NURS 6501N Midterm Exam
Questions 1 - 200
Advanced / Hard / Mixed Difficulty
Covering Pathophysiology, Advanced Pharmacology, and Clinical Application
1. A patient presents with severe dehydration following prolonged vomiting and
diarrhea. Which of the following acid-base imbalances is most likely to develop?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Valid answer: A
Explanation: Prolonged vomiting and diarrhea lead to the loss of bicarbonate-
rich gastrointestinal fluids, resulting in metabolic acidosis. The body loses base,
causing a decrease in serum bicarbonate and a subsequent drop in pH. Metabolic
alkalosis would occur with excessive loss of acid (e.g., gastric suctioning).
Respiratory imbalances are related to ventilation issues, not fluid loss.
2. A 55-year-old male with a history of hypertension and diabetes presents with
sudden onset of severe chest pain radiating to the jaw and left arm. An EKG
shows ST-segment elevation in leads V1-V4. Which of the following is the most
likely diagnosis?
A. Unstable angina
B. Anterior wall myocardial infarction
C. Inferior wall myocardial infarction
D. Pericarditis
Valid answer: B
Explanation: ST-segment elevation in leads V1-V4 indicates an anterior wall
myocardial infarction, typically caused by occlusion of the left anterior descending
artery. Unstable angina does not show ST-segment elevation. Inferior wall MI
pg. 1
,shows changes in leads II, III, and aVF. Pericarditis shows diffuse ST-segment
elevation in all leads.
3. A patient with chronic obstructive pulmonary disease (COPD) has arterial
blood gas results showing pH 7.31, PaCO2 58 mmHg, and HCO3 30 mEq/L. Which
of the following best describes this acid-base disturbance?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
Valid answer: B
Explanation: The pH is low (acidosis) and PaCO2 is elevated (respiratory
acidosis). The HCO3 is elevated (30 mEq/L), indicating metabolic compensation,
which is characteristic of chronic respiratory acidosis. In acute respiratory acidosis,
the HCO3 would be normal.
4. A patient is receiving a loop diuretic for heart failure. Which of the following
electrolyte imbalances is the nurse most concerned about?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Valid answer: B
Explanation: Loop diuretics inhibit sodium and chloride reabsorption in the
ascending loop of Henle, leading to increased potassium excretion. This places the
patient at high risk for hypokalemia. Hyperkalemia is associated with potassium-
sparing diuretics. Hypernatremia and hypocalcemia are less directly related to
loop diuretic use.
pg. 2
,5. A 70-year-old female with a history of osteoporosis presents with acute onset
of severe back pain after lifting a heavy object. X-ray reveals a compression
fracture of the L1 vertebra. Which of the following is the most likely underlying
cause?
A. Osteoarthritis
B. Osteoporosis
C. Paget's disease
D. Metastatic bone disease
Valid answer: B
Explanation: Osteoporosis is the most common cause of vertebral compression
fractures in elderly patients, especially postmenopausal women. The bones
become weak and brittle, leading to fractures with minimal trauma. Osteoarthritis
affects joints, not bone integrity. Paget's disease causes bone enlargement and
deformity. Metastatic disease can cause pathologic fractures but is less common
without other signs.
6. A patient with cirrhosis develops ascites and esophageal varices. Which of the
following pathophysiological mechanisms is primarily responsible for these
complications?
A. Increased oncotic pressure from hypoalbuminemia
B. Decreased portal vein pressure
C. Portal hypertension and hypoalbuminemia
D. Increased systemic vascular resistance
Valid answer: C
Explanation: Portal hypertension leads to increased hydrostatic pressure in the
portal system, causing fluid to leak into the peritoneal cavity (ascites) and the
development of collateral vessels (esophageal varices). Hypoalbuminemia from
decreased liver synthesis of albumin reduces oncotic pressure, further contributing
to ascites. The other options are incorrect.
pg. 3
, 7. A patient with type 1 diabetes mellitus is brought to the emergency
department with confusion, fruity-smelling breath, and Kussmaul respirations.
Which of the following laboratory findings is most consistent with this
presentation?
A. Blood glucose 150 mg/dL, pH 7.38
B. Blood glucose 350 mg/dL, pH 7.30
C. Blood glucose 650 mg/dL, pH 7.20
D. Blood glucose 850 mg/dL, pH 7.45
Valid answer: C
Explanation: The patient is presenting with diabetic ketoacidosis (DKA),
characterized by severe hyperglycemia (often >600 mg/dL), metabolic acidosis (pH
<7.30), and ketone body production. Kussmaul respirations (deep, rapid breathing)
are a compensatory mechanism for metabolic acidosis. Fruity-smelling breath is
due to acetone.
8. A patient develops a deep vein thrombosis (DVT) in the left leg following a
prolonged hospital stay. Which of the following components of Virchow's triad is
most likely responsible for this complication?
A. Hypercoagulability
B. Stasis of blood flow
C. Endothelial injury
D. Increased platelet count
Valid answer: B
Explanation: Virchow's triad consists of stasis, hypercoagulability, and
endothelial injury. Prolonged immobility leads to stasis of blood flow, which is a
major risk factor for DVT. While hypercoagulability and endothelial injury can
contribute, stasis from immobility is the primary mechanism in this scenario.
9. A 65-year-old male presents with difficulty urinating, weak urinary stream,
and nocturia. Digital rectal examination reveals an enlarged, smooth prostate.
pg. 4
Questions 1 - 200
Advanced / Hard / Mixed Difficulty
Covering Pathophysiology, Advanced Pharmacology, and Clinical Application
1. A patient presents with severe dehydration following prolonged vomiting and
diarrhea. Which of the following acid-base imbalances is most likely to develop?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Valid answer: A
Explanation: Prolonged vomiting and diarrhea lead to the loss of bicarbonate-
rich gastrointestinal fluids, resulting in metabolic acidosis. The body loses base,
causing a decrease in serum bicarbonate and a subsequent drop in pH. Metabolic
alkalosis would occur with excessive loss of acid (e.g., gastric suctioning).
Respiratory imbalances are related to ventilation issues, not fluid loss.
2. A 55-year-old male with a history of hypertension and diabetes presents with
sudden onset of severe chest pain radiating to the jaw and left arm. An EKG
shows ST-segment elevation in leads V1-V4. Which of the following is the most
likely diagnosis?
A. Unstable angina
B. Anterior wall myocardial infarction
C. Inferior wall myocardial infarction
D. Pericarditis
Valid answer: B
Explanation: ST-segment elevation in leads V1-V4 indicates an anterior wall
myocardial infarction, typically caused by occlusion of the left anterior descending
artery. Unstable angina does not show ST-segment elevation. Inferior wall MI
pg. 1
,shows changes in leads II, III, and aVF. Pericarditis shows diffuse ST-segment
elevation in all leads.
3. A patient with chronic obstructive pulmonary disease (COPD) has arterial
blood gas results showing pH 7.31, PaCO2 58 mmHg, and HCO3 30 mEq/L. Which
of the following best describes this acid-base disturbance?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
Valid answer: B
Explanation: The pH is low (acidosis) and PaCO2 is elevated (respiratory
acidosis). The HCO3 is elevated (30 mEq/L), indicating metabolic compensation,
which is characteristic of chronic respiratory acidosis. In acute respiratory acidosis,
the HCO3 would be normal.
4. A patient is receiving a loop diuretic for heart failure. Which of the following
electrolyte imbalances is the nurse most concerned about?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Valid answer: B
Explanation: Loop diuretics inhibit sodium and chloride reabsorption in the
ascending loop of Henle, leading to increased potassium excretion. This places the
patient at high risk for hypokalemia. Hyperkalemia is associated with potassium-
sparing diuretics. Hypernatremia and hypocalcemia are less directly related to
loop diuretic use.
pg. 2
,5. A 70-year-old female with a history of osteoporosis presents with acute onset
of severe back pain after lifting a heavy object. X-ray reveals a compression
fracture of the L1 vertebra. Which of the following is the most likely underlying
cause?
A. Osteoarthritis
B. Osteoporosis
C. Paget's disease
D. Metastatic bone disease
Valid answer: B
Explanation: Osteoporosis is the most common cause of vertebral compression
fractures in elderly patients, especially postmenopausal women. The bones
become weak and brittle, leading to fractures with minimal trauma. Osteoarthritis
affects joints, not bone integrity. Paget's disease causes bone enlargement and
deformity. Metastatic disease can cause pathologic fractures but is less common
without other signs.
6. A patient with cirrhosis develops ascites and esophageal varices. Which of the
following pathophysiological mechanisms is primarily responsible for these
complications?
A. Increased oncotic pressure from hypoalbuminemia
B. Decreased portal vein pressure
C. Portal hypertension and hypoalbuminemia
D. Increased systemic vascular resistance
Valid answer: C
Explanation: Portal hypertension leads to increased hydrostatic pressure in the
portal system, causing fluid to leak into the peritoneal cavity (ascites) and the
development of collateral vessels (esophageal varices). Hypoalbuminemia from
decreased liver synthesis of albumin reduces oncotic pressure, further contributing
to ascites. The other options are incorrect.
pg. 3
, 7. A patient with type 1 diabetes mellitus is brought to the emergency
department with confusion, fruity-smelling breath, and Kussmaul respirations.
Which of the following laboratory findings is most consistent with this
presentation?
A. Blood glucose 150 mg/dL, pH 7.38
B. Blood glucose 350 mg/dL, pH 7.30
C. Blood glucose 650 mg/dL, pH 7.20
D. Blood glucose 850 mg/dL, pH 7.45
Valid answer: C
Explanation: The patient is presenting with diabetic ketoacidosis (DKA),
characterized by severe hyperglycemia (often >600 mg/dL), metabolic acidosis (pH
<7.30), and ketone body production. Kussmaul respirations (deep, rapid breathing)
are a compensatory mechanism for metabolic acidosis. Fruity-smelling breath is
due to acetone.
8. A patient develops a deep vein thrombosis (DVT) in the left leg following a
prolonged hospital stay. Which of the following components of Virchow's triad is
most likely responsible for this complication?
A. Hypercoagulability
B. Stasis of blood flow
C. Endothelial injury
D. Increased platelet count
Valid answer: B
Explanation: Virchow's triad consists of stasis, hypercoagulability, and
endothelial injury. Prolonged immobility leads to stasis of blood flow, which is a
major risk factor for DVT. While hypercoagulability and endothelial injury can
contribute, stasis from immobility is the primary mechanism in this scenario.
9. A 65-year-old male presents with difficulty urinating, weak urinary stream,
and nocturia. Digital rectal examination reveals an enlarged, smooth prostate.
pg. 4
