NU 518 EXAM / Advanced Nursing/Pathophysiology
ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED A+
LATEST
1. Which physiologic mechanism best explains why a patient with chronic
heart failure develops peripheral edema?
A. Increased colloid oncotic pressure
B. Decreased hydrostatic pressure
C. Activation of the renin–angiotensin–aldosterone system
D. Increased lymphatic drainage
Correct Answer: C
Rationale: RAAS activation causes sodium/water retention → ↑ intravascular
volume → ↑ capillary hydrostatic pressure → fluid shifts into interstitial spaces →
edema.
2. A patient with COPD suddenly becomes confused and restless. What is the
most likely primary cause?
A. Metabolic alkalosis
B. Hypercapnia
C. Hypokalemia
D. Dehydration
Correct Answer: B
Rationale: Rising CO₂ levels cause cerebral vasodilation and depressed CNS
function → confusion and agitation. Common acute change in COPD
exacerbations.
,3. Which lab value requires immediate provider notification for a patient
receiving IV heparin?
A. aPTT of 65 seconds
B. Platelets 48,000/µL
C. INR 1.1
D. Hematocrit 35%
Correct Answer: B
Rationale: Platelets <50,000 indicate risk of heparin-induced thrombocytopenia
(HIT), a medical emergency.
4. A nurse assesses a patient with sepsis who is now hypotensive, confused,
and has cold extremities. What shock stage is most likely?
A. Initial
B. Compensatory
C. Progressive
D. Refractory
Correct Answer: C
Rationale: Progressive shock presents with organ hypoperfusion → confusion,
hypotension, cool skin.
5. Which finding indicates left-sided heart failure rather than right-sided?
A. Ascites
B. Jugular vein distention
C. Pulmonary crackles
D. Lower-extremity edema
Correct Answer: C
Rationale: Left-sided failure → pulmonary congestion; right-sided → systemic
fluid accumulation.
,6. A patient receiving morphine IV becomes difficult to arouse with RR of 6.
What should the nurse do first?
A. Administer oxygen via mask
B. Notify the provider
C. Administer naloxone
D. Document findings
Correct Answer: C
Rationale: RR <8 indicates life-threatening opioid-induced respiratory depression.
Naloxone is the priority intervention.
7. Which electrolyte imbalance is associated with positive Chvostek’s and
Trousseau’s signs?
A. Hypernatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypermagnesemia
Correct Answer: B
Rationale: Hypocalcemia increases neuromuscular excitability → classic clinical
signs.
8. Which change in vital signs is the earliest reliable indicator of internal
bleeding?
A. Decreased blood pressure
B. Increased heart rate
C. Decreased oxygen saturation
D. Increased respiratory rate
Correct Answer: B
Rationale: Tachycardia appears before hypotension as compensation for decreased
blood volume.
, 9. A nurse notes ST-elevation on a cardiac monitor. What does this represent?
A. Ventricular repolarization
B. Atrial depolarization
C. Ventricular ischemia/injury
D. Normal sinus rhythm variation
Correct Answer: C
Rationale: STEMI = acute myocardial injury; requires immediate intervention.
10. A patient with pneumonia reports sharp chest pain that worsens with
inspiration. This description is most consistent with:
A. Angina
B. Pleuritic chest pain
C. GERD
D. Pericarditis
Correct Answer: B
Rationale: Pleuritic pain is sharp and triggered by deep breathing due to inflamed
pleura.
11. Which factor most increases preload?
A. Diuresis
B. Hemorrhage
C. Fluid volume overload
D. Vasodilation
Correct Answer: C
Rationale: Excess fluid increases venous return → ↑ preload.
ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED A+
LATEST
1. Which physiologic mechanism best explains why a patient with chronic
heart failure develops peripheral edema?
A. Increased colloid oncotic pressure
B. Decreased hydrostatic pressure
C. Activation of the renin–angiotensin–aldosterone system
D. Increased lymphatic drainage
Correct Answer: C
Rationale: RAAS activation causes sodium/water retention → ↑ intravascular
volume → ↑ capillary hydrostatic pressure → fluid shifts into interstitial spaces →
edema.
2. A patient with COPD suddenly becomes confused and restless. What is the
most likely primary cause?
A. Metabolic alkalosis
B. Hypercapnia
C. Hypokalemia
D. Dehydration
Correct Answer: B
Rationale: Rising CO₂ levels cause cerebral vasodilation and depressed CNS
function → confusion and agitation. Common acute change in COPD
exacerbations.
,3. Which lab value requires immediate provider notification for a patient
receiving IV heparin?
A. aPTT of 65 seconds
B. Platelets 48,000/µL
C. INR 1.1
D. Hematocrit 35%
Correct Answer: B
Rationale: Platelets <50,000 indicate risk of heparin-induced thrombocytopenia
(HIT), a medical emergency.
4. A nurse assesses a patient with sepsis who is now hypotensive, confused,
and has cold extremities. What shock stage is most likely?
A. Initial
B. Compensatory
C. Progressive
D. Refractory
Correct Answer: C
Rationale: Progressive shock presents with organ hypoperfusion → confusion,
hypotension, cool skin.
5. Which finding indicates left-sided heart failure rather than right-sided?
A. Ascites
B. Jugular vein distention
C. Pulmonary crackles
D. Lower-extremity edema
Correct Answer: C
Rationale: Left-sided failure → pulmonary congestion; right-sided → systemic
fluid accumulation.
,6. A patient receiving morphine IV becomes difficult to arouse with RR of 6.
What should the nurse do first?
A. Administer oxygen via mask
B. Notify the provider
C. Administer naloxone
D. Document findings
Correct Answer: C
Rationale: RR <8 indicates life-threatening opioid-induced respiratory depression.
Naloxone is the priority intervention.
7. Which electrolyte imbalance is associated with positive Chvostek’s and
Trousseau’s signs?
A. Hypernatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypermagnesemia
Correct Answer: B
Rationale: Hypocalcemia increases neuromuscular excitability → classic clinical
signs.
8. Which change in vital signs is the earliest reliable indicator of internal
bleeding?
A. Decreased blood pressure
B. Increased heart rate
C. Decreased oxygen saturation
D. Increased respiratory rate
Correct Answer: B
Rationale: Tachycardia appears before hypotension as compensation for decreased
blood volume.
, 9. A nurse notes ST-elevation on a cardiac monitor. What does this represent?
A. Ventricular repolarization
B. Atrial depolarization
C. Ventricular ischemia/injury
D. Normal sinus rhythm variation
Correct Answer: C
Rationale: STEMI = acute myocardial injury; requires immediate intervention.
10. A patient with pneumonia reports sharp chest pain that worsens with
inspiration. This description is most consistent with:
A. Angina
B. Pleuritic chest pain
C. GERD
D. Pericarditis
Correct Answer: B
Rationale: Pleuritic pain is sharp and triggered by deep breathing due to inflamed
pleura.
11. Which factor most increases preload?
A. Diuresis
B. Hemorrhage
C. Fluid volume overload
D. Vasodilation
Correct Answer: C
Rationale: Excess fluid increases venous return → ↑ preload.
