Test bank for NRNP 6540 Final Exam – (2025_2026)
1. A 35-year-old female presents with fatigue, pallor, and shortness of breath. Lab results reveal
hemoglobin of 8 g/dL and MCV of 70 fL. What is the most likely cause?
A. Iron deficiency anemia
B. Vitamin B12 deficiency
C. Folate deficiency
D. Aplastic anemia
Answer: A. Iron deficiency anemia
Rationale: Microcytic anemia (low MCV) with fatigue and pallor is most consistent with iron
deficiency, commonly due to chronic blood loss or dietary insufficiency.
2. A patient with COPD presents with worsening dyspnea. ABG shows pH 7.32, PaCO₂ 55
mmHg, and HCO₃⁻ 28 mEq/L. What is the acid-base disturbance?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis with compensation
D. Respiratory alkalosis
Answer: C. Respiratory acidosis with compensation
Rationale: Low pH and elevated PaCO₂ indicate primary respiratory acidosis. The slightly
elevated HCO₃⁻ shows renal compensation.
3. Which of the following vaccines is contraindicated in pregnancy?
A. Tdap
B. Influenza (inactivated)
C. MMR
D. Hepatitis B
Answer: C. MMR
Rationale: MMR is a live attenuated vaccine and is contraindicated in pregnancy due to
teratogenic risk.
4. A 60-year-old male presents with sudden-onset chest pain radiating to the left arm. ECG
shows ST-elevation in leads II, III, aVF. Which coronary artery is likely involved?
A. Left anterior descending
B. Right coronary artery
,C. Left circumflex
D. Posterior descending
Answer: B. Right coronary artery
Rationale: ST-elevation in the inferior leads (II, III, aVF) indicates inferior MI, most commonly
due to RCA occlusion.
5. A patient reports polyuria, polydipsia, and fatigue. Lab results: fasting glucose 145 mg/dL,
HbA1c 7.2%. What is the appropriate first-line therapy?
A. Insulin therapy
B. Metformin
C. Sulfonylurea
D. GLP-1 agonist
Answer: B. Metformin
Rationale: Metformin is first-line therapy for type 2 diabetes unless contraindicated (renal
impairment).
6. Which of the following is the most sensitive marker for myocardial injury?
A. CK-MB
B. Troponin I/T
C. Myoglobin
D. LDH
Answer: B. Troponin I/T
Rationale: Troponin is highly specific and sensitive for myocardial injury and remains elevated
longer than CK-MB.
7. A patient with hypertension has been started on lisinopril. Which side effect should be closely
monitored?
A. Hyperkalemia
B. Hypoglycemia
C. Hypocalcemia
D. Hypernatremia
Answer: A. Hyperkalemia
Rationale: ACE inhibitors can cause elevated potassium levels due to reduced aldosterone
secretion.
, 8. A 28-year-old female presents with dysuria, frequency, and urgency. Urinalysis shows
positive leukocyte esterase and nitrites. What is the first-line treatment?
A. Ciprofloxacin
B. Nitrofurantoin
C. Amoxicillin
D. Doxycycline
Answer: B. Nitrofurantoin
Rationale: Nitrofurantoin is first-line therapy for uncomplicated urinary tract infections in
women, unless contraindicated.
9. Which of the following symptoms is most characteristic of hypothyroidism?
A. Heat intolerance
B. Weight loss
C. Bradycardia
D. Diarrhea
Answer: C. Bradycardia
Rationale: Hypothyroidism slows metabolism, causing bradycardia, fatigue, weight gain, and
cold intolerance.
10. A patient with asthma is prescribed albuterol as a rescue inhaler. How does albuterol work?
A. Inhibits leukotrienes
B. Blocks muscarinic receptors
C. Stimulates β₂-adrenergic receptors
D. Reduces histamine release
Answer: C. Stimulates β₂-adrenergic receptors
Rationale: Albuterol is a short-acting β₂ agonist that relaxes bronchial smooth muscle.
11. A patient presents with right lower quadrant pain, fever, and leukocytosis. What is the most
likely diagnosis?
A. Cholecystitis
B. Appendicitis
C. Diverticulitis
D. Peptic ulcer disease
Answer: B. Appendicitis
Rationale: RLQ pain, fever, and leukocytosis are classic findings of acute appendicitis.
1. A 35-year-old female presents with fatigue, pallor, and shortness of breath. Lab results reveal
hemoglobin of 8 g/dL and MCV of 70 fL. What is the most likely cause?
A. Iron deficiency anemia
B. Vitamin B12 deficiency
C. Folate deficiency
D. Aplastic anemia
Answer: A. Iron deficiency anemia
Rationale: Microcytic anemia (low MCV) with fatigue and pallor is most consistent with iron
deficiency, commonly due to chronic blood loss or dietary insufficiency.
2. A patient with COPD presents with worsening dyspnea. ABG shows pH 7.32, PaCO₂ 55
mmHg, and HCO₃⁻ 28 mEq/L. What is the acid-base disturbance?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis with compensation
D. Respiratory alkalosis
Answer: C. Respiratory acidosis with compensation
Rationale: Low pH and elevated PaCO₂ indicate primary respiratory acidosis. The slightly
elevated HCO₃⁻ shows renal compensation.
3. Which of the following vaccines is contraindicated in pregnancy?
A. Tdap
B. Influenza (inactivated)
C. MMR
D. Hepatitis B
Answer: C. MMR
Rationale: MMR is a live attenuated vaccine and is contraindicated in pregnancy due to
teratogenic risk.
4. A 60-year-old male presents with sudden-onset chest pain radiating to the left arm. ECG
shows ST-elevation in leads II, III, aVF. Which coronary artery is likely involved?
A. Left anterior descending
B. Right coronary artery
,C. Left circumflex
D. Posterior descending
Answer: B. Right coronary artery
Rationale: ST-elevation in the inferior leads (II, III, aVF) indicates inferior MI, most commonly
due to RCA occlusion.
5. A patient reports polyuria, polydipsia, and fatigue. Lab results: fasting glucose 145 mg/dL,
HbA1c 7.2%. What is the appropriate first-line therapy?
A. Insulin therapy
B. Metformin
C. Sulfonylurea
D. GLP-1 agonist
Answer: B. Metformin
Rationale: Metformin is first-line therapy for type 2 diabetes unless contraindicated (renal
impairment).
6. Which of the following is the most sensitive marker for myocardial injury?
A. CK-MB
B. Troponin I/T
C. Myoglobin
D. LDH
Answer: B. Troponin I/T
Rationale: Troponin is highly specific and sensitive for myocardial injury and remains elevated
longer than CK-MB.
7. A patient with hypertension has been started on lisinopril. Which side effect should be closely
monitored?
A. Hyperkalemia
B. Hypoglycemia
C. Hypocalcemia
D. Hypernatremia
Answer: A. Hyperkalemia
Rationale: ACE inhibitors can cause elevated potassium levels due to reduced aldosterone
secretion.
, 8. A 28-year-old female presents with dysuria, frequency, and urgency. Urinalysis shows
positive leukocyte esterase and nitrites. What is the first-line treatment?
A. Ciprofloxacin
B. Nitrofurantoin
C. Amoxicillin
D. Doxycycline
Answer: B. Nitrofurantoin
Rationale: Nitrofurantoin is first-line therapy for uncomplicated urinary tract infections in
women, unless contraindicated.
9. Which of the following symptoms is most characteristic of hypothyroidism?
A. Heat intolerance
B. Weight loss
C. Bradycardia
D. Diarrhea
Answer: C. Bradycardia
Rationale: Hypothyroidism slows metabolism, causing bradycardia, fatigue, weight gain, and
cold intolerance.
10. A patient with asthma is prescribed albuterol as a rescue inhaler. How does albuterol work?
A. Inhibits leukotrienes
B. Blocks muscarinic receptors
C. Stimulates β₂-adrenergic receptors
D. Reduces histamine release
Answer: C. Stimulates β₂-adrenergic receptors
Rationale: Albuterol is a short-acting β₂ agonist that relaxes bronchial smooth muscle.
11. A patient presents with right lower quadrant pain, fever, and leukocytosis. What is the most
likely diagnosis?
A. Cholecystitis
B. Appendicitis
C. Diverticulitis
D. Peptic ulcer disease
Answer: B. Appendicitis
Rationale: RLQ pain, fever, and leukocytosis are classic findings of acute appendicitis.
