NRNP 6566 COMPREHENSIVE FINAL EXAM
CHAMBERLAIN UNIVERSITY /ACTUAL EXAM
QUESTIONS AND 100% VERIFIED ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A 68-year-old man with severe pneumonia is mechanically ventilated for
worsening hypoxemic respiratory failure. His predicted body weight is 70 kg. The
clinician wants to initiate a lung-protective ventilation strategy consistent with
ARDS management. Which initial tidal volume is most appropriate?
A. 280 mL
B. 420 mL
C. 560 mL
D. 700 mL
Answer: B
Rationale: Lung-protective ventilation for ARDS generally begins with a tidal
volume of approximately 6 mL/kg of predicted body weight. For a 70-kg
predicted body weight, 6 × 70 = 420 mL. Tidal volumes of 8–10 mL/kg increase
the risk of ventilator-induced lung injury. Plateau pressure should generally remain
below 30 cm H₂O.
2. A 54-year-old woman presents with sudden dyspnea and pleuritic chest pain 5
days after hip replacement surgery. Her heart rate is 118/min, respiratory rate is
28/min, and oxygen saturation is 89% on room air. Pulmonary embolism is
strongly suspected. Which diagnostic study is most appropriate for definitive
evaluation in a hemodynamically stable patient without a contraindication to
contrast?
A. Chest radiograph
B. Ventilation-perfusion scan
C. CT pulmonary angiography
D. Transthoracic echocardiography
,Answer: C
Rationale: CT pulmonary angiography (CTPA) is the standard definitive
imaging study for suspected pulmonary embolism in a hemodynamically stable
patient who can receive iodinated contrast. Chest radiography may help identify
alternative diagnoses but does not establish PE. Echocardiography is particularly
useful for assessing right-heart strain in unstable patients.
3. A 62-year-old patient with COPD becomes increasingly somnolent after
receiving supplemental oxygen. ABG results are: pH 7.28, PaCO₂ 68 mm Hg,
HCO₃⁻ 31 mEq/L, and PaO₂ 58 mm Hg. Which acid-base disturbance best explains
these findings?
A. Acute respiratory alkalosis
B. Chronic respiratory alkalosis
C. Acute-on-chronic respiratory acidosis
D. Metabolic acidosis with respiratory compensation
Answer: C
Rationale: The low pH indicates acidemia, while the markedly elevated PaCO₂
indicates respiratory acidosis. The elevated bicarbonate demonstrates renal
compensation, suggesting chronic CO₂ retention. The worsening acidemia
indicates an acute deterioration superimposed on chronic respiratory acidosis,
making acute-on-chronic respiratory acidosis the best interpretation.
4. A 71-year-old woman with septic shock remains hypotensive after receiving an
appropriate initial crystalloid bolus. Her MAP is 56 mm Hg, and lactate is 4.1
mmol/L. Which medication should be initiated as the first-line vasopressor?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Epinephrine
Answer: B
,Rationale: Norepinephrine is the preferred first-line vasopressor for septic
shock when hypotension persists despite adequate fluid resuscitation. The initial
hemodynamic goal is generally a MAP of at least 65 mm Hg. Dopamine is less
favored because of its arrhythmogenic potential.
5. A 59-year-old man with septic shock has received adequate intravenous fluids.
His blood pressure remains 78/44 mm Hg, with a MAP of 55 mm Hg. Lactate is
3.8 mmol/L. Which intervention should occur next?
A. Begin norepinephrine infusion
B. Administer a loop diuretic
C. Initiate oral midodrine
D. Restrict intravenous fluids
Answer: A
Rationale: Persistent hypotension after adequate fluid resuscitation in septic shock
requires vasopressor therapy. Norepinephrine is the preferred initial agent, with a
target MAP generally ≥65 mm Hg. Delaying vasopressor therapy in persistent
shock can worsen tissue hypoperfusion.
6. A hospitalized patient develops potassium of 7.1 mEq/L. ECG demonstrates
peaked T waves followed by progressive QRS widening. Which medication should
be administered first to reduce the immediate risk of fatal cardiac dysrhythmia?
A. Regular insulin with dextrose
B. Sodium zirconium cyclosilicate
C. Calcium gluconate
D. Furosemide
Answer: C
Rationale: Severe hyperkalemia accompanied by ECG changes requires
immediate cardiac membrane stabilization with intravenous calcium. Calcium
does not substantially lower serum potassium but reduces the risk of ventricular
, dysrhythmia. Insulin with dextrose shifts potassium intracellularly and should
follow or accompany stabilization.
7. A 73-year-old patient with vomiting and diarrhea has creatinine of 2.6 mg/dL,
BUN of 68 mg/dL, and a fractional excretion of sodium below 1%. The patient has
dry mucous membranes and orthostatic hypotension. Which type of AKI is most
likely?
A. Acute tubular necrosis
B. Prerenal acute kidney injury
C. Acute interstitial nephritis
D. Postrenal obstruction
Answer: B
Rationale: Volume depletion produces decreased renal perfusion and prerenal
AKI. Findings supporting this diagnosis include hypotension, clinical dehydration,
an elevated BUN-to-creatinine ratio, and a low fractional excretion of sodium.
Treatment focuses on correcting the underlying volume deficit.
8. A 67-year-old man with benign prostatic hyperplasia develops oliguria and
bilateral hydronephrosis. His serum creatinine has increased substantially over 48
hours. Which intervention most directly addresses the cause of his kidney injury?
A. Increase dietary protein
B. Administer an ACE inhibitor
C. Relieve the urinary obstruction
D. Begin high-dose corticosteroids
Answer: C
Rationale: Hydronephrosis with oliguria in a patient with urinary outlet disease
indicates postrenal AKI from obstruction. Prompt relief of obstruction, such as
bladder catheterization when appropriate, is essential to restore urinary flow and
prevent permanent renal injury.
CHAMBERLAIN UNIVERSITY /ACTUAL EXAM
QUESTIONS AND 100% VERIFIED ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A 68-year-old man with severe pneumonia is mechanically ventilated for
worsening hypoxemic respiratory failure. His predicted body weight is 70 kg. The
clinician wants to initiate a lung-protective ventilation strategy consistent with
ARDS management. Which initial tidal volume is most appropriate?
A. 280 mL
B. 420 mL
C. 560 mL
D. 700 mL
Answer: B
Rationale: Lung-protective ventilation for ARDS generally begins with a tidal
volume of approximately 6 mL/kg of predicted body weight. For a 70-kg
predicted body weight, 6 × 70 = 420 mL. Tidal volumes of 8–10 mL/kg increase
the risk of ventilator-induced lung injury. Plateau pressure should generally remain
below 30 cm H₂O.
2. A 54-year-old woman presents with sudden dyspnea and pleuritic chest pain 5
days after hip replacement surgery. Her heart rate is 118/min, respiratory rate is
28/min, and oxygen saturation is 89% on room air. Pulmonary embolism is
strongly suspected. Which diagnostic study is most appropriate for definitive
evaluation in a hemodynamically stable patient without a contraindication to
contrast?
A. Chest radiograph
B. Ventilation-perfusion scan
C. CT pulmonary angiography
D. Transthoracic echocardiography
,Answer: C
Rationale: CT pulmonary angiography (CTPA) is the standard definitive
imaging study for suspected pulmonary embolism in a hemodynamically stable
patient who can receive iodinated contrast. Chest radiography may help identify
alternative diagnoses but does not establish PE. Echocardiography is particularly
useful for assessing right-heart strain in unstable patients.
3. A 62-year-old patient with COPD becomes increasingly somnolent after
receiving supplemental oxygen. ABG results are: pH 7.28, PaCO₂ 68 mm Hg,
HCO₃⁻ 31 mEq/L, and PaO₂ 58 mm Hg. Which acid-base disturbance best explains
these findings?
A. Acute respiratory alkalosis
B. Chronic respiratory alkalosis
C. Acute-on-chronic respiratory acidosis
D. Metabolic acidosis with respiratory compensation
Answer: C
Rationale: The low pH indicates acidemia, while the markedly elevated PaCO₂
indicates respiratory acidosis. The elevated bicarbonate demonstrates renal
compensation, suggesting chronic CO₂ retention. The worsening acidemia
indicates an acute deterioration superimposed on chronic respiratory acidosis,
making acute-on-chronic respiratory acidosis the best interpretation.
4. A 71-year-old woman with septic shock remains hypotensive after receiving an
appropriate initial crystalloid bolus. Her MAP is 56 mm Hg, and lactate is 4.1
mmol/L. Which medication should be initiated as the first-line vasopressor?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Epinephrine
Answer: B
,Rationale: Norepinephrine is the preferred first-line vasopressor for septic
shock when hypotension persists despite adequate fluid resuscitation. The initial
hemodynamic goal is generally a MAP of at least 65 mm Hg. Dopamine is less
favored because of its arrhythmogenic potential.
5. A 59-year-old man with septic shock has received adequate intravenous fluids.
His blood pressure remains 78/44 mm Hg, with a MAP of 55 mm Hg. Lactate is
3.8 mmol/L. Which intervention should occur next?
A. Begin norepinephrine infusion
B. Administer a loop diuretic
C. Initiate oral midodrine
D. Restrict intravenous fluids
Answer: A
Rationale: Persistent hypotension after adequate fluid resuscitation in septic shock
requires vasopressor therapy. Norepinephrine is the preferred initial agent, with a
target MAP generally ≥65 mm Hg. Delaying vasopressor therapy in persistent
shock can worsen tissue hypoperfusion.
6. A hospitalized patient develops potassium of 7.1 mEq/L. ECG demonstrates
peaked T waves followed by progressive QRS widening. Which medication should
be administered first to reduce the immediate risk of fatal cardiac dysrhythmia?
A. Regular insulin with dextrose
B. Sodium zirconium cyclosilicate
C. Calcium gluconate
D. Furosemide
Answer: C
Rationale: Severe hyperkalemia accompanied by ECG changes requires
immediate cardiac membrane stabilization with intravenous calcium. Calcium
does not substantially lower serum potassium but reduces the risk of ventricular
, dysrhythmia. Insulin with dextrose shifts potassium intracellularly and should
follow or accompany stabilization.
7. A 73-year-old patient with vomiting and diarrhea has creatinine of 2.6 mg/dL,
BUN of 68 mg/dL, and a fractional excretion of sodium below 1%. The patient has
dry mucous membranes and orthostatic hypotension. Which type of AKI is most
likely?
A. Acute tubular necrosis
B. Prerenal acute kidney injury
C. Acute interstitial nephritis
D. Postrenal obstruction
Answer: B
Rationale: Volume depletion produces decreased renal perfusion and prerenal
AKI. Findings supporting this diagnosis include hypotension, clinical dehydration,
an elevated BUN-to-creatinine ratio, and a low fractional excretion of sodium.
Treatment focuses on correcting the underlying volume deficit.
8. A 67-year-old man with benign prostatic hyperplasia develops oliguria and
bilateral hydronephrosis. His serum creatinine has increased substantially over 48
hours. Which intervention most directly addresses the cause of his kidney injury?
A. Increase dietary protein
B. Administer an ACE inhibitor
C. Relieve the urinary obstruction
D. Begin high-dose corticosteroids
Answer: C
Rationale: Hydronephrosis with oliguria in a patient with urinary outlet disease
indicates postrenal AKI from obstruction. Prompt relief of obstruction, such as
bladder catheterization when appropriate, is essential to restore urinary flow and
prevent permanent renal injury.
