NRNP 6540 MIDTERM EXAM LATEST 2025/2026 /NRNP6540 MIDTERM
EXAM QUESTIONS AND ANSWERS (VERIFIED ANSWERS)|WALDEN
UNIVERSITY
1. A nurse practitioner is assessing a client with chronic hypertension.
Sustained hypertension can lead to left ventricular hypertrophy
primarily due to:
A) Increased preload.
B) Decreased afterload.
C) Increased systemic vascular resistance.
D) Decreased myocardial oxygen demand.
E) Arterial vasodilation.
Correct Answer: C) Increased systemic vascular resistance.
Rationale: Chronic hypertension increases the afterload (the
resistance the left ventricle must overcome to eject blood). To pump
blood against this increased systemic vascular resistance, the left
ventricular muscle thickens (hypertrophies) to generate more force.
2. Which of the following is the primary pathophysiological event that
leads to the classic symptoms of a myocardial infarction (MI)?
A) Chronic systemic inflammation.
B) Progressive atherosclerosis leading to gradual lumen narrowing.
C) Complete occlusion of a coronary artery by a thrombus.
D) Reversible myocardial ischemia.
E) Valvular dysfunction causing backflow.
Correct Answer: C) Complete occlusion of a coronary artery by a
thrombus.
Rationale: A myocardial infarction occurs when there is prolonged and
complete ischemia, typically due to the rupture of an atherosclerotic
plaque and subsequent thrombus formation that completely occludes a
coronary artery, leading to myocardial cell death.
3. A client with chronic kidney disease (CKD) is experiencing anemia. The
nurse practitioner understands that this is primarily due to:
A) Iron deficiency from dietary restrictions.
B) Decreased erythropoietin production by the kidneys.
C) Increased destruction of red blood cells.
D) Folate deficiency from dialysis.
E) Bone marrow suppression from uremic toxins.
Correct Answer: B) Decreased erythropoietin production by the
kidneys.
Rationale: The kidneys are responsible for producing erythropoietin, a
hormone that stimulates red blood cell production in the bone marrow.
, In CKD, the damaged kidneys produce less erythropoietin, leading to
normochromic, normocytic anemia.
4. Which of the following is the primary mechanism by which nonsteroidal
anti-inflammatory drugs (NSAIDs) can cause peptic ulcer disease?
A) Increasing stomach acid production.
B) Directly irritating the gastric mucosa.
C) Inhibiting prostaglandin synthesis, which reduces gastric mucosal
protection.
D) Stimulating gastrin release.
E) Accelerating gastric emptying.
Correct Answer: C) Inhibiting prostaglandin synthesis, which reduces
gastric mucosal protection.
Rationale: NSAIDs inhibit cyclooxygenase (COX) enzymes, particularly
COX-1. COX-1 produces prostaglandins that protect the gastric mucosa
by promoting mucus and bicarbonate secretion and maintaining
mucosal blood flow. Inhibition of these protective prostaglandins leads
to increased risk of ulceration.
5. A client with asthma experiences bronchoconstriction in response to
allergens. This response is primarily mediated by the release of:
A) Acetylcholine.
B) Epinephrine.
C) Histamine and leukotrienes.
D) Prostaglandins.
E) Serotonin.
Correct Answer: C) Histamine and leukotrienes.
Rationale: In an allergic asthma response, exposure to an allergen
triggers mast cells to degranulate, releasing inflammatory mediators
such as histamine, leukotrienes, and prostaglandins. Histamine and
leukotrienes are potent bronchoconstrictors and also contribute to
inflammation and mucus production.
6. A nurse practitioner is assessing a client with suspected deep vein
thrombosis (DVT). The pain associated with DVT is primarily caused by:
A) Arterial spasm.
B) Ischemia of the deep muscle tissue.
C) Inflammation and distention of the venous wall.
D) Nerve compression.
E) Lactic acid buildup from exercise.
Correct Answer: C) Inflammation and distention of the venous wall.
, Rationale: The pain of a DVT results from inflammation of the vein
wall (phlebitis) and the distention of the vessel by the thrombus, rather
than arterial ischemia.
7. Which of the following is the primary pathophysiological defect in Type
1 Diabetes Mellitus?
A) Insulin resistance in peripheral tissues.
B) Impaired insulin secretion due to pancreatic beta-cell destruction.
C) Excessive glucagon production.
D) Increased hepatic glucose production.
E) Decreased glucose absorption from the gastrointestinal tract.
Correct Answer: B) Impaired insulin secretion due to pancreatic beta-
cell destruction.
Rationale: Type 1 Diabetes Mellitus is an autoimmune disorder
characterized by the absolute deficiency of insulin due to the immune-
mediated destruction of the insulin-producing beta cells in the
pancreatic islets of Langerhans.
8. A client with a head injury develops symptoms of increased intracranial
pressure (ICP), including hypertension, bradycardia, and irregular
respirations. This triad of symptoms is known as:
A) Cheyne-Stokes respirations.
B) Cushing's triad.
C) Kernig's sign.
D) Brudzinski's sign.
E) Babinski's reflex.
Correct Answer: B) Cushing's triad.
Rationale: Cushing's triad (hypertension, bradycardia, and irregular
respirations, often with a widened pulse pressure) is a classic, but late,
sign of significantly increased ICP, indicating severe brainstem
compression.
9. Which cellular adaptation involves an increase in the size of cells,
leading to an increase in the size of the affected organ?
A) Atrophy.
B) Hyperplasia.
C) Hypertrophy.
D) Metaplasia.
E) Dysplasia.
Correct Answer: C) Hypertrophy.
Rationale: Hypertrophy is an increase in the size of individual cells,
, which in turn leads to an increase in the size of the organ. This often
occurs in response to increased workload (e.g., cardiac muscle in
hypertension).
10. A client with liver cirrhosis is at risk for developing esophageal
varices primarily due to:
A) Decreased albumin production.
B) Impaired coagulation.
C) Portal hypertension.
D) Hepatic encephalopathy.
E) Decreased bile production.
Correct Answer: C) Portal hypertension.
Rationale: Liver cirrhosis causes scarring and obstruction of blood
flow through the liver, leading to increased pressure in the portal
venous system (portal hypertension). This increased pressure causes
collateral veins in the esophagus to become distended and tortuous
(varices), making them prone to rupture and hemorrhage.
11. The hallmark pathophysiological change in emphysema is:
A) Chronic inflammation of the small airways.
B) Hyperresponsiveness of the bronchi.
C) Destruction of alveolar walls and enlargement of air spaces.
D) Excessive mucus production in the bronchi.
E) Bronchial smooth muscle hypertrophy.
Correct Answer: C) Destruction of alveolar walls and enlargement of
air spaces.
Rationale: Emphysema is characterized by the irreversible destruction
of the walls between the alveoli, leading to the formation of larger,
inefficient air spaces, loss of elastic recoil, and impaired gas exchange.
12. A client with uncontrolled Type 2 Diabetes Mellitus develops
hyperosmolar hyperglycemic state (HHS). The most significant
differentiating factor from diabetic ketoacidosis (DKA) is the absence
of:
A) Hyperglycemia.
B) Dehydration.
C) Severe acidosis and ketosis.
D) Electrolyte imbalances.
E) Altered mental status.
Correct Answer: C) Severe acidosis and ketosis.
Rationale: While both HHS and DKA involve severe hyperglycemia
EXAM QUESTIONS AND ANSWERS (VERIFIED ANSWERS)|WALDEN
UNIVERSITY
1. A nurse practitioner is assessing a client with chronic hypertension.
Sustained hypertension can lead to left ventricular hypertrophy
primarily due to:
A) Increased preload.
B) Decreased afterload.
C) Increased systemic vascular resistance.
D) Decreased myocardial oxygen demand.
E) Arterial vasodilation.
Correct Answer: C) Increased systemic vascular resistance.
Rationale: Chronic hypertension increases the afterload (the
resistance the left ventricle must overcome to eject blood). To pump
blood against this increased systemic vascular resistance, the left
ventricular muscle thickens (hypertrophies) to generate more force.
2. Which of the following is the primary pathophysiological event that
leads to the classic symptoms of a myocardial infarction (MI)?
A) Chronic systemic inflammation.
B) Progressive atherosclerosis leading to gradual lumen narrowing.
C) Complete occlusion of a coronary artery by a thrombus.
D) Reversible myocardial ischemia.
E) Valvular dysfunction causing backflow.
Correct Answer: C) Complete occlusion of a coronary artery by a
thrombus.
Rationale: A myocardial infarction occurs when there is prolonged and
complete ischemia, typically due to the rupture of an atherosclerotic
plaque and subsequent thrombus formation that completely occludes a
coronary artery, leading to myocardial cell death.
3. A client with chronic kidney disease (CKD) is experiencing anemia. The
nurse practitioner understands that this is primarily due to:
A) Iron deficiency from dietary restrictions.
B) Decreased erythropoietin production by the kidneys.
C) Increased destruction of red blood cells.
D) Folate deficiency from dialysis.
E) Bone marrow suppression from uremic toxins.
Correct Answer: B) Decreased erythropoietin production by the
kidneys.
Rationale: The kidneys are responsible for producing erythropoietin, a
hormone that stimulates red blood cell production in the bone marrow.
, In CKD, the damaged kidneys produce less erythropoietin, leading to
normochromic, normocytic anemia.
4. Which of the following is the primary mechanism by which nonsteroidal
anti-inflammatory drugs (NSAIDs) can cause peptic ulcer disease?
A) Increasing stomach acid production.
B) Directly irritating the gastric mucosa.
C) Inhibiting prostaglandin synthesis, which reduces gastric mucosal
protection.
D) Stimulating gastrin release.
E) Accelerating gastric emptying.
Correct Answer: C) Inhibiting prostaglandin synthesis, which reduces
gastric mucosal protection.
Rationale: NSAIDs inhibit cyclooxygenase (COX) enzymes, particularly
COX-1. COX-1 produces prostaglandins that protect the gastric mucosa
by promoting mucus and bicarbonate secretion and maintaining
mucosal blood flow. Inhibition of these protective prostaglandins leads
to increased risk of ulceration.
5. A client with asthma experiences bronchoconstriction in response to
allergens. This response is primarily mediated by the release of:
A) Acetylcholine.
B) Epinephrine.
C) Histamine and leukotrienes.
D) Prostaglandins.
E) Serotonin.
Correct Answer: C) Histamine and leukotrienes.
Rationale: In an allergic asthma response, exposure to an allergen
triggers mast cells to degranulate, releasing inflammatory mediators
such as histamine, leukotrienes, and prostaglandins. Histamine and
leukotrienes are potent bronchoconstrictors and also contribute to
inflammation and mucus production.
6. A nurse practitioner is assessing a client with suspected deep vein
thrombosis (DVT). The pain associated with DVT is primarily caused by:
A) Arterial spasm.
B) Ischemia of the deep muscle tissue.
C) Inflammation and distention of the venous wall.
D) Nerve compression.
E) Lactic acid buildup from exercise.
Correct Answer: C) Inflammation and distention of the venous wall.
, Rationale: The pain of a DVT results from inflammation of the vein
wall (phlebitis) and the distention of the vessel by the thrombus, rather
than arterial ischemia.
7. Which of the following is the primary pathophysiological defect in Type
1 Diabetes Mellitus?
A) Insulin resistance in peripheral tissues.
B) Impaired insulin secretion due to pancreatic beta-cell destruction.
C) Excessive glucagon production.
D) Increased hepatic glucose production.
E) Decreased glucose absorption from the gastrointestinal tract.
Correct Answer: B) Impaired insulin secretion due to pancreatic beta-
cell destruction.
Rationale: Type 1 Diabetes Mellitus is an autoimmune disorder
characterized by the absolute deficiency of insulin due to the immune-
mediated destruction of the insulin-producing beta cells in the
pancreatic islets of Langerhans.
8. A client with a head injury develops symptoms of increased intracranial
pressure (ICP), including hypertension, bradycardia, and irregular
respirations. This triad of symptoms is known as:
A) Cheyne-Stokes respirations.
B) Cushing's triad.
C) Kernig's sign.
D) Brudzinski's sign.
E) Babinski's reflex.
Correct Answer: B) Cushing's triad.
Rationale: Cushing's triad (hypertension, bradycardia, and irregular
respirations, often with a widened pulse pressure) is a classic, but late,
sign of significantly increased ICP, indicating severe brainstem
compression.
9. Which cellular adaptation involves an increase in the size of cells,
leading to an increase in the size of the affected organ?
A) Atrophy.
B) Hyperplasia.
C) Hypertrophy.
D) Metaplasia.
E) Dysplasia.
Correct Answer: C) Hypertrophy.
Rationale: Hypertrophy is an increase in the size of individual cells,
, which in turn leads to an increase in the size of the organ. This often
occurs in response to increased workload (e.g., cardiac muscle in
hypertension).
10. A client with liver cirrhosis is at risk for developing esophageal
varices primarily due to:
A) Decreased albumin production.
B) Impaired coagulation.
C) Portal hypertension.
D) Hepatic encephalopathy.
E) Decreased bile production.
Correct Answer: C) Portal hypertension.
Rationale: Liver cirrhosis causes scarring and obstruction of blood
flow through the liver, leading to increased pressure in the portal
venous system (portal hypertension). This increased pressure causes
collateral veins in the esophagus to become distended and tortuous
(varices), making them prone to rupture and hemorrhage.
11. The hallmark pathophysiological change in emphysema is:
A) Chronic inflammation of the small airways.
B) Hyperresponsiveness of the bronchi.
C) Destruction of alveolar walls and enlargement of air spaces.
D) Excessive mucus production in the bronchi.
E) Bronchial smooth muscle hypertrophy.
Correct Answer: C) Destruction of alveolar walls and enlargement of
air spaces.
Rationale: Emphysema is characterized by the irreversible destruction
of the walls between the alveoli, leading to the formation of larger,
inefficient air spaces, loss of elastic recoil, and impaired gas exchange.
12. A client with uncontrolled Type 2 Diabetes Mellitus develops
hyperosmolar hyperglycemic state (HHS). The most significant
differentiating factor from diabetic ketoacidosis (DKA) is the absence
of:
A) Hyperglycemia.
B) Dehydration.
C) Severe acidosis and ketosis.
D) Electrolyte imbalances.
E) Altered mental status.
Correct Answer: C) Severe acidosis and ketosis.
Rationale: While both HHS and DKA involve severe hyperglycemia
