NUR 634 MIDTERM EXAMINATION 2025/2026 UPDATE |QUESTIONS
AND ANSWERS (LATEST VERSION): GRAND CANYON UNIVERSITY
Course
NUR 634
1. Which assessment finding should an advanced practice nurse prioritize when evaluating a
patient with acute respiratory distress?
A. Mild bilateral ankle edema
B. Oxygen saturation of 86% with increasing work of breathing
C. Chronic dry skin
D. Decreased appetite for two days
Correct Answer: B
Rationale: An oxygen saturation of 86% accompanied by increased work of breathing indicates
potentially significant hypoxemia and respiratory compromise. Airway and breathing take
priority under the ABC framework.
2. Which finding is most concerning in a patient reporting chest discomfort?
A. Pain occurring after strenuous exercise and resolving with rest
B. Mild tenderness reproducible with palpation
C. Sudden crushing substernal pain accompanied by diaphoresis
D. Brief discomfort after eating a large meal
Correct Answer: C
Rationale: Crushing substernal chest pain accompanied by diaphoresis is concerning for acute
coronary syndrome. Immediate assessment, ECG evaluation, and appropriate emergency
management are warranted.
3. Which laboratory value is most useful when evaluating long-term glycemic control?
A. Random glucose
B. Fasting glucose
C. Hemoglobin A1C
D. Urine ketones
Correct Answer: C
,Rationale: Hemoglobin A1C reflects average blood glucose exposure over approximately the
preceding 2–3 months and is therefore useful for assessing longer-term glycemic control.
4. A patient with diabetes reports polyuria, polydipsia, and unexplained weight loss. What
should the clinician suspect?
A. Hypoglycemia
B. Hyperglycemia
C. Hypothyroidism
D. Hypercalcemia
Correct Answer: B
Rationale: Excessive urination and thirst are classic manifestations of hyperglycemia.
Unintentional weight loss can also occur when glucose cannot be effectively utilized.
5. Which finding is characteristic of hypothyroidism?
A. Heat intolerance
B. Tachycardia
C. Weight loss despite increased appetite
D. Fatigue and cold intolerance
Correct Answer: D
Rationale: Hypothyroidism commonly causes fatigue, cold intolerance, weight gain,
constipation, dry skin, and slowed heart rate. Hyperthyroidism produces many of the opposite
findings.
6. Which presentation is most consistent with hyperthyroidism?
A. Bradycardia and cold intolerance
B. Weight gain and constipation
C. Heat intolerance, tremor, and tachycardia
D. Dry skin and slowed reflexes
Correct Answer: C
Rationale: Excess thyroid hormone increases metabolic activity and sympathetic effects,
commonly producing heat intolerance, tachycardia, tremor, anxiety, and weight loss.
,7. Which medication class is commonly used as first-line pharmacologic therapy for many
patients with type 2 diabetes?
A. Metformin
B. Warfarin
C. Levothyroxine
D. Furosemide
Correct Answer: A
Rationale: Metformin is commonly used as an initial pharmacologic option for type 2 diabetes
when appropriate. Treatment should be individualized according to comorbidities, kidney
function, cardiovascular risk, and current guidelines.
8. Which assessment is particularly important before prescribing metformin?
A. Visual acuity only
B. Renal function
C. Hearing acuity
D. Skin temperature
Correct Answer: B
Rationale: Metformin use is closely associated with kidney function because impaired renal
function affects medication safety and dosing considerations.
9. A patient taking an ACE inhibitor develops persistent cough. Which adverse effect is most
likely responsible?
A. Bradykinin accumulation
B. Increased insulin secretion
C. Histamine depletion
D. Increased calcium absorption
Correct Answer: A
Rationale: ACE inhibition decreases the breakdown of bradykinin. Accumulation of bradykinin is
associated with the characteristic persistent dry cough seen with ACE inhibitors.
, 10. Which adverse effect is particularly important to monitor in a patient taking an ACE
inhibitor?
A. Hyperkalemia
B. Hypoglycemia in every patient
C. Severe hearing loss
D. Hypernatremia
Correct Answer: A
Rationale: ACE inhibitors can decrease aldosterone activity and increase serum potassium.
Renal function and potassium should therefore be monitored.
11. A patient taking lisinopril develops swelling of the lips and tongue. What is the priority?
A. Tell the patient to take the next dose with food
B. Recognize possible angioedema and initiate urgent evaluation
C. Reassure the patient that this is expected
D. Increase the dose
Correct Answer: B
Rationale: ACE inhibitor–associated angioedema can compromise the airway and represents a
potentially life-threatening adverse reaction. Immediate assessment is required.
12. Which finding is most suggestive of iron-deficiency anemia?
A. Elevated hemoglobin
B. Microcytic, hypochromic red blood cells
C. Increased mean corpuscular volume
D. Increased hematocrit
Correct Answer: B
Rationale: Iron deficiency classically produces microcytic, hypochromic anemia. Evaluation
should also identify the underlying cause, particularly potential blood loss.
13. Which patient is at increased risk for iron-deficiency anemia?
A. A patient with chronic gastrointestinal blood loss
B. A patient with consistently adequate iron intake
AND ANSWERS (LATEST VERSION): GRAND CANYON UNIVERSITY
Course
NUR 634
1. Which assessment finding should an advanced practice nurse prioritize when evaluating a
patient with acute respiratory distress?
A. Mild bilateral ankle edema
B. Oxygen saturation of 86% with increasing work of breathing
C. Chronic dry skin
D. Decreased appetite for two days
Correct Answer: B
Rationale: An oxygen saturation of 86% accompanied by increased work of breathing indicates
potentially significant hypoxemia and respiratory compromise. Airway and breathing take
priority under the ABC framework.
2. Which finding is most concerning in a patient reporting chest discomfort?
A. Pain occurring after strenuous exercise and resolving with rest
B. Mild tenderness reproducible with palpation
C. Sudden crushing substernal pain accompanied by diaphoresis
D. Brief discomfort after eating a large meal
Correct Answer: C
Rationale: Crushing substernal chest pain accompanied by diaphoresis is concerning for acute
coronary syndrome. Immediate assessment, ECG evaluation, and appropriate emergency
management are warranted.
3. Which laboratory value is most useful when evaluating long-term glycemic control?
A. Random glucose
B. Fasting glucose
C. Hemoglobin A1C
D. Urine ketones
Correct Answer: C
,Rationale: Hemoglobin A1C reflects average blood glucose exposure over approximately the
preceding 2–3 months and is therefore useful for assessing longer-term glycemic control.
4. A patient with diabetes reports polyuria, polydipsia, and unexplained weight loss. What
should the clinician suspect?
A. Hypoglycemia
B. Hyperglycemia
C. Hypothyroidism
D. Hypercalcemia
Correct Answer: B
Rationale: Excessive urination and thirst are classic manifestations of hyperglycemia.
Unintentional weight loss can also occur when glucose cannot be effectively utilized.
5. Which finding is characteristic of hypothyroidism?
A. Heat intolerance
B. Tachycardia
C. Weight loss despite increased appetite
D. Fatigue and cold intolerance
Correct Answer: D
Rationale: Hypothyroidism commonly causes fatigue, cold intolerance, weight gain,
constipation, dry skin, and slowed heart rate. Hyperthyroidism produces many of the opposite
findings.
6. Which presentation is most consistent with hyperthyroidism?
A. Bradycardia and cold intolerance
B. Weight gain and constipation
C. Heat intolerance, tremor, and tachycardia
D. Dry skin and slowed reflexes
Correct Answer: C
Rationale: Excess thyroid hormone increases metabolic activity and sympathetic effects,
commonly producing heat intolerance, tachycardia, tremor, anxiety, and weight loss.
,7. Which medication class is commonly used as first-line pharmacologic therapy for many
patients with type 2 diabetes?
A. Metformin
B. Warfarin
C. Levothyroxine
D. Furosemide
Correct Answer: A
Rationale: Metformin is commonly used as an initial pharmacologic option for type 2 diabetes
when appropriate. Treatment should be individualized according to comorbidities, kidney
function, cardiovascular risk, and current guidelines.
8. Which assessment is particularly important before prescribing metformin?
A. Visual acuity only
B. Renal function
C. Hearing acuity
D. Skin temperature
Correct Answer: B
Rationale: Metformin use is closely associated with kidney function because impaired renal
function affects medication safety and dosing considerations.
9. A patient taking an ACE inhibitor develops persistent cough. Which adverse effect is most
likely responsible?
A. Bradykinin accumulation
B. Increased insulin secretion
C. Histamine depletion
D. Increased calcium absorption
Correct Answer: A
Rationale: ACE inhibition decreases the breakdown of bradykinin. Accumulation of bradykinin is
associated with the characteristic persistent dry cough seen with ACE inhibitors.
, 10. Which adverse effect is particularly important to monitor in a patient taking an ACE
inhibitor?
A. Hyperkalemia
B. Hypoglycemia in every patient
C. Severe hearing loss
D. Hypernatremia
Correct Answer: A
Rationale: ACE inhibitors can decrease aldosterone activity and increase serum potassium.
Renal function and potassium should therefore be monitored.
11. A patient taking lisinopril develops swelling of the lips and tongue. What is the priority?
A. Tell the patient to take the next dose with food
B. Recognize possible angioedema and initiate urgent evaluation
C. Reassure the patient that this is expected
D. Increase the dose
Correct Answer: B
Rationale: ACE inhibitor–associated angioedema can compromise the airway and represents a
potentially life-threatening adverse reaction. Immediate assessment is required.
12. Which finding is most suggestive of iron-deficiency anemia?
A. Elevated hemoglobin
B. Microcytic, hypochromic red blood cells
C. Increased mean corpuscular volume
D. Increased hematocrit
Correct Answer: B
Rationale: Iron deficiency classically produces microcytic, hypochromic anemia. Evaluation
should also identify the underlying cause, particularly potential blood loss.
13. Which patient is at increased risk for iron-deficiency anemia?
A. A patient with chronic gastrointestinal blood loss
B. A patient with consistently adequate iron intake
