NURS 6645 – Week 6 Midterm Exam Advanced
Pathophysiology, Pharmacology, and Clinical Decision-
Making (Q&A) GRADED A+
This NURS 6645 – Week 6 Midterm Exam is a comprehensive, graduate-level assessment designed to
evaluate advanced nursing students’ understanding of pathophysiology, pharmacology, diagnostic
reasoning, and clinical decision-making. The exam emphasizes high-yield, commonly tested concepts
including cardiovascular, respiratory, renal, endocrine, and infectious disease management, along with
professional and legal responsibilities. All questions are written in NCLEX-style format to support exam
readiness and advanced practice competency.
CARDIOVASCULAR & PATHOPHYSIOLOGY
1. The primary defect in systolic heart failure is:
A. Impaired relaxation
B. Reduced myocardial contractility
C. Increased ventricular compliance
D. Elevated preload
Rationale: Systolic HF is defined by decreased ejection fraction
due to weak ventricular contraction.
2. Heart failure with preserved ejection fraction (HFpEF) is
caused by:
A. Ventricular dilation
B. Impaired ventricular relaxation
C. Reduced preload
D. Decreased afterload
,Rationale: HFpEF results from stiff ventricles that cannot relax
and fill properly.
3. BNP is released in response to:
A. Myocardial ischemia
B. Renal failure
C. Ventricular stretch and volume overload
D. Hypoxia
Rationale: BNP increases when ventricles are stretched, making
it a key marker for HF.
4. Which drug class improves survival in systolic HF?
A. Diuretics
B. Digoxin
C. ACE inhibitors
D. Calcium channel blockers
Rationale: ACE inhibitors reduce remodeling and mortality, not
just symptoms.
5. Acute pulmonary edema is best treated initially with:
A. IV fluids
B. IV furosemide
C. Oral beta blockers
D. Digoxin
Rationale: Loop diuretics rapidly reduce preload and pulmonary
congestion.
,RESPIRATORY & ACID–BASE
6. Chronic CO₂ retention in COPD leads to:
A. Respiratory alkalosis
B. Compensated respiratory acidosis
C. Metabolic acidosis
D. Uncompensated alkalosis
Rationale: Kidneys retain bicarbonate to compensate for chronic
respiratory acidosis.
7. Which ABG shows uncompensated metabolic acidosis?
A. pH 7.48, HCO₃⁻ 28
B. pH 7.38, HCO₃⁻ 22
C. pH 7.30, HCO₃⁻ 18, PaCO₂ 40
D. pH 7.45, PaCO₂ 30
Rationale: Low pH + low HCO₃⁻ without CO₂ compensation.
8. The primary cause of respiratory alkalosis is:
A. Hypoventilation
B. Hyperventilation
C. Renal failure
D. Metabolic acidosis
Rationale: Excessive breathing lowers CO₂ levels.
, RENAL & ELECTROLYTES
9. Anemia in CKD is caused by decreased:
A. Iron absorption
B. Vitamin B12
C. Erythropoietin production
D. Hemoglobin synthesis
Rationale: Diseased kidneys cannot produce adequate
erythropoietin.
10. The earliest sign of acute kidney injury is:
A. Elevated creatinine
B. Decreased urine output
C. Hyperkalemia
D. Metabolic acidosis
Rationale: Oliguria appears before lab changes.
11. Which electrolyte imbalance is most dangerous in DKA
treatment?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Rationale: Insulin drives potassium into cells → life-threatening
hypokalemia.
Pathophysiology, Pharmacology, and Clinical Decision-
Making (Q&A) GRADED A+
This NURS 6645 – Week 6 Midterm Exam is a comprehensive, graduate-level assessment designed to
evaluate advanced nursing students’ understanding of pathophysiology, pharmacology, diagnostic
reasoning, and clinical decision-making. The exam emphasizes high-yield, commonly tested concepts
including cardiovascular, respiratory, renal, endocrine, and infectious disease management, along with
professional and legal responsibilities. All questions are written in NCLEX-style format to support exam
readiness and advanced practice competency.
CARDIOVASCULAR & PATHOPHYSIOLOGY
1. The primary defect in systolic heart failure is:
A. Impaired relaxation
B. Reduced myocardial contractility
C. Increased ventricular compliance
D. Elevated preload
Rationale: Systolic HF is defined by decreased ejection fraction
due to weak ventricular contraction.
2. Heart failure with preserved ejection fraction (HFpEF) is
caused by:
A. Ventricular dilation
B. Impaired ventricular relaxation
C. Reduced preload
D. Decreased afterload
,Rationale: HFpEF results from stiff ventricles that cannot relax
and fill properly.
3. BNP is released in response to:
A. Myocardial ischemia
B. Renal failure
C. Ventricular stretch and volume overload
D. Hypoxia
Rationale: BNP increases when ventricles are stretched, making
it a key marker for HF.
4. Which drug class improves survival in systolic HF?
A. Diuretics
B. Digoxin
C. ACE inhibitors
D. Calcium channel blockers
Rationale: ACE inhibitors reduce remodeling and mortality, not
just symptoms.
5. Acute pulmonary edema is best treated initially with:
A. IV fluids
B. IV furosemide
C. Oral beta blockers
D. Digoxin
Rationale: Loop diuretics rapidly reduce preload and pulmonary
congestion.
,RESPIRATORY & ACID–BASE
6. Chronic CO₂ retention in COPD leads to:
A. Respiratory alkalosis
B. Compensated respiratory acidosis
C. Metabolic acidosis
D. Uncompensated alkalosis
Rationale: Kidneys retain bicarbonate to compensate for chronic
respiratory acidosis.
7. Which ABG shows uncompensated metabolic acidosis?
A. pH 7.48, HCO₃⁻ 28
B. pH 7.38, HCO₃⁻ 22
C. pH 7.30, HCO₃⁻ 18, PaCO₂ 40
D. pH 7.45, PaCO₂ 30
Rationale: Low pH + low HCO₃⁻ without CO₂ compensation.
8. The primary cause of respiratory alkalosis is:
A. Hypoventilation
B. Hyperventilation
C. Renal failure
D. Metabolic acidosis
Rationale: Excessive breathing lowers CO₂ levels.
, RENAL & ELECTROLYTES
9. Anemia in CKD is caused by decreased:
A. Iron absorption
B. Vitamin B12
C. Erythropoietin production
D. Hemoglobin synthesis
Rationale: Diseased kidneys cannot produce adequate
erythropoietin.
10. The earliest sign of acute kidney injury is:
A. Elevated creatinine
B. Decreased urine output
C. Hyperkalemia
D. Metabolic acidosis
Rationale: Oliguria appears before lab changes.
11. Which electrolyte imbalance is most dangerous in DKA
treatment?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Rationale: Insulin drives potassium into cells → life-threatening
hypokalemia.
