NURS 661 Exam 2 Study Guide –
Maryville University Examination
Questions And Correct Answers
(Verified Answers) Plus Rationales 2027
Q&A | Instant Download Pdf
1. A patient with chronic kidney disease develops metabolic acidosis.
Which compensatory response is expected first?
A. Decreased respiratory rate
B. Increased bicarbonate retention by the kidneys
C. Increased respiratory rate
D. Increased secretion of insulin
Rationale: Metabolic acidosis stimulates peripheral chemoreceptors,
leading to hyperventilation (Kussmaul respirations) to eliminate carbon
dioxide, thereby increasing blood pH. The kidneys attempt to retain
bicarbonate, but this process is slower and often impaired in chronic
,kidney disease. Insulin secretion is unrelated to acid-base compensation,
and decreased respiratory rate would worsen acidosis.
2. Which electrolyte imbalance is most likely to cause peaked T waves
on an electrocardiogram?
A. Hypocalcemia
B. Hyponatremia
C. Hyperkalemia
D. Hypomagnesemia
Rationale: Hyperkalemia alters cardiac conduction by accelerating
ventricular repolarization, producing peaked T waves. Severe
hyperkalemia can progress to widened QRS complexes, ventricular
arrhythmias, and cardiac arrest. The other electrolyte disturbances
produce different electrocardiographic changes.
3. The renin-angiotensin-aldosterone system is activated primarily in
response to:
A. Elevated serum sodium
B. Decreased renal perfusion pressure
,C. Increased atrial stretch
D. Hyperglycemia
Rationale: Reduced renal blood flow stimulates juxtaglomerular cells to
release renin, initiating the renin-angiotensin-aldosterone system. This
ultimately increases sodium and water retention while promoting
vasoconstriction to restore blood pressure. Increased atrial stretch
instead stimulates atrial natriuretic peptide.
4. Which hormone primarily lowers serum calcium levels?
A. Parathyroid hormone
B. Calcitonin
C. Aldosterone
D. Cortisol
Rationale: Calcitonin, released by thyroid C cells, inhibits osteoclast
activity and lowers serum calcium. Parathyroid hormone increases
calcium through bone resorption, intestinal absorption, and renal
conservation. Aldosterone and cortisol are not primary calcium-
regulating hormones.
, 5. A patient presents with polyuria, polydipsia, and fasting
hyperglycemia. Which pathophysiologic process best explains these
findings?
A. Increased insulin sensitivity
B. Increased glycogen synthesis
C. Insulin deficiency or resistance causing impaired glucose utilization
D. Excess glucagon suppression
Rationale: Insulin deficiency or resistance prevents glucose uptake by
cells, resulting in hyperglycemia. Excess glucose spills into urine, causing
osmotic diuresis, dehydration, and increased thirst. The remaining
options describe opposite physiologic effects.
6. Which laboratory value is the best indicator of long-term glucose
control?
A. Random glucose
B. Fasting insulin level
C. Oral glucose tolerance test
D. Hemoglobin A1c
Rationale: Hemoglobin A1c reflects average blood glucose over
approximately three months by measuring glycosylated hemoglobin. It
Maryville University Examination
Questions And Correct Answers
(Verified Answers) Plus Rationales 2027
Q&A | Instant Download Pdf
1. A patient with chronic kidney disease develops metabolic acidosis.
Which compensatory response is expected first?
A. Decreased respiratory rate
B. Increased bicarbonate retention by the kidneys
C. Increased respiratory rate
D. Increased secretion of insulin
Rationale: Metabolic acidosis stimulates peripheral chemoreceptors,
leading to hyperventilation (Kussmaul respirations) to eliminate carbon
dioxide, thereby increasing blood pH. The kidneys attempt to retain
bicarbonate, but this process is slower and often impaired in chronic
,kidney disease. Insulin secretion is unrelated to acid-base compensation,
and decreased respiratory rate would worsen acidosis.
2. Which electrolyte imbalance is most likely to cause peaked T waves
on an electrocardiogram?
A. Hypocalcemia
B. Hyponatremia
C. Hyperkalemia
D. Hypomagnesemia
Rationale: Hyperkalemia alters cardiac conduction by accelerating
ventricular repolarization, producing peaked T waves. Severe
hyperkalemia can progress to widened QRS complexes, ventricular
arrhythmias, and cardiac arrest. The other electrolyte disturbances
produce different electrocardiographic changes.
3. The renin-angiotensin-aldosterone system is activated primarily in
response to:
A. Elevated serum sodium
B. Decreased renal perfusion pressure
,C. Increased atrial stretch
D. Hyperglycemia
Rationale: Reduced renal blood flow stimulates juxtaglomerular cells to
release renin, initiating the renin-angiotensin-aldosterone system. This
ultimately increases sodium and water retention while promoting
vasoconstriction to restore blood pressure. Increased atrial stretch
instead stimulates atrial natriuretic peptide.
4. Which hormone primarily lowers serum calcium levels?
A. Parathyroid hormone
B. Calcitonin
C. Aldosterone
D. Cortisol
Rationale: Calcitonin, released by thyroid C cells, inhibits osteoclast
activity and lowers serum calcium. Parathyroid hormone increases
calcium through bone resorption, intestinal absorption, and renal
conservation. Aldosterone and cortisol are not primary calcium-
regulating hormones.
, 5. A patient presents with polyuria, polydipsia, and fasting
hyperglycemia. Which pathophysiologic process best explains these
findings?
A. Increased insulin sensitivity
B. Increased glycogen synthesis
C. Insulin deficiency or resistance causing impaired glucose utilization
D. Excess glucagon suppression
Rationale: Insulin deficiency or resistance prevents glucose uptake by
cells, resulting in hyperglycemia. Excess glucose spills into urine, causing
osmotic diuresis, dehydration, and increased thirst. The remaining
options describe opposite physiologic effects.
6. Which laboratory value is the best indicator of long-term glucose
control?
A. Random glucose
B. Fasting insulin level
C. Oral glucose tolerance test
D. Hemoglobin A1c
Rationale: Hemoglobin A1c reflects average blood glucose over
approximately three months by measuring glycosylated hemoglobin. It
