MSN Midterm Milestone | Modules 1–6 Cumulative Performance
Review 2026 |Galen
1. In cellular adaptation, which process involves a reversible change in which
one adult cell type is replaced by another adult cell type?
A. Hyperplasia
B. Dysplasia
C. Atrophy
D. Metaplasia
Answer: D
Rationale: Metaplasia is a reversible replacement of one mature cell type by another, often
as a response to chronic irritation.
2. A patient presents with metabolic acidosis. Which compensatory mechanism
would the nurse practitioner expect to see?
A. Decreased respiratory rate
B. Increased renal excretion of bicarbonate
C. Increased respiratory rate (Kussmaul breathing)
D. Retention of carbon dioxide
Answer: C
Rationale: To compensate for metabolic acidosis, the lungs increase the rate and depth of
ventilation to blow off CO2 and raise the pH.
,3. Which level of evidence is considered the ‘gold standard’ in the hierarchy of
evidence-based practice?
A. Expert opinion
B. Case-control studies
C. Qualitative research
D. Systematic reviews of Randomized Controlled Trials (RCTs)
Answer: D
Rationale: Systematic reviews or meta-analyses of all relevant RCTs provide the highest
level of evidence for clinical decision-making.
4. According to Patricia Benner’s stages of clinical competence, a nurse who has
been in the same situation for 2-3 years and can develop a plan of care is at
what level?
A. Competent
B. Proficient
C. Novice
D. Expert
Answer: A
Rationale: The Competent nurse has usually been on the job in the same or similar
situations for two to three years and develops a plan based on conscious, abstract,
analytical thinking.
5. Which pharmacokinetic process is primarily affected by a patient’s liver
function?
A. Metabolism
B. Distribution
C. Absorption
D. Excretion
Answer: A
, Rationale: The liver is the primary site for drug metabolism, utilizing enzymes like the
Cytochrome P450 system.
6. In the PICO(T) format for research, what does the ‘I’ represent?
A. Implementation
B. Intervention
C. Investigation
D. Individual
Answer: B
Rationale: PICO(T) stands for Patient/Population, Intervention, Comparison, Outcome,
and Time.
7. Which ethical principle refers to the obligation to ‘do no harm’ to a patient?
A. Non-maleficence
B. Autonomy
C. Beneficence
D. Justice
Answer: A
Rationale: Non-maleficence is the bioethical principle of avoiding the causation of harm.
8. During a physical assessment, the practitioner uses the bell of the
stethoscope primarily to hear which sounds?
A. High-pitched breath sounds
B. Low-pitched vascular sounds and murmurs
C. Normal S1 and S2 heart sounds
D. Bowel sounds
Answer: B
Rationale: The bell is used for low-frequency sounds like bruits or certain heart murmurs;
the diaphragm is for high-frequency sounds.
Review 2026 |Galen
1. In cellular adaptation, which process involves a reversible change in which
one adult cell type is replaced by another adult cell type?
A. Hyperplasia
B. Dysplasia
C. Atrophy
D. Metaplasia
Answer: D
Rationale: Metaplasia is a reversible replacement of one mature cell type by another, often
as a response to chronic irritation.
2. A patient presents with metabolic acidosis. Which compensatory mechanism
would the nurse practitioner expect to see?
A. Decreased respiratory rate
B. Increased renal excretion of bicarbonate
C. Increased respiratory rate (Kussmaul breathing)
D. Retention of carbon dioxide
Answer: C
Rationale: To compensate for metabolic acidosis, the lungs increase the rate and depth of
ventilation to blow off CO2 and raise the pH.
,3. Which level of evidence is considered the ‘gold standard’ in the hierarchy of
evidence-based practice?
A. Expert opinion
B. Case-control studies
C. Qualitative research
D. Systematic reviews of Randomized Controlled Trials (RCTs)
Answer: D
Rationale: Systematic reviews or meta-analyses of all relevant RCTs provide the highest
level of evidence for clinical decision-making.
4. According to Patricia Benner’s stages of clinical competence, a nurse who has
been in the same situation for 2-3 years and can develop a plan of care is at
what level?
A. Competent
B. Proficient
C. Novice
D. Expert
Answer: A
Rationale: The Competent nurse has usually been on the job in the same or similar
situations for two to three years and develops a plan based on conscious, abstract,
analytical thinking.
5. Which pharmacokinetic process is primarily affected by a patient’s liver
function?
A. Metabolism
B. Distribution
C. Absorption
D. Excretion
Answer: A
, Rationale: The liver is the primary site for drug metabolism, utilizing enzymes like the
Cytochrome P450 system.
6. In the PICO(T) format for research, what does the ‘I’ represent?
A. Implementation
B. Intervention
C. Investigation
D. Individual
Answer: B
Rationale: PICO(T) stands for Patient/Population, Intervention, Comparison, Outcome,
and Time.
7. Which ethical principle refers to the obligation to ‘do no harm’ to a patient?
A. Non-maleficence
B. Autonomy
C. Beneficence
D. Justice
Answer: A
Rationale: Non-maleficence is the bioethical principle of avoiding the causation of harm.
8. During a physical assessment, the practitioner uses the bell of the
stethoscope primarily to hear which sounds?
A. High-pitched breath sounds
B. Low-pitched vascular sounds and murmurs
C. Normal S1 and S2 heart sounds
D. Bowel sounds
Answer: B
Rationale: The bell is used for low-frequency sounds like bruits or certain heart murmurs;
the diaphragm is for high-frequency sounds.
