NURS 6645 – Week 6 Midterm Examination Advanced
Pathophysiology, Pharmacology, and Clinical Decision-
Making ( Questions& verified answers )
Overview:
This midterm examination is a comprehensive, graduate-level assessment designed for
advanced practice nursing students in NURS 6645. It consists of 100 long, case-based,
NCLEX-style questions covering high-yield topics including cardiovascular, respiratory,
renal, endocrine, hematologic, infectious, neurologic, and gastrointestinal systems, as well
as pharmacology, safety, and professional practice. Each question is accompanied by the
correct answer in bold and a rationale to reinforce understanding. The exam emphasizes
critical thinking, clinical reasoning, and evidence-based decision-making to prepare students
for real-world patient care scenarios and advanced practice competency.
CARDIOVASCULAR & HEMODYNAMICS
1.
A 70-year-old patient presents with exertional dyspnea, orthopnea, and an echocardiogram
showing left ventricular hypertrophy with a normal ejection fraction. Which underlying
abnormality most likely explains this condition?
A. Reduced myocardial contractility
B. Impaired ventricular relaxation leading to poor filling
C. Valvular regurgitation
D. Reduced preload
Rationale: HFpEF is caused by diastolic dysfunction due to stiff ventricles.
2.
A patient with chronic hypertension develops sudden pulmonary congestion after receiving IV
fluids. Which hemodynamic change most likely precipitated this event?
A. Reduced systemic vascular resistance
B. Elevated left ventricular end-diastolic pressure
,C. Decreased afterload
D. Increased cardiac output
Rationale: High filling pressures lead to pulmonary edema.
3.
A patient taking furosemide for heart failure reports dizziness when standing. Which physiologic
mechanism best explains this symptom?
A. Reflex bradycardia
B. Intravascular volume depletion causing orthostatic hypotension
C. Increased preload
D. Enhanced venous return
Rationale: Diuretics reduce volume, lowering blood pressure on standing.
4.
A widened pulse pressure is most likely found in which condition?
A. Cardiogenic shock
B. Chronic aortic regurgitation
C. Pulmonary embolism
D. Cardiac tamponade
Rationale: Regurgitation increases systolic and lowers diastolic pressure.
5.
A patient with heart failure shows improved survival after starting carvedilol. Which mechanism
explains this benefit?
A. Immediate diuresis
B. Reduced sympathetic nervous system activation
C. Increased myocardial oxygen demand
D. Vasoconstriction
Rationale: Beta blockers reduce neurohormonal damage and remodeling.
,RESPIRATORY & ACID–BASE
6.
A patient with panic disorder presents with lightheadedness and tingling in the fingers. ABG
shows pH 7.52, PaCO₂ 28 mmHg. What is the primary cause?
A. Renal bicarbonate loss
B. Excessive CO₂ elimination from hyperventilation
C. Metabolic acidosis
D. Hypoventilation
Rationale: Anxiety causes respiratory alkalosis via hyperventilation.
7.
A patient with severe COPD shows rising PaCO₂ and declining mental status. Which finding
signals impending respiratory failure?
A. PaO₂ 78 mmHg
B. Progressive CO₂ retention with falling pH
C. Mild tachypnea
D. Normal bicarbonate
Rationale: CO₂ narcosis indicates ventilatory failure.
8.
A patient with prolonged vomiting presents with weakness. Which acid–base disorder is most
likely?
A. Metabolic acidosis
B. Metabolic alkalosis due to loss of gastric acid
C. Respiratory acidosis
D. Mixed disorder
Rationale: Loss of hydrogen ions causes alkalosis.
, RENAL & ELECTROLYTES
9.
A hospitalized patient becomes oliguric after severe dehydration. Which type of AKI is most
likely?
A. Intrinsic
B. Post-renal
C. Pre-renal hypoperfusion
D. Glomerular
Rationale: Volume depletion reduces renal perfusion.
10.
An older adult taking NSAIDs and ACE inhibitors develops rising creatinine. Which combined
effect explains this injury?
A. Increased renal blood flow
B. Reduced afferent and efferent arteriolar compensation
C. Increased GFR
D. Enhanced sodium retention
Rationale: NSAIDs constrict afferent; ACE inhibitors dilate efferent arterioles.
11.
A potassium level of 6.9 mEq/L with ECG changes requires which immediate intervention?
A. Oral sodium polystyrene
B. Insulin infusion
C. IV calcium gluconate
D. Loop diuretics
Rationale: Calcium stabilizes cardiac membranes.
12.
Pathophysiology, Pharmacology, and Clinical Decision-
Making ( Questions& verified answers )
Overview:
This midterm examination is a comprehensive, graduate-level assessment designed for
advanced practice nursing students in NURS 6645. It consists of 100 long, case-based,
NCLEX-style questions covering high-yield topics including cardiovascular, respiratory,
renal, endocrine, hematologic, infectious, neurologic, and gastrointestinal systems, as well
as pharmacology, safety, and professional practice. Each question is accompanied by the
correct answer in bold and a rationale to reinforce understanding. The exam emphasizes
critical thinking, clinical reasoning, and evidence-based decision-making to prepare students
for real-world patient care scenarios and advanced practice competency.
CARDIOVASCULAR & HEMODYNAMICS
1.
A 70-year-old patient presents with exertional dyspnea, orthopnea, and an echocardiogram
showing left ventricular hypertrophy with a normal ejection fraction. Which underlying
abnormality most likely explains this condition?
A. Reduced myocardial contractility
B. Impaired ventricular relaxation leading to poor filling
C. Valvular regurgitation
D. Reduced preload
Rationale: HFpEF is caused by diastolic dysfunction due to stiff ventricles.
2.
A patient with chronic hypertension develops sudden pulmonary congestion after receiving IV
fluids. Which hemodynamic change most likely precipitated this event?
A. Reduced systemic vascular resistance
B. Elevated left ventricular end-diastolic pressure
,C. Decreased afterload
D. Increased cardiac output
Rationale: High filling pressures lead to pulmonary edema.
3.
A patient taking furosemide for heart failure reports dizziness when standing. Which physiologic
mechanism best explains this symptom?
A. Reflex bradycardia
B. Intravascular volume depletion causing orthostatic hypotension
C. Increased preload
D. Enhanced venous return
Rationale: Diuretics reduce volume, lowering blood pressure on standing.
4.
A widened pulse pressure is most likely found in which condition?
A. Cardiogenic shock
B. Chronic aortic regurgitation
C. Pulmonary embolism
D. Cardiac tamponade
Rationale: Regurgitation increases systolic and lowers diastolic pressure.
5.
A patient with heart failure shows improved survival after starting carvedilol. Which mechanism
explains this benefit?
A. Immediate diuresis
B. Reduced sympathetic nervous system activation
C. Increased myocardial oxygen demand
D. Vasoconstriction
Rationale: Beta blockers reduce neurohormonal damage and remodeling.
,RESPIRATORY & ACID–BASE
6.
A patient with panic disorder presents with lightheadedness and tingling in the fingers. ABG
shows pH 7.52, PaCO₂ 28 mmHg. What is the primary cause?
A. Renal bicarbonate loss
B. Excessive CO₂ elimination from hyperventilation
C. Metabolic acidosis
D. Hypoventilation
Rationale: Anxiety causes respiratory alkalosis via hyperventilation.
7.
A patient with severe COPD shows rising PaCO₂ and declining mental status. Which finding
signals impending respiratory failure?
A. PaO₂ 78 mmHg
B. Progressive CO₂ retention with falling pH
C. Mild tachypnea
D. Normal bicarbonate
Rationale: CO₂ narcosis indicates ventilatory failure.
8.
A patient with prolonged vomiting presents with weakness. Which acid–base disorder is most
likely?
A. Metabolic acidosis
B. Metabolic alkalosis due to loss of gastric acid
C. Respiratory acidosis
D. Mixed disorder
Rationale: Loss of hydrogen ions causes alkalosis.
, RENAL & ELECTROLYTES
9.
A hospitalized patient becomes oliguric after severe dehydration. Which type of AKI is most
likely?
A. Intrinsic
B. Post-renal
C. Pre-renal hypoperfusion
D. Glomerular
Rationale: Volume depletion reduces renal perfusion.
10.
An older adult taking NSAIDs and ACE inhibitors develops rising creatinine. Which combined
effect explains this injury?
A. Increased renal blood flow
B. Reduced afferent and efferent arteriolar compensation
C. Increased GFR
D. Enhanced sodium retention
Rationale: NSAIDs constrict afferent; ACE inhibitors dilate efferent arterioles.
11.
A potassium level of 6.9 mEq/L with ECG changes requires which immediate intervention?
A. Oral sodium polystyrene
B. Insulin infusion
C. IV calcium gluconate
D. Loop diuretics
Rationale: Calcium stabilizes cardiac membranes.
12.
