NURS 8020C – Quiz 2 Blueprint Study
Guide exam with multiple choice
questions with verified answers
and rationale updated 2026
graded A+
Question 1
A 68‑year‑old man with hypertension and diabetes presents with dyspnea, peripheral edema, and an
S3 gallop. Echocardiography shows an ejection fraction of 30 %. Which type of heart failure does this
best describe?
A. Diastolic heart failure
B. Systolic heart failure
C. Right‑sided heart failure
D. High‑output heart failure
Answer: B
Rationale: An EF ≈ 30 % indicates reduced contractility (systolic dysfunction). Diastolic failure
preserves EF; right‑sided failure primarily causes jugular venous distension; high‑output failure is
rare and associated with a normal or high EF.
Question 2
In the same patient, which medication class has been shown to reduce mortality in systolic heart
failure?
A. Calcium‑channel blockers
B. Thiazide diuretics
C. ACE inhibitors
D. Loop diuretics
,Answer: C
Rationale: ACE inhibitors (and ARBs, β‑blockers, aldosterone antagonists) improve survival by
decreasing afterload and preventing ventricular remodeling. Calcium‑channel blockers can worsen
HF; diuretics relieve congestion but do not confer mortality benefit.
Question 3
A 55‑year‑old woman with a 30‑pack‑year smoking history has progressive dyspnea and a
barrel‑shaped chest. Pulmonary function testing shows FEV₁/FVC = 0.60. Which best describes the
underlying pathophysiology?
A. Loss of elastic recoil and airway collapse during expiration
B. Increased surfactant production
C. Hyper‑inflation of alveoli due to increased compliance
D. Restriction of lung parenchyma by fibrosis
Answer: A
Rationale: COPD (especially emphysema) destroys alveolar walls → loss of elastic recoil →
small‑airway collapse on expiration → airflow obstruction (FEV₁/FVC < 0.70). Surfactant is not
increased; compliance is increased but recoil loss is the hallmark; fibrosis causes restriction.
Question 4
In a patient with COPD, which arterial blood gas pattern is most typical during an acute
exacerbation?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Mixed respiratory alkalosis & metabolic acidosis
D. Respiratory acidosis with metabolic compensation
Answer: D
Rationale: Exacerbations cause CO₂ retention → respiratory acidosis; kidneys retain bicarbonate,
producing a compensated picture with elevated PaCO₂ and moderately raised HCO₃⁻. Pure
respiratory alkalosis or metabolic acidosis is not typical.
,Question 5
A 14‑year‑old with newly diagnosed type 1 diabetes presents with polyuria, polydipsia, weight loss,
glucose = 600 mg/dL, pH = 7.1, and Kussmaul respirations. Which best describes the metabolic
derangement?
A. HHS
B. Lactic acidosis
C. Diabetic ketoacidosis (DKA)
D. Respiratory alkalosis
Answer: C
Rationale: DKA features hyperglycemia (>250 mg/dL), anion‑gap metabolic acidosis,
ketonemia/ketonuria, and compensatory Kussmaul breathing. HHS lacks ketoacidosis and occurs in
type 2 diabetes.
Question 6
A patient with DKA is started on insulin infusion. Which electrolyte disturbance is most likely during
the first few hours of therapy?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Answer: B
Rationale: Insulin drives potassium into cells, causing a rapid fall in serum K⁺ despite total‑body
depletion. Without replacement, hypokalemia can precipitate arrhythmias.
Question 7
A 65‑year‑old man is admitted with glucose = 850 mg/dL, serum osmolality = 340 mOsm/kg, and
absent ketones; he is alert but confused. Which condition fits this presentation?
A. DKA
, B. Lactic acidosis
C. HHS
D. Alcoholic ketoacidosis
Answer: C
Rationale: HHS presents with extreme hyperglycemia (>600 mg/dL), hyperosmolality, minimal
ketosis, and altered mental status, typically in older patients with type 2 diabetes. DKA has
ketoacidosis; alcoholic ketoacidosis has ketones and lower glucose.
Question 8
A patient with sepsis has lactate = 6 mmol/L. According to the Surviving Sepsis Campaign, what
defines septic shock?
A. Lactate > 2 mmol/L and need for vasopressors
B. MAP < 65 mmHg after fluid resuscitation & lactate > 2 mmol/L
C. SIRS criteria plus a known source of infection
D. Positive blood cultures and fever > 38 °C
Answer: B
Rationale: Septic shock = refractory hypotension requiring vasopressors to maintain
MAP ≥ 65 mmHg despite adequate fluids, plus lactate > 2 mmol/L indicating tissue hypoperfusion.
Question 9
A patient with septic shock receives norepinephrine. What is the primary mechanism raising blood
pressure?
A. α‑1 adrenergic receptor stimulation → vasoconstriction
B. β‑1 adrenergic receptor stimulation → ↑HR
C. Dopaminergic receptor stimulation → renal vasodilation
D. Muscarinic receptor antagonism
Answer: A
Guide exam with multiple choice
questions with verified answers
and rationale updated 2026
graded A+
Question 1
A 68‑year‑old man with hypertension and diabetes presents with dyspnea, peripheral edema, and an
S3 gallop. Echocardiography shows an ejection fraction of 30 %. Which type of heart failure does this
best describe?
A. Diastolic heart failure
B. Systolic heart failure
C. Right‑sided heart failure
D. High‑output heart failure
Answer: B
Rationale: An EF ≈ 30 % indicates reduced contractility (systolic dysfunction). Diastolic failure
preserves EF; right‑sided failure primarily causes jugular venous distension; high‑output failure is
rare and associated with a normal or high EF.
Question 2
In the same patient, which medication class has been shown to reduce mortality in systolic heart
failure?
A. Calcium‑channel blockers
B. Thiazide diuretics
C. ACE inhibitors
D. Loop diuretics
,Answer: C
Rationale: ACE inhibitors (and ARBs, β‑blockers, aldosterone antagonists) improve survival by
decreasing afterload and preventing ventricular remodeling. Calcium‑channel blockers can worsen
HF; diuretics relieve congestion but do not confer mortality benefit.
Question 3
A 55‑year‑old woman with a 30‑pack‑year smoking history has progressive dyspnea and a
barrel‑shaped chest. Pulmonary function testing shows FEV₁/FVC = 0.60. Which best describes the
underlying pathophysiology?
A. Loss of elastic recoil and airway collapse during expiration
B. Increased surfactant production
C. Hyper‑inflation of alveoli due to increased compliance
D. Restriction of lung parenchyma by fibrosis
Answer: A
Rationale: COPD (especially emphysema) destroys alveolar walls → loss of elastic recoil →
small‑airway collapse on expiration → airflow obstruction (FEV₁/FVC < 0.70). Surfactant is not
increased; compliance is increased but recoil loss is the hallmark; fibrosis causes restriction.
Question 4
In a patient with COPD, which arterial blood gas pattern is most typical during an acute
exacerbation?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Mixed respiratory alkalosis & metabolic acidosis
D. Respiratory acidosis with metabolic compensation
Answer: D
Rationale: Exacerbations cause CO₂ retention → respiratory acidosis; kidneys retain bicarbonate,
producing a compensated picture with elevated PaCO₂ and moderately raised HCO₃⁻. Pure
respiratory alkalosis or metabolic acidosis is not typical.
,Question 5
A 14‑year‑old with newly diagnosed type 1 diabetes presents with polyuria, polydipsia, weight loss,
glucose = 600 mg/dL, pH = 7.1, and Kussmaul respirations. Which best describes the metabolic
derangement?
A. HHS
B. Lactic acidosis
C. Diabetic ketoacidosis (DKA)
D. Respiratory alkalosis
Answer: C
Rationale: DKA features hyperglycemia (>250 mg/dL), anion‑gap metabolic acidosis,
ketonemia/ketonuria, and compensatory Kussmaul breathing. HHS lacks ketoacidosis and occurs in
type 2 diabetes.
Question 6
A patient with DKA is started on insulin infusion. Which electrolyte disturbance is most likely during
the first few hours of therapy?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Answer: B
Rationale: Insulin drives potassium into cells, causing a rapid fall in serum K⁺ despite total‑body
depletion. Without replacement, hypokalemia can precipitate arrhythmias.
Question 7
A 65‑year‑old man is admitted with glucose = 850 mg/dL, serum osmolality = 340 mOsm/kg, and
absent ketones; he is alert but confused. Which condition fits this presentation?
A. DKA
, B. Lactic acidosis
C. HHS
D. Alcoholic ketoacidosis
Answer: C
Rationale: HHS presents with extreme hyperglycemia (>600 mg/dL), hyperosmolality, minimal
ketosis, and altered mental status, typically in older patients with type 2 diabetes. DKA has
ketoacidosis; alcoholic ketoacidosis has ketones and lower glucose.
Question 8
A patient with sepsis has lactate = 6 mmol/L. According to the Surviving Sepsis Campaign, what
defines septic shock?
A. Lactate > 2 mmol/L and need for vasopressors
B. MAP < 65 mmHg after fluid resuscitation & lactate > 2 mmol/L
C. SIRS criteria plus a known source of infection
D. Positive blood cultures and fever > 38 °C
Answer: B
Rationale: Septic shock = refractory hypotension requiring vasopressors to maintain
MAP ≥ 65 mmHg despite adequate fluids, plus lactate > 2 mmol/L indicating tissue hypoperfusion.
Question 9
A patient with septic shock receives norepinephrine. What is the primary mechanism raising blood
pressure?
A. α‑1 adrenergic receptor stimulation → vasoconstriction
B. β‑1 adrenergic receptor stimulation → ↑HR
C. Dopaminergic receptor stimulation → renal vasodilation
D. Muscarinic receptor antagonism
Answer: A
