NR 507 WEEK 1-4 MIDTERM EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | LATEST EXAM UPDATE 2026/2027
SECTION ONE: QUESTIONS 1–100
Question 1
A 65-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with increasing
dyspnea and a new-onset productive cough. An arterial blood gas (ABG) analysis reveals a pH of 7.31, PaCO2 of
68 mmHg, and HCO3- of 32 mEq/L. Which of the following best describes his acid-base status?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis
C. Metabolic alkalosis with compensation
D. Respiratory acidosis with metabolic compensation
🟢 D. Respiratory acidosis with metabolic compensation
🔴 RATIONALE: The elevated PaCO2 indicates a primary respiratory acidosis. The increased HCO3- suggests a
compensatory metabolic response. Since the pH is not normalized and the HCO3- is elevated, it indicates a
chronic process with renal compensation.
Question 2
A patient is diagnosed with a pleural effusion. Thoracentesis reveals a fluid with a high protein content (greater
than 3 g/dL), high lactate dehydrogenase (LDH), and a low glucose level. This exudative effusion is most
consistent with which of the following conditions?
A. Congestive heart failure
,B. Cirrhosis of the liver
C. Pneumonia
D. Nephrotic syndrome
🟢 C. Pneumonia
🔴 RATIONALE: Exudative effusions are caused by inflammatory conditions (e.g., pneumonia, malignancy) that
increase capillary permeability. High protein and LDH (Light's criteria) differentiate it from transudative effusions
seen in CHF, cirrhosis, or nephrotic syndrome.
Question 3
A 58-year-old female presents with fatigue, weight gain, and cold intolerance. Her laboratory results show
elevated thyroid-stimulating hormone (TSH) and low free T4 levels. Which of the following is the most likely
cause of her condition?
A. Graves' disease
B. Toxic multinodular goiter
C. Hashimoto's thyroiditis
D. Subacute granulomatous thyroiditis
🟢 C. Hashimoto's thyroiditis
🔴 RATIONALE: Elevated TSH with low free T4 is classic for primary hypothyroidism. Hashimoto's thyroiditis is
an autoimmune disorder and the most common cause of primary hypothyroidism in areas with sufficient iodine
intake.
Question 4
A patient with type 1 diabetes mellitus is found unresponsive. His blood glucose is 650 mg/dL, and serum
osmolality is 340 mOsm/kg. Arterial blood gas shows a pH of 7.20 and HCO3- of 12 mEq/L. Which of the
following is the primary underlying pathophysiological process?
,A. Increased hepatic glycogenolysis
B. Decreased peripheral glucose utilization
C. Severe insulin deficiency leading to lipolysis and ketogenesis
D. Impaired renal excretion of glucose
🟢 C. Severe insulin deficiency leading to lipolysis and ketogenesis
🔴 RATIONALE: Diabetic ketoacidosis (DKA) results from an absolute insulin deficiency, leading to uncontrolled
lipolysis, production of ketone bodies, and metabolic acidosis. This condition is characterized by hyperglycemia,
ketonemia, and metabolic acidosis.
Question 5
A 72-year-old male with benign prostatic hyperplasia (BPH) presents with acute urinary retention. Which of the
following best explains the mechanism of obstruction in this patient?
A. Neurogenic bladder
B. Urethral stricture
C. Mechanical obstruction of the urethra by an enlarged prostate
D. Detrusor muscle overactivity
🟢 C. Mechanical obstruction of the urethra by an enlarged prostate
🔴 RATIONALE: BPH causes mechanical obstruction of the urethra due to the enlarged prostate gland
compressing the urethra, leading to symptoms like hesitancy, weak stream, and, in severe cases, acute urinary
retention.
Question 6
A patient with a history of deep vein thrombosis (DVT) presents with sudden-onset pleuritic chest pain and
hemoptysis. A ventilation-perfusion (V/Q) scan shows a high-probability mismatch. Which of the following is the
most likely underlying diagnosis?
, A. Myocardial infarction
B. Pericarditis
C. Pulmonary embolism
D. Pneumothorax
🟢 C. Pulmonary embolism
🔴 RATIONALE: A V/Q scan mismatch (ventilation present, perfusion absent) is indicative of a pulmonary
embolus. The patient's history of DVT and acute symptoms of pleuritic pain and hemoptysis are also classic for
pulmonary embolism.
Question 7
A 45-year-old female is diagnosed with iron deficiency anemia. Which of the following laboratory findings
would be most consistent with this diagnosis?
A. Elevated serum ferritin
B. High mean corpuscular volume (MCV)
C. Low serum iron and low total iron-binding capacity (TIBC)
D. Low serum ferritin and low serum iron
🟢 D. Low serum ferritin and low serum iron
🔴 RATIONALE: Iron deficiency anemia is characterized by low serum iron, low serum ferritin (which reflects
body iron stores), and high total iron-binding capacity (TIBC).
Question 8
A patient with a history of chronic heart failure develops ascites and peripheral edema. This fluid accumulation
is primarily due to:
A. Decreased plasma oncotic pressure
B. Increased capillary hydrostatic pressure
RATIONALES 2026 Q&A | LATEST EXAM UPDATE 2026/2027
SECTION ONE: QUESTIONS 1–100
Question 1
A 65-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with increasing
dyspnea and a new-onset productive cough. An arterial blood gas (ABG) analysis reveals a pH of 7.31, PaCO2 of
68 mmHg, and HCO3- of 32 mEq/L. Which of the following best describes his acid-base status?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis
C. Metabolic alkalosis with compensation
D. Respiratory acidosis with metabolic compensation
🟢 D. Respiratory acidosis with metabolic compensation
🔴 RATIONALE: The elevated PaCO2 indicates a primary respiratory acidosis. The increased HCO3- suggests a
compensatory metabolic response. Since the pH is not normalized and the HCO3- is elevated, it indicates a
chronic process with renal compensation.
Question 2
A patient is diagnosed with a pleural effusion. Thoracentesis reveals a fluid with a high protein content (greater
than 3 g/dL), high lactate dehydrogenase (LDH), and a low glucose level. This exudative effusion is most
consistent with which of the following conditions?
A. Congestive heart failure
,B. Cirrhosis of the liver
C. Pneumonia
D. Nephrotic syndrome
🟢 C. Pneumonia
🔴 RATIONALE: Exudative effusions are caused by inflammatory conditions (e.g., pneumonia, malignancy) that
increase capillary permeability. High protein and LDH (Light's criteria) differentiate it from transudative effusions
seen in CHF, cirrhosis, or nephrotic syndrome.
Question 3
A 58-year-old female presents with fatigue, weight gain, and cold intolerance. Her laboratory results show
elevated thyroid-stimulating hormone (TSH) and low free T4 levels. Which of the following is the most likely
cause of her condition?
A. Graves' disease
B. Toxic multinodular goiter
C. Hashimoto's thyroiditis
D. Subacute granulomatous thyroiditis
🟢 C. Hashimoto's thyroiditis
🔴 RATIONALE: Elevated TSH with low free T4 is classic for primary hypothyroidism. Hashimoto's thyroiditis is
an autoimmune disorder and the most common cause of primary hypothyroidism in areas with sufficient iodine
intake.
Question 4
A patient with type 1 diabetes mellitus is found unresponsive. His blood glucose is 650 mg/dL, and serum
osmolality is 340 mOsm/kg. Arterial blood gas shows a pH of 7.20 and HCO3- of 12 mEq/L. Which of the
following is the primary underlying pathophysiological process?
,A. Increased hepatic glycogenolysis
B. Decreased peripheral glucose utilization
C. Severe insulin deficiency leading to lipolysis and ketogenesis
D. Impaired renal excretion of glucose
🟢 C. Severe insulin deficiency leading to lipolysis and ketogenesis
🔴 RATIONALE: Diabetic ketoacidosis (DKA) results from an absolute insulin deficiency, leading to uncontrolled
lipolysis, production of ketone bodies, and metabolic acidosis. This condition is characterized by hyperglycemia,
ketonemia, and metabolic acidosis.
Question 5
A 72-year-old male with benign prostatic hyperplasia (BPH) presents with acute urinary retention. Which of the
following best explains the mechanism of obstruction in this patient?
A. Neurogenic bladder
B. Urethral stricture
C. Mechanical obstruction of the urethra by an enlarged prostate
D. Detrusor muscle overactivity
🟢 C. Mechanical obstruction of the urethra by an enlarged prostate
🔴 RATIONALE: BPH causes mechanical obstruction of the urethra due to the enlarged prostate gland
compressing the urethra, leading to symptoms like hesitancy, weak stream, and, in severe cases, acute urinary
retention.
Question 6
A patient with a history of deep vein thrombosis (DVT) presents with sudden-onset pleuritic chest pain and
hemoptysis. A ventilation-perfusion (V/Q) scan shows a high-probability mismatch. Which of the following is the
most likely underlying diagnosis?
, A. Myocardial infarction
B. Pericarditis
C. Pulmonary embolism
D. Pneumothorax
🟢 C. Pulmonary embolism
🔴 RATIONALE: A V/Q scan mismatch (ventilation present, perfusion absent) is indicative of a pulmonary
embolus. The patient's history of DVT and acute symptoms of pleuritic pain and hemoptysis are also classic for
pulmonary embolism.
Question 7
A 45-year-old female is diagnosed with iron deficiency anemia. Which of the following laboratory findings
would be most consistent with this diagnosis?
A. Elevated serum ferritin
B. High mean corpuscular volume (MCV)
C. Low serum iron and low total iron-binding capacity (TIBC)
D. Low serum ferritin and low serum iron
🟢 D. Low serum ferritin and low serum iron
🔴 RATIONALE: Iron deficiency anemia is characterized by low serum iron, low serum ferritin (which reflects
body iron stores), and high total iron-binding capacity (TIBC).
Question 8
A patient with a history of chronic heart failure develops ascites and peripheral edema. This fluid accumulation
is primarily due to:
A. Decreased plasma oncotic pressure
B. Increased capillary hydrostatic pressure
