NUR 504 - EXAM 1 QUESTIONS & ANSWERS| GRADE A| 100% CORRECT
(VERIFIED SOLUTIONS)
1. A 68-year-old patient with a long history of hypertension presents for an
outpatient evaluation and reports gradually worsening fatigue, nocturia,
and swelling of both ankles. Laboratory testing demonstrates an elevated
serum creatinine and reduced estimated glomerular filtration rate. Which
pathophysiologic process most directly explains the patient's progressive
renal dysfunction?
A. Increased glomerular filtration caused by persistent hypovolemia
B. Progressive nephron injury associated with chronic intraglomerular
hypertension
C. Increased erythropoietin production by damaged renal tissue
D. Suppression of the renin-angiotensin-aldosterone system caused by
hypertension
Answer: B
2. A patient with newly diagnosed hypertension asks why blood pressure
remains elevated despite having no symptoms. The nurse practitioner
explains that chronic hypertension can gradually damage multiple organs
even when the patient feels well. Which complication is most directly
associated with long-standing uncontrolled hypertension?
A. Acute appendicitis
B. Iron-deficiency anemia
C. Chronic osteoarthritis
D. Left ventricular hypertrophy
Answer: D
3. A 55-year-old patient with diabetes mellitus has a blood pressure of 168/96
mmHg on repeated measurements and laboratory evidence of albuminuria.
The clinician is evaluating the patient's cardiovascular and renal risk. Which
mechanism contributes most directly to the development of diabetic
nephropathy?
A. Glomerular hyperfiltration followed by structural glomerular injury
pg. 1
, B. Complete absence of renal blood flow
C. Increased renal production of insulin
D. Suppression of glomerular capillary pressure
Answer: A
4. A patient presents with several weeks of progressive fatigue, exertional
dyspnea, and reduced exercise tolerance. The complete blood count
demonstrates a hemoglobin concentration of 8.7 g/dL with microcytosis
and hypochromia. Which additional laboratory finding would most strongly
support iron-deficiency anemia?
A. Elevated ferritin with decreased total iron-binding capacity
B. Increased vitamin B12 concentration
C. Decreased ferritin with increased total iron-binding capacity
D. Increased mean corpuscular volume
Answer: C
5. A 72-year-old patient reports weakness, numbness in both feet, difficulty
maintaining balance, and a sore tongue. Laboratory testing shows
macrocytosis. Which deficiency should the clinician consider most strongly
as an underlying cause?
A. Vitamin B12 deficiency
B. Vitamin K deficiency
C. Vitamin C deficiency
D. Calcium deficiency
Answer: A
6. A patient with chronic obstructive pulmonary disease has worsening
dyspnea and increasing somnolence. Arterial blood gas results reveal pH
7.29, PaCO2 58 mmHg, and HCO3− 27 mEq/L. Which acid-base disturbance
is primarily responsible for these findings?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Metabolic acidosis
pg. 2
, D. Respiratory acidosis
Answer: D
7. A patient experiencing severe vomiting for several days develops weakness
and dizziness. Laboratory studies reveal a pH of 7.49 and an elevated serum
bicarbonate concentration. Which disturbance best explains these findings?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Metabolic acidosis
Answer: B
8. A patient with profuse diarrhea develops tachypnea and laboratory
evidence of decreased serum bicarbonate. Which compensatory response
would the clinician expect to occur?
A. Hypoventilation to retain carbon dioxide
B. Increased renal bicarbonate loss
C. Increased ventilation to decrease carbon dioxide
D. Decreased respiratory rate to increase carbonic acid
Answer: C
9. A patient with diabetic ketoacidosis presents with abdominal pain, nausea,
vomiting, dehydration, and deep rapid respirations. Which physiologic
abnormality is primarily responsible for the development of metabolic
acidosis?
A. Accumulation of ketoacids caused by insufficient effective insulin
B. Excessive bicarbonate production by the kidneys
C. Increased cellular uptake of glucose
D. Excessive carbon dioxide retention caused by hypoventilation
Answer: A
10. A patient with severe dehydration has a blood pressure of 88/54 mmHg,
tachycardia, dry mucous membranes, and poor urine output. Which
physiologic mechanism initially helps maintain perfusion during significant
volume depletion?
pg. 3
, A. Increased parasympathetic stimulation
B. Decreased systemic vascular resistance
C. Increased atrial natriuretic peptide secretion
D. Activation of the sympathetic nervous system and renin-angiotensin-
aldosterone system
Answer: D
11. A patient develops sudden unilateral weakness, facial drooping, and
difficulty speaking. The symptoms began 45 minutes ago. Which action is
most important when evaluating this patient for a possible acute ischemic
stroke?
A. Determine the exact time the patient was last known to be neurologically
normal
B. Administer oral fluids immediately
C. Delay imaging until laboratory results are available
D. Place the patient in a standing position to evaluate gait
Answer: A
12. A patient with atrial fibrillation is being evaluated for the risk of ischemic
stroke. Which mechanism explains the increased risk of thromboembolism
associated with atrial fibrillation?
A. Excessive ventricular contraction eliminates blood stasis
B. Ineffective atrial contraction promotes blood stasis and thrombus
formation
C. Increased platelet destruction prevents clot formation
D. Reduced atrial pressure causes systemic hemorrhage
Answer: B
13. A patient with chronic heart failure reports progressive shortness of breath,
orthopnea, and bilateral lower-extremity edema. Which physiologic
mechanism contributes substantially to the fluid retention associated with
heart failure?
A. Suppression of aldosterone secretion
B. Increased renal sodium and water excretion
pg. 4
(VERIFIED SOLUTIONS)
1. A 68-year-old patient with a long history of hypertension presents for an
outpatient evaluation and reports gradually worsening fatigue, nocturia,
and swelling of both ankles. Laboratory testing demonstrates an elevated
serum creatinine and reduced estimated glomerular filtration rate. Which
pathophysiologic process most directly explains the patient's progressive
renal dysfunction?
A. Increased glomerular filtration caused by persistent hypovolemia
B. Progressive nephron injury associated with chronic intraglomerular
hypertension
C. Increased erythropoietin production by damaged renal tissue
D. Suppression of the renin-angiotensin-aldosterone system caused by
hypertension
Answer: B
2. A patient with newly diagnosed hypertension asks why blood pressure
remains elevated despite having no symptoms. The nurse practitioner
explains that chronic hypertension can gradually damage multiple organs
even when the patient feels well. Which complication is most directly
associated with long-standing uncontrolled hypertension?
A. Acute appendicitis
B. Iron-deficiency anemia
C. Chronic osteoarthritis
D. Left ventricular hypertrophy
Answer: D
3. A 55-year-old patient with diabetes mellitus has a blood pressure of 168/96
mmHg on repeated measurements and laboratory evidence of albuminuria.
The clinician is evaluating the patient's cardiovascular and renal risk. Which
mechanism contributes most directly to the development of diabetic
nephropathy?
A. Glomerular hyperfiltration followed by structural glomerular injury
pg. 1
, B. Complete absence of renal blood flow
C. Increased renal production of insulin
D. Suppression of glomerular capillary pressure
Answer: A
4. A patient presents with several weeks of progressive fatigue, exertional
dyspnea, and reduced exercise tolerance. The complete blood count
demonstrates a hemoglobin concentration of 8.7 g/dL with microcytosis
and hypochromia. Which additional laboratory finding would most strongly
support iron-deficiency anemia?
A. Elevated ferritin with decreased total iron-binding capacity
B. Increased vitamin B12 concentration
C. Decreased ferritin with increased total iron-binding capacity
D. Increased mean corpuscular volume
Answer: C
5. A 72-year-old patient reports weakness, numbness in both feet, difficulty
maintaining balance, and a sore tongue. Laboratory testing shows
macrocytosis. Which deficiency should the clinician consider most strongly
as an underlying cause?
A. Vitamin B12 deficiency
B. Vitamin K deficiency
C. Vitamin C deficiency
D. Calcium deficiency
Answer: A
6. A patient with chronic obstructive pulmonary disease has worsening
dyspnea and increasing somnolence. Arterial blood gas results reveal pH
7.29, PaCO2 58 mmHg, and HCO3− 27 mEq/L. Which acid-base disturbance
is primarily responsible for these findings?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Metabolic acidosis
pg. 2
, D. Respiratory acidosis
Answer: D
7. A patient experiencing severe vomiting for several days develops weakness
and dizziness. Laboratory studies reveal a pH of 7.49 and an elevated serum
bicarbonate concentration. Which disturbance best explains these findings?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Metabolic acidosis
Answer: B
8. A patient with profuse diarrhea develops tachypnea and laboratory
evidence of decreased serum bicarbonate. Which compensatory response
would the clinician expect to occur?
A. Hypoventilation to retain carbon dioxide
B. Increased renal bicarbonate loss
C. Increased ventilation to decrease carbon dioxide
D. Decreased respiratory rate to increase carbonic acid
Answer: C
9. A patient with diabetic ketoacidosis presents with abdominal pain, nausea,
vomiting, dehydration, and deep rapid respirations. Which physiologic
abnormality is primarily responsible for the development of metabolic
acidosis?
A. Accumulation of ketoacids caused by insufficient effective insulin
B. Excessive bicarbonate production by the kidneys
C. Increased cellular uptake of glucose
D. Excessive carbon dioxide retention caused by hypoventilation
Answer: A
10. A patient with severe dehydration has a blood pressure of 88/54 mmHg,
tachycardia, dry mucous membranes, and poor urine output. Which
physiologic mechanism initially helps maintain perfusion during significant
volume depletion?
pg. 3
, A. Increased parasympathetic stimulation
B. Decreased systemic vascular resistance
C. Increased atrial natriuretic peptide secretion
D. Activation of the sympathetic nervous system and renin-angiotensin-
aldosterone system
Answer: D
11. A patient develops sudden unilateral weakness, facial drooping, and
difficulty speaking. The symptoms began 45 minutes ago. Which action is
most important when evaluating this patient for a possible acute ischemic
stroke?
A. Determine the exact time the patient was last known to be neurologically
normal
B. Administer oral fluids immediately
C. Delay imaging until laboratory results are available
D. Place the patient in a standing position to evaluate gait
Answer: A
12. A patient with atrial fibrillation is being evaluated for the risk of ischemic
stroke. Which mechanism explains the increased risk of thromboembolism
associated with atrial fibrillation?
A. Excessive ventricular contraction eliminates blood stasis
B. Ineffective atrial contraction promotes blood stasis and thrombus
formation
C. Increased platelet destruction prevents clot formation
D. Reduced atrial pressure causes systemic hemorrhage
Answer: B
13. A patient with chronic heart failure reports progressive shortness of breath,
orthopnea, and bilateral lower-extremity edema. Which physiologic
mechanism contributes substantially to the fluid retention associated with
heart failure?
A. Suppression of aldosterone secretion
B. Increased renal sodium and water excretion
pg. 4
