NURS 8022 Practice Exam — Exam 2 Latest Actual”
Exam Questions And Answers With Rationale Grade
A+.
Question 1
A 59-year-old male presents with sudden onset of severe chest pain radiating to his left arm
and jaw. His ECG shows ST-segment elevations in leads V2–V5. Which coronary artery is
most likely occluded?
A. Right coronary artery (RCA)
B. Left circumflex artery (LCx)
C. Left anterior descending artery (LAD)
D. Posterior descending artery (PDA)
Correct Answer: C. Left anterior descending artery (LAD)
Rationale: The LAD supplies the anterior wall of the left ventricle. ST-segment
elevations in V2–V5 indicate an anterior MI, which is most commonly due to
LAD occlusion. The RCA typically affects inferior leads (II, III, aVF), and LCx
affects lateral leads (I, aVL, V5–V6).
Question 2
A 45-year-old female with rheumatoid arthritis has new onset fatigue and pallor. Lab values
show hemoglobin 8.2 g/dL, MCV 70 fL, and ferritin 15 ng/mL. The most appropriate next
step is:
A. Start oral vitamin B12
B. Begin iron supplementation
C. Perform a bone marrow biopsy
D. Administer erythropoietin
Correct Answer: B. Begin iron supplementation
Rationale: Low ferritin and low MCV indicate iron deficiency anemia. Ferritin
is the best initial test to diagnose iron deficiency. Iron supplementation is
appropriate. B12 is used for macrocytic anemia, and bone marrow biopsy is not
first-line unless the cause is unclear or refractory to treatment.
,Question 3
A patient with COPD presents with increasing dyspnea and a respiratory rate of 32. ABG
reveals: pH 7.25, PaCO₂ 60 mmHg, PaO₂ 55 mmHg, HCO₃⁻ 28 mEq/L. What is the primary
acid-base disturbance?
A. Metabolic acidosis
B. Acute respiratory acidosis
C. Chronic respiratory acidosis with compensation
D. Mixed metabolic and respiratory acidosis
Correct Answer: B. Acute respiratory acidosis
Rationale: Elevated PaCO₂ with a low pH indicates respiratory acidosis.
Bicarbonate is slightly elevated but not sufficiently to indicate chronic
compensation. This suggests an acute exacerbation of COPD leading to acute
CO₂ retention and respiratory acidosis.
Question 4
During an abdominal exam, you note a bruit in the epigastric region that radiates to the back.
This finding is most suspicious for:
A. Appendicitis
B. Abdominal aortic aneurysm (AAA)
C. Peptic ulcer disease
D. Hepatitis
Correct Answer: B. Abdominal aortic aneurysm (AAA)
Rationale: A bruit in the epigastric region that radiates to the back is
characteristic of turbulent flow in an aneurysmal abdominal aorta. Ultrasound
is the initial diagnostic test. Appendicitis and hepatitis don’t produce bruits;
peptic ulcer pain is epigastric but without vascular bruit.
Question 5
A 32-year-old G2P1 at 28 weeks gestation reports painless vaginal bleeding. What is the
most appropriate immediate action?
A. Perform digital vaginal exam
B. Obtain a transvaginal ultrasound
C. Check hemoglobin and type & screen
D. Proceed to speculum exam
,Correct Answer: C. Check hemoglobin and type & screen
Rationale: In a third-trimester bleed, the immediate priorities are maternal
stabilization and preparation for possible transfusion. Digital vaginal exam is
contraindicated until placenta previa is ruled out. Transvaginal U/S may be
needed later, but initial labs are key to manage bleeding.
Question 6
A patient with suspected meningitis has a positive Kernig’s sign. Which action is most
appropriate?
A. Perform a lumbar puncture immediately
B. Start broad-spectrum antibiotics
C. Administer oral corticosteroids
D. Order a CT scan of the abdomen
Correct Answer: B. Start broad-spectrum antibiotics
Rationale: A positive Kernig’s sign suggests meningeal irritation. Meningitis is
a medical emergency; empiric antibiotics should be started promptly. LP may
follow after stabilization, and steroids may be added depending on age and
suspected pathogen. A CT abdomen is irrelevant.
Question 7
A 70-year-old with new onset atrial fibrillation is started on warfarin. Which lab value is
most important to monitor?
A. Platelet count
B. Prothrombin time/INR
C. Serum creatinine
D. Troponin
Correct Answer: B. Prothrombin time/INR
Rationale: Warfarin’s therapeutic effect and bleeding risk are monitored using
INR. Platelets are important for other anticoagulants, creatinine for dosage
adjustments of certain drugs, and troponin for MI evaluation.
Question 8
A 25-year-old presents with sudden, severe left lower quadrant pain and vomiting. Suspicion
is high for:
, A. Cholecystitis
B. Acute appendicitis
C. Ovarian torsion
D. Nephrolithiasis
Correct Answer: C. Ovarian torsion
Rationale: Sudden onset severe lower quadrant pain in a premenopausal female
with vomiting raises suspicion for ovarian torsion — a surgical emergency.
Appendicitis is usually right side, cholecystitis is RUQ pain, and nephrolithiasis
typically causes flank/ureteral colic.
Question 9
A patient with congestive heart failure presents with BNP elevated at 1200 pg/mL. BNP
primarily helps to:
A. Diagnose myocardial infarction
B. Evaluate severity of heart failure
C. Assess for pulmonary embolism
D. Differentiate viral vs bacterial infection
Correct Answer: B. Evaluate severity of heart failure
Rationale: B-type natriuretic peptide (BNP) levels rise with increased
ventricular stretch in heart failure. High BNP supports HF diagnosis and
correlates with severity. It’s not used to diagnose MI, PE, or infections.
Question 10
A school-aged child with asthma uses a rescue inhaler >2 days/week and has nighttime
symptoms >2 nights/month. According to step-wise management, the next best intervention
is:
A. Continue current regimen only
B. Add a low-dose inhaled corticosteroid
C. Switch to oral steroids daily
D. Discontinue all bronchodilators
Correct Answer: B. Add a low-dose inhaled corticosteroid
Rationale: Frequent symptoms indicate persistent asthma. A low-dose ICS is
appropriate next step. Oral steroids are for acute exacerbations, not daily
control, and bronchodilators shouldn’t be discontinued.
Exam Questions And Answers With Rationale Grade
A+.
Question 1
A 59-year-old male presents with sudden onset of severe chest pain radiating to his left arm
and jaw. His ECG shows ST-segment elevations in leads V2–V5. Which coronary artery is
most likely occluded?
A. Right coronary artery (RCA)
B. Left circumflex artery (LCx)
C. Left anterior descending artery (LAD)
D. Posterior descending artery (PDA)
Correct Answer: C. Left anterior descending artery (LAD)
Rationale: The LAD supplies the anterior wall of the left ventricle. ST-segment
elevations in V2–V5 indicate an anterior MI, which is most commonly due to
LAD occlusion. The RCA typically affects inferior leads (II, III, aVF), and LCx
affects lateral leads (I, aVL, V5–V6).
Question 2
A 45-year-old female with rheumatoid arthritis has new onset fatigue and pallor. Lab values
show hemoglobin 8.2 g/dL, MCV 70 fL, and ferritin 15 ng/mL. The most appropriate next
step is:
A. Start oral vitamin B12
B. Begin iron supplementation
C. Perform a bone marrow biopsy
D. Administer erythropoietin
Correct Answer: B. Begin iron supplementation
Rationale: Low ferritin and low MCV indicate iron deficiency anemia. Ferritin
is the best initial test to diagnose iron deficiency. Iron supplementation is
appropriate. B12 is used for macrocytic anemia, and bone marrow biopsy is not
first-line unless the cause is unclear or refractory to treatment.
,Question 3
A patient with COPD presents with increasing dyspnea and a respiratory rate of 32. ABG
reveals: pH 7.25, PaCO₂ 60 mmHg, PaO₂ 55 mmHg, HCO₃⁻ 28 mEq/L. What is the primary
acid-base disturbance?
A. Metabolic acidosis
B. Acute respiratory acidosis
C. Chronic respiratory acidosis with compensation
D. Mixed metabolic and respiratory acidosis
Correct Answer: B. Acute respiratory acidosis
Rationale: Elevated PaCO₂ with a low pH indicates respiratory acidosis.
Bicarbonate is slightly elevated but not sufficiently to indicate chronic
compensation. This suggests an acute exacerbation of COPD leading to acute
CO₂ retention and respiratory acidosis.
Question 4
During an abdominal exam, you note a bruit in the epigastric region that radiates to the back.
This finding is most suspicious for:
A. Appendicitis
B. Abdominal aortic aneurysm (AAA)
C. Peptic ulcer disease
D. Hepatitis
Correct Answer: B. Abdominal aortic aneurysm (AAA)
Rationale: A bruit in the epigastric region that radiates to the back is
characteristic of turbulent flow in an aneurysmal abdominal aorta. Ultrasound
is the initial diagnostic test. Appendicitis and hepatitis don’t produce bruits;
peptic ulcer pain is epigastric but without vascular bruit.
Question 5
A 32-year-old G2P1 at 28 weeks gestation reports painless vaginal bleeding. What is the
most appropriate immediate action?
A. Perform digital vaginal exam
B. Obtain a transvaginal ultrasound
C. Check hemoglobin and type & screen
D. Proceed to speculum exam
,Correct Answer: C. Check hemoglobin and type & screen
Rationale: In a third-trimester bleed, the immediate priorities are maternal
stabilization and preparation for possible transfusion. Digital vaginal exam is
contraindicated until placenta previa is ruled out. Transvaginal U/S may be
needed later, but initial labs are key to manage bleeding.
Question 6
A patient with suspected meningitis has a positive Kernig’s sign. Which action is most
appropriate?
A. Perform a lumbar puncture immediately
B. Start broad-spectrum antibiotics
C. Administer oral corticosteroids
D. Order a CT scan of the abdomen
Correct Answer: B. Start broad-spectrum antibiotics
Rationale: A positive Kernig’s sign suggests meningeal irritation. Meningitis is
a medical emergency; empiric antibiotics should be started promptly. LP may
follow after stabilization, and steroids may be added depending on age and
suspected pathogen. A CT abdomen is irrelevant.
Question 7
A 70-year-old with new onset atrial fibrillation is started on warfarin. Which lab value is
most important to monitor?
A. Platelet count
B. Prothrombin time/INR
C. Serum creatinine
D. Troponin
Correct Answer: B. Prothrombin time/INR
Rationale: Warfarin’s therapeutic effect and bleeding risk are monitored using
INR. Platelets are important for other anticoagulants, creatinine for dosage
adjustments of certain drugs, and troponin for MI evaluation.
Question 8
A 25-year-old presents with sudden, severe left lower quadrant pain and vomiting. Suspicion
is high for:
, A. Cholecystitis
B. Acute appendicitis
C. Ovarian torsion
D. Nephrolithiasis
Correct Answer: C. Ovarian torsion
Rationale: Sudden onset severe lower quadrant pain in a premenopausal female
with vomiting raises suspicion for ovarian torsion — a surgical emergency.
Appendicitis is usually right side, cholecystitis is RUQ pain, and nephrolithiasis
typically causes flank/ureteral colic.
Question 9
A patient with congestive heart failure presents with BNP elevated at 1200 pg/mL. BNP
primarily helps to:
A. Diagnose myocardial infarction
B. Evaluate severity of heart failure
C. Assess for pulmonary embolism
D. Differentiate viral vs bacterial infection
Correct Answer: B. Evaluate severity of heart failure
Rationale: B-type natriuretic peptide (BNP) levels rise with increased
ventricular stretch in heart failure. High BNP supports HF diagnosis and
correlates with severity. It’s not used to diagnose MI, PE, or infections.
Question 10
A school-aged child with asthma uses a rescue inhaler >2 days/week and has nighttime
symptoms >2 nights/month. According to step-wise management, the next best intervention
is:
A. Continue current regimen only
B. Add a low-dose inhaled corticosteroid
C. Switch to oral steroids daily
D. Discontinue all bronchodilators
Correct Answer: B. Add a low-dose inhaled corticosteroid
Rationale: Frequent symptoms indicate persistent asthma. A low-dose ICS is
appropriate next step. Oral steroids are for acute exacerbations, not daily
control, and bronchodilators shouldn’t be discontinued.
