NRNP 6566 FINAL EXAM PREP
QUESTIONS AND ANSWERS. VERIFIED
1. A 68-year-old male with a history of heart failure (EF 35%) presents with worsening
dyspnea. According to the latest guidelines, which medication combination is preferred for
reducing mortality in HFrEF?
A. Lisinopril and Amlodipine
B. Furosemide and Digoxin
C. Sacubitril/Valsartan, Carvedilol, and Spironolactone
D. Losartan and Hydrochlorothiazide
Answer: C
Conceptual Explanation: ARNI (Sacubitril/Valsartan), Beta-blockers (like Carvedilol), and
Mineralocorticoid Receptor Antagonists (like Spironolactone) are the pillars of GDMT for
HFrEF.
2. Which of the following findings on an EKG is most characteristic of Wolf-Parkinson-White
(WPW) syndrome?
A. Prolonged QT interval
,B. Short PR interval and Delta wave
C. ST-segment elevation in V1-V3
D. Inverted T-waves in all leads
Answer: B
Conceptual Explanation: WPW is characterized by a short PR interval and a slurred
upstroke of the QRS complex, known as a delta wave, due to an accessory pathway.
3. In a patient with Acute Respiratory Distress Syndrome (ARDS), what is the primary goal of
low-tidal-volume ventilation (6 mL/kg)?
A. To improve oxygenation to 100%
B. To normalize the pH to 7.45
C. To decrease the respiratory rate
D. To prevent volutrauma and barotrauma
Answer: D
Conceptual Explanation: Low tidal volume ventilation is a lung-protective strategy used
in ARDS to prevent ventilator-induced lung injury (volutrauma/barotrauma).
4. A patient presents with a serum sodium of 122 mEq/L and symptoms of confusion. What is
the maximum safe rate of sodium correction in the first 24 hours to avoid Osmotic
Demyelination Syndrome?
A. 2-4 mEq/L
, B. 8-10 mEq/L
C. 12-15 mEq/L
D. 20 mEq/L
Answer: B
Conceptual Explanation: Correcting hyponatremia too quickly (more than 8-10 mEq/L in
24 hours) can cause permanent neurological damage via osmotic demyelination.
5. Which clinical sign is most associated with an increased risk of mortality in a patient
diagnosed with Acute Pancreatitis?
A. Elevated Lipase > 3x normal
B. Grey Turner’s sign
C. BUN > 20 mg/dL and rising
D. Mid-epigastric pain radiating to the back
Answer: C
Conceptual Explanation: Rising BUN is a key indicator of intravascular volume depletion
and is a strong predictor of mortality in the Ranson or BISAP criteria.
6. An 82-year-old female presents with a hip fracture. She has a history of dementia and atrial
fibrillation. Which post-operative complication is she at highest risk for?
A. Vitamin B12 deficiency
B. Hyperthyroidism
QUESTIONS AND ANSWERS. VERIFIED
1. A 68-year-old male with a history of heart failure (EF 35%) presents with worsening
dyspnea. According to the latest guidelines, which medication combination is preferred for
reducing mortality in HFrEF?
A. Lisinopril and Amlodipine
B. Furosemide and Digoxin
C. Sacubitril/Valsartan, Carvedilol, and Spironolactone
D. Losartan and Hydrochlorothiazide
Answer: C
Conceptual Explanation: ARNI (Sacubitril/Valsartan), Beta-blockers (like Carvedilol), and
Mineralocorticoid Receptor Antagonists (like Spironolactone) are the pillars of GDMT for
HFrEF.
2. Which of the following findings on an EKG is most characteristic of Wolf-Parkinson-White
(WPW) syndrome?
A. Prolonged QT interval
,B. Short PR interval and Delta wave
C. ST-segment elevation in V1-V3
D. Inverted T-waves in all leads
Answer: B
Conceptual Explanation: WPW is characterized by a short PR interval and a slurred
upstroke of the QRS complex, known as a delta wave, due to an accessory pathway.
3. In a patient with Acute Respiratory Distress Syndrome (ARDS), what is the primary goal of
low-tidal-volume ventilation (6 mL/kg)?
A. To improve oxygenation to 100%
B. To normalize the pH to 7.45
C. To decrease the respiratory rate
D. To prevent volutrauma and barotrauma
Answer: D
Conceptual Explanation: Low tidal volume ventilation is a lung-protective strategy used
in ARDS to prevent ventilator-induced lung injury (volutrauma/barotrauma).
4. A patient presents with a serum sodium of 122 mEq/L and symptoms of confusion. What is
the maximum safe rate of sodium correction in the first 24 hours to avoid Osmotic
Demyelination Syndrome?
A. 2-4 mEq/L
, B. 8-10 mEq/L
C. 12-15 mEq/L
D. 20 mEq/L
Answer: B
Conceptual Explanation: Correcting hyponatremia too quickly (more than 8-10 mEq/L in
24 hours) can cause permanent neurological damage via osmotic demyelination.
5. Which clinical sign is most associated with an increased risk of mortality in a patient
diagnosed with Acute Pancreatitis?
A. Elevated Lipase > 3x normal
B. Grey Turner’s sign
C. BUN > 20 mg/dL and rising
D. Mid-epigastric pain radiating to the back
Answer: C
Conceptual Explanation: Rising BUN is a key indicator of intravascular volume depletion
and is a strong predictor of mortality in the Ranson or BISAP criteria.
6. An 82-year-old female presents with a hip fracture. She has a history of dementia and atrial
fibrillation. Which post-operative complication is she at highest risk for?
A. Vitamin B12 deficiency
B. Hyperthyroidism
