
3. A 72-year-old male with a history of hypertension and type 2 diabetes
presents with gradually worsening dyspnea, orthopnea, and bilateral lower
extremity edema over the past month. On examination, he has jugular venous
distention, an S3 gallop, and hepatomegaly. Echocardiography reveals a left
ventricular ejection fraction of 30% with global hypokinesis. Which of the
following pathophysiological mechanisms is most directly responsible for this
patient's edema?
A. Decreased plasma oncotic pressure due to hepatic congestion
B. Increased hydrostatic pressure from venous hypertension
C. Impaired lymphatic drainage from right ventricular failure
D. Primary renal sodium retention from decreased renal perfusion
Correct Answer: B. Increased hydrostatic pressure from venous hypertension
Rationale: This patient has heart failure with reduced ejection fraction (HFrEF).
Lower extremity edema in heart failure results primarily from elevated venous
pressure secondary to increased right atrial pressure. The increased venous
hydrostatic pressure forces fluid into the interstitial space. Option A describes
decreased oncotic pressure, which would occur in nephrotic syndrome or hepatic
, failure, not heart failure. Option C describes lymphedema, which is a separate
entity. Option D describes secondary aldosteronism, which contributes to fluid
retention but is a compensatory response rather than the direct mechanism of
peripheral edema formation.
4. A 28-year-old gravida 2 para 1 woman at 34 weeks gestation presents with a
blood pressure of 158/92 mmHg and 3+ proteinuria on urine dipstick. She
reports a severe headache and visual disturbances over the past 24 hours.
Laboratory studies reveal a platelet count of 85,000/mm³, aspartate
aminotransferase (AST) of 78 U/L, and creatinine of 1.6 mg/dL. Which of the
following is the most appropriate next step in management?
A. Administer magnesium sulfate and prepare for immediate delivery
B. Initiate oral labetalol and monitor blood pressure every 4 hours
C. Obtain a 24-hour urine collection for protein quantification
D. Discharge with close outpatient follow-up and daily blood pressure monitoring
Correct Answer: A. Administer magnesium sulfate and prepare for immediate
delivery
Rationale: This patient meets criteria for severe preeclampsia with features of
hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). The
presence of severe hypertension, visual disturbances, thrombocytopenia, and
elevated liver enzymes indicates end-organ dysfunction. Immediate delivery is the
definitive treatment for severe preeclampsia, and magnesium sulfate administration
is essential for seizure prophylaxis. Option B would be insufficient given the severity.
Option C delays management in an emergency situation. Option D is inappropriate
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE |
EXAM PREP | STUDY GUIDE | PRACTICE TEST
SECTION ONE: QUESTIONS 1-50
1. A 68-year-old male with a 45-pack-year smoking history presents with
progressive dyspnea on exertion and a chronic productive cough. Pulmonary
function testing reveals a forced expiratory volume in 1 second (FEV1) of 52% of
predicted, FEV1/FVC ratio of 0.62, and a markedly reduced diffusing capacity of
the lungs for carbon monoxide (DLCO). Which of the following
pathophysiological mechanisms best explains this patient's clinical
presentation?
A. Destruction of alveolar septa with loss of elastic recoil and impaired gas
exchange
B. Chronic inflammation of the bronchial walls with excessive mucus production
and airway narrowing
C. Fibrotic thickening of the alveolar-capillary membrane with restrictive
ventilatory defect
D. Reversible bronchoconstriction mediated by type I hypersensitivity reaction
,Correct Answer: A. Destruction of alveolar septa with loss of elastic recoil and
impaired gas exchange
Rationale: This patient presents with classic features of emphysema, a subtype of
chronic obstructive pulmonary disease (COPD). The reduced DLCO indicates
alveolar-capillary membrane destruction, which is the hallmark of emphysema. The
airflow obstruction in emphysema results from loss of elastic recoil rather than
airway inflammation alone. Option B describes chronic bronchitis, which would
present with FEV1/FVC reduction but typically preserved DLCO. Option C describes
interstitial lung disease, which would show restrictive pattern with reduced FVC.
Option D describes asthma, which demonstrates reversible airway obstruction with
normal DLCO.
2. A 45-year-old female with a history of systemic lupus erythematosus
develops sudden-onset pleuritic chest pain, dyspnea, and a pericardial friction
rub on auscultation. ECG reveals diffuse ST-segment elevation with PR-
segment depression. Which of the following medications is most appropriate
for initial management of this patient's acute condition?
A. Colchicine 0.6 mg twice daily
B. Prednisone 60 mg daily
C. Ibuprofen 600 mg every 8 hours
D. Hydroxychloroquine 200 mg twice daily
Correct Answer: C. Ibuprofen 600 mg every 8 hours
Rationale: This patient has acute pericarditis as a manifestation of her systemic
lupus erythematosus. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
,ibuprofen are first-line therapy for acute pericarditis without high-risk features.
Colchicine (Option A) is used as adjunctive therapy, not monotherapy. Prednisone
(Option B) is reserved for refractory cases or specific autoimmune conditions but
should be avoided in initial treatment due to potential for chronic relapsing
pericarditis. Hydroxychloroquine (Option D) is a disease-modifying antirheumatic
drug for SLE maintenance but provides no acute anti-inflammatory effect for
pericarditis.
3. A 72-year-old male with a history of hypertension and type 2 diabetes
presents with gradually worsening dyspnea, orthopnea, and bilateral lower
extremity edema over the past month. On examination, he has jugular venous
distention, an S3 gallop, and hepatomegaly. Echocardiography reveals a left
ventricular ejection fraction of 30% with global hypokinesis. Which of the
following pathophysiological mechanisms is most directly responsible for this
patient's edema?
A. Decreased plasma oncotic pressure due to hepatic congestion
B. Increased hydrostatic pressure from venous hypertension
C. Impaired lymphatic drainage from right ventricular failure
D. Primary renal sodium retention from decreased renal perfusion
Correct Answer: B. Increased hydrostatic pressure from venous hypertension
Rationale: This patient has heart failure with reduced ejection fraction (HFrEF).
Lower extremity edema in heart failure results primarily from elevated venous
pressure secondary to increased right atrial pressure. The increased venous
hydrostatic pressure forces fluid into the interstitial space. Option A describes
decreased oncotic pressure, which would occur in nephrotic syndrome or hepatic
, failure, not heart failure. Option C describes lymphedema, which is a separate
entity. Option D describes secondary aldosteronism, which contributes to fluid
retention but is a compensatory response rather than the direct mechanism of
peripheral edema formation.
4. A 28-year-old gravida 2 para 1 woman at 34 weeks gestation presents with a
blood pressure of 158/92 mmHg and 3+ proteinuria on urine dipstick. She
reports a severe headache and visual disturbances over the past 24 hours.
Laboratory studies reveal a platelet count of 85,000/mm³, aspartate
aminotransferase (AST) of 78 U/L, and creatinine of 1.6 mg/dL. Which of the
following is the most appropriate next step in management?
A. Administer magnesium sulfate and prepare for immediate delivery
B. Initiate oral labetalol and monitor blood pressure every 4 hours
C. Obtain a 24-hour urine collection for protein quantification
D. Discharge with close outpatient follow-up and daily blood pressure monitoring
Correct Answer: A. Administer magnesium sulfate and prepare for immediate
delivery
Rationale: This patient meets criteria for severe preeclampsia with features of
hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). The
presence of severe hypertension, visual disturbances, thrombocytopenia, and
elevated liver enzymes indicates end-organ dysfunction. Immediate delivery is the
definitive treatment for severe preeclampsia, and magnesium sulfate administration
is essential for seizure prophylaxis. Option B would be insufficient given the severity.
Option C delays management in an emergency situation. Option D is inappropriate
