NSG 526 — EXAM 2 COMPLETE SOLUTION (2025/2026)
Introduction
NSG 526, an advanced clinical nursing course, focuses on equipping students with the
knowledge and skills to manage complex patient conditions through advanced
pathophysiology, pharmacology, and clinical decision-making. Exam 2 assesses critical
domains, including advanced pathophysiology, pharmacologic mechanisms and safe
administration, complex diagnostic interpretation, clinical reasoning and prioritization,
multi-system disorders, hemodynamic instability, laboratory trend analysis, immune and
inflammatory disorders, and advanced conditions in endocrine, renal, neuro,
cardiovascular, and respiratory systems. This exam bundle provides 100 original,
scenario-based questions with detailed solutions to ensure comprehensive mastery for
the 2025/2026 academic year, presented in Markdown for clarity and accessibility.
Question 1:
A 62-year-old male presents with fever, tachycardia, and hypotension. Labs show WBC
18,000/µL, lactate 3.2 mmol/L, and procalcitonin elevated. What is the most likely
diagnosis?
A. Hypovolemic shock
B. Sepsis
C. Cardiogenic shock
D. Anaphylactic shock
Answer: B — Sepsis
Rationale: Sepsis is indicated by fever, tachycardia, hypotension, elevated WBC, and
lactate >2 mmol/L, with procalcitonin suggesting infection. Hypovolemic shock lacks
infection signs (A), cardiogenic shows cardiac failure (C), anaphylactic involves allergic
triggers (D).
Solution: Initiate sepsis protocol: broad-spectrum antibiotics, IV fluids (30 mL/kg), and
vasopressors if MAP <65 mmHg after fluid resuscitation.
Question 2:
Which type of shock is characterized by inadequate preload due to fluid loss?
A. Cardiogenic
B. Hypovolemic
C. Distributive
D. Obstructive
Answer: B — Hypovolemic
,Rationale: Hypovolemic shock results from reduced preload due to blood/fluid loss (e.g.,
hemorrhage, dehydration). Cardiogenic is pump failure (A), distributive is vasodilation
(C), obstructive is flow obstruction (D).
Solution: Administer IV crystalloids or blood products, identify and control bleeding
source.
Question 3:
A patient’s ECG shows a prolonged PR interval and irregular rhythm. What is this
condition?
A. Atrial fibrillation
B. First-degree heart block
C. Ventricular tachycardia
D. Bundle branch block
Answer: B — First-degree heart block
Rationale: Prolonged PR interval (>200 ms) indicates first-degree heart block, a delay in
AV node conduction. Atrial fibrillation shows irregular P waves (A), ventricular
tachycardia is wide QRS (C), bundle branch block alters QRS (D).
Solution: Monitor; no immediate intervention unless symptomatic.
Question 4:
A patient with acute respiratory failure has PaO2 55 mmHg and SpO2 88% on room air.
What is the priority intervention?
A. Administer bronchodilators
B. Initiate supplemental oxygen
C. Start mechanical ventilation
D. Order chest X-ray
Answer: B — Initiate supplemental oxygen
Rationale: Hypoxemia (PaO2 <60 mmHg, SpO2 <90%) requires immediate oxygen to
improve gas exchange. Bronchodilators are for obstruction (A), ventilation for refractory
cases (C), X-ray diagnostic (D).
Solution: Apply nasal cannula or non-rebreather mask, titrate to SpO2 >92%.
Question 5:
A patient with diabetic ketoacidosis (DKA) has pH 7.25, HCO3- 15 mEq/L, and glucose
450 mg/dL. What is the primary acid–base disorder?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
,D. Respiratory alkalosis
Answer: A — Metabolic acidosis
Rationale: DKA causes metabolic acidosis (low pH, low HCO3-) due to ketone production.
Respiratory acidosis involves CO2 retention (B), metabolic alkalosis high HCO3- (C),
respiratory alkalosis low PaCO2 (D).
Solution: Administer IV insulin, fluids, and monitor electrolytes.
Question 6:
Which medication is contraindicated in a patient with anaphylactic shock and
bronchospasm?
A. Epinephrine
B. Diphenhydramine
C. Propranolol
D. Methylprednisolone
Answer: C — Propranolol
Rationale: Propranolol, a beta-blocker, worsens bronchospasm by blocking
bronchodilation. Epinephrine reverses anaphylaxis (A), diphenhydramine reduces
histamine (B), methylprednisolone decreases inflammation (D).
Solution: Administer IM epinephrine 0.3–0.5 mg, antihistamines, and steroids.
Question 7:
A patient with sepsis develops oliguria and creatinine 2.8 mg/dL. This suggests:
A. Prerenal acute kidney injury
B. Intrinsic acute kidney injury
C. Chronic kidney disease
D. Postrenal obstruction
Answer: B — Intrinsic acute kidney injury
Rationale: Sepsis causes intrinsic AKI (e.g., acute tubular necrosis) with elevated
creatinine and oliguria. Prerenal is hypoperfusion (A), chronic is gradual (C), postrenal is
obstruction (D).
Solution: Ensure adequate fluid resuscitation, monitor renal function, avoid
nephrotoxins.
Question 8:
A patient’s ABG shows pH 7.48, PaCO2 30 mmHg, HCO3- 22 mEq/L. What is the
disorder?
A. Metabolic acidosis
B. Respiratory alkalosis
, C. Metabolic alkalosis
D. Respiratory acidosis
Answer: B — Respiratory alkalosis
Rationale: High pH and low PaCO2 indicate hyperventilation causing respiratory
alkalosis. Metabolic acidosis low HCO3- (A), metabolic alkalosis high HCO3- (C),
respiratory acidosis high PaCO2 (D).
Solution: Address underlying cause (e.g., anxiety, hypoxia), monitor breathing.
Question 9:
Which lab trend suggests worsening multi-organ dysfunction syndrome (MODS)?
A. Decreasing lactate
B. Rising bilirubin and INR
C. Normalizing creatinine
D. Stable platelet count
Answer: B — Rising bilirubin and INR
Rationale: MODS involves liver dysfunction (rising bilirubin, INR). Decreasing lactate (A)
and normalizing creatinine (C) suggest improvement, stable platelets (D) are neutral.
Solution: Support organ function, monitor labs, treat underlying sepsis.
Question 10:
A patient with thyroid storm is tachycardic and febrile. Which medication is first-line?
A. Levothyroxine
B. Propylthiouracil (PTU)
C. Insulin
D. Hydrocortisone
Answer: B — Propylthiouracil (PTU)
Rationale: PTU inhibits thyroid hormone synthesis in thyroid storm. Levothyroxine
worsens it (A), insulin for DKA (C), hydrocortisone adjunctive (D).
Solution: Administer PTU, beta-blockers (e.g., propranolol), and supportive care.
Question 11:
A patient with STEMI shows ST elevation in leads V1–V4. This indicates occlusion in:
A. Right coronary artery
B. Left anterior descending artery
C. Circumflex artery
D. Posterior descending artery
Introduction
NSG 526, an advanced clinical nursing course, focuses on equipping students with the
knowledge and skills to manage complex patient conditions through advanced
pathophysiology, pharmacology, and clinical decision-making. Exam 2 assesses critical
domains, including advanced pathophysiology, pharmacologic mechanisms and safe
administration, complex diagnostic interpretation, clinical reasoning and prioritization,
multi-system disorders, hemodynamic instability, laboratory trend analysis, immune and
inflammatory disorders, and advanced conditions in endocrine, renal, neuro,
cardiovascular, and respiratory systems. This exam bundle provides 100 original,
scenario-based questions with detailed solutions to ensure comprehensive mastery for
the 2025/2026 academic year, presented in Markdown for clarity and accessibility.
Question 1:
A 62-year-old male presents with fever, tachycardia, and hypotension. Labs show WBC
18,000/µL, lactate 3.2 mmol/L, and procalcitonin elevated. What is the most likely
diagnosis?
A. Hypovolemic shock
B. Sepsis
C. Cardiogenic shock
D. Anaphylactic shock
Answer: B — Sepsis
Rationale: Sepsis is indicated by fever, tachycardia, hypotension, elevated WBC, and
lactate >2 mmol/L, with procalcitonin suggesting infection. Hypovolemic shock lacks
infection signs (A), cardiogenic shows cardiac failure (C), anaphylactic involves allergic
triggers (D).
Solution: Initiate sepsis protocol: broad-spectrum antibiotics, IV fluids (30 mL/kg), and
vasopressors if MAP <65 mmHg after fluid resuscitation.
Question 2:
Which type of shock is characterized by inadequate preload due to fluid loss?
A. Cardiogenic
B. Hypovolemic
C. Distributive
D. Obstructive
Answer: B — Hypovolemic
,Rationale: Hypovolemic shock results from reduced preload due to blood/fluid loss (e.g.,
hemorrhage, dehydration). Cardiogenic is pump failure (A), distributive is vasodilation
(C), obstructive is flow obstruction (D).
Solution: Administer IV crystalloids or blood products, identify and control bleeding
source.
Question 3:
A patient’s ECG shows a prolonged PR interval and irregular rhythm. What is this
condition?
A. Atrial fibrillation
B. First-degree heart block
C. Ventricular tachycardia
D. Bundle branch block
Answer: B — First-degree heart block
Rationale: Prolonged PR interval (>200 ms) indicates first-degree heart block, a delay in
AV node conduction. Atrial fibrillation shows irregular P waves (A), ventricular
tachycardia is wide QRS (C), bundle branch block alters QRS (D).
Solution: Monitor; no immediate intervention unless symptomatic.
Question 4:
A patient with acute respiratory failure has PaO2 55 mmHg and SpO2 88% on room air.
What is the priority intervention?
A. Administer bronchodilators
B. Initiate supplemental oxygen
C. Start mechanical ventilation
D. Order chest X-ray
Answer: B — Initiate supplemental oxygen
Rationale: Hypoxemia (PaO2 <60 mmHg, SpO2 <90%) requires immediate oxygen to
improve gas exchange. Bronchodilators are for obstruction (A), ventilation for refractory
cases (C), X-ray diagnostic (D).
Solution: Apply nasal cannula or non-rebreather mask, titrate to SpO2 >92%.
Question 5:
A patient with diabetic ketoacidosis (DKA) has pH 7.25, HCO3- 15 mEq/L, and glucose
450 mg/dL. What is the primary acid–base disorder?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
,D. Respiratory alkalosis
Answer: A — Metabolic acidosis
Rationale: DKA causes metabolic acidosis (low pH, low HCO3-) due to ketone production.
Respiratory acidosis involves CO2 retention (B), metabolic alkalosis high HCO3- (C),
respiratory alkalosis low PaCO2 (D).
Solution: Administer IV insulin, fluids, and monitor electrolytes.
Question 6:
Which medication is contraindicated in a patient with anaphylactic shock and
bronchospasm?
A. Epinephrine
B. Diphenhydramine
C. Propranolol
D. Methylprednisolone
Answer: C — Propranolol
Rationale: Propranolol, a beta-blocker, worsens bronchospasm by blocking
bronchodilation. Epinephrine reverses anaphylaxis (A), diphenhydramine reduces
histamine (B), methylprednisolone decreases inflammation (D).
Solution: Administer IM epinephrine 0.3–0.5 mg, antihistamines, and steroids.
Question 7:
A patient with sepsis develops oliguria and creatinine 2.8 mg/dL. This suggests:
A. Prerenal acute kidney injury
B. Intrinsic acute kidney injury
C. Chronic kidney disease
D. Postrenal obstruction
Answer: B — Intrinsic acute kidney injury
Rationale: Sepsis causes intrinsic AKI (e.g., acute tubular necrosis) with elevated
creatinine and oliguria. Prerenal is hypoperfusion (A), chronic is gradual (C), postrenal is
obstruction (D).
Solution: Ensure adequate fluid resuscitation, monitor renal function, avoid
nephrotoxins.
Question 8:
A patient’s ABG shows pH 7.48, PaCO2 30 mmHg, HCO3- 22 mEq/L. What is the
disorder?
A. Metabolic acidosis
B. Respiratory alkalosis
, C. Metabolic alkalosis
D. Respiratory acidosis
Answer: B — Respiratory alkalosis
Rationale: High pH and low PaCO2 indicate hyperventilation causing respiratory
alkalosis. Metabolic acidosis low HCO3- (A), metabolic alkalosis high HCO3- (C),
respiratory acidosis high PaCO2 (D).
Solution: Address underlying cause (e.g., anxiety, hypoxia), monitor breathing.
Question 9:
Which lab trend suggests worsening multi-organ dysfunction syndrome (MODS)?
A. Decreasing lactate
B. Rising bilirubin and INR
C. Normalizing creatinine
D. Stable platelet count
Answer: B — Rising bilirubin and INR
Rationale: MODS involves liver dysfunction (rising bilirubin, INR). Decreasing lactate (A)
and normalizing creatinine (C) suggest improvement, stable platelets (D) are neutral.
Solution: Support organ function, monitor labs, treat underlying sepsis.
Question 10:
A patient with thyroid storm is tachycardic and febrile. Which medication is first-line?
A. Levothyroxine
B. Propylthiouracil (PTU)
C. Insulin
D. Hydrocortisone
Answer: B — Propylthiouracil (PTU)
Rationale: PTU inhibits thyroid hormone synthesis in thyroid storm. Levothyroxine
worsens it (A), insulin for DKA (C), hydrocortisone adjunctive (D).
Solution: Administer PTU, beta-blockers (e.g., propranolol), and supportive care.
Question 11:
A patient with STEMI shows ST elevation in leads V1–V4. This indicates occlusion in:
A. Right coronary artery
B. Left anterior descending artery
C. Circumflex artery
D. Posterior descending artery
