NUR 616 ADVANCED CLINICAL
NURSING MASTERY EXAM QUESTIONS
AND ANSWERS
1. Which of the following describes the mechanism of action for Sacubitril in the treatment of
heart failure?
A. Inhibition of the sodium-glucose cotransporter 2 in the proximal tubule
B. Direct antagonism of the angiotensin II type 1 receptor
C. Blockade of the mineralocorticoid receptor in the distal tubules
D. Inhibition of the enzyme neprilysin to increase natriuretic peptide levels
Answer: D
Conceptual Explanation: Sacubitril is a neprilysin inhibitor; by inhibiting neprilysin, it
prevents the breakdown of natriuretic peptides, leading to vasodilation and natriuresis.
2. In a patient with chronic kidney disease, which hormone deficiency primarily leads to renal
anemia?
A. Renin
B. Erythropoietin
C. Calcitriol
,D. Aldosterone
Answer: B
Conceptual Explanation: The kidneys produce erythropoietin (EPO), which stimulates red
blood cell production in the bone marrow. CKD reduces EPO production, causing anemia.
3. A patient presents with a pH of 7.25, PaCO2 of 55 mmHg, and HCO3- of 26 mEq/L. Which
acid-base imbalance is present?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Answer: D
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
indicates a respiratory cause for the acidosis.
4. Which of the following cytochrome P450 enzymes is responsible for the metabolism of the
majority of clinically used drugs?
A. CYP3A4
B. CYP1A2
C. CYP2C19
D. CYP2D6
, Answer: A
Conceptual Explanation: CYP3A4 is the most abundant CYP enzyme in the liver and is
involved in the metabolism of approximately 50% of all prescribed drugs.
5. In Myasthenia Gravis, the autoantibodies are primarily directed against which structure?
A. Voltage-gated calcium channels
B. Pre-synaptic vesicle proteins
C. Post-synaptic acetylcholine receptors
D. Myelin basic protein
Answer: C
Conceptual Explanation: Myasthenia Gravis is characterized by antibodies against the
nicotinic acetylcholine receptors at the neuromuscular junction.
6. Which clinical finding is most diagnostic of Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)?
A. Serum osmolality < 275 mOsm/kg with concentrated urine
B. Urine osmolality < 100 mOsm/kg
C. Serum sodium > 145 mEq/L
D. Hypervolemia with peripheral edema
Answer: A
NURSING MASTERY EXAM QUESTIONS
AND ANSWERS
1. Which of the following describes the mechanism of action for Sacubitril in the treatment of
heart failure?
A. Inhibition of the sodium-glucose cotransporter 2 in the proximal tubule
B. Direct antagonism of the angiotensin II type 1 receptor
C. Blockade of the mineralocorticoid receptor in the distal tubules
D. Inhibition of the enzyme neprilysin to increase natriuretic peptide levels
Answer: D
Conceptual Explanation: Sacubitril is a neprilysin inhibitor; by inhibiting neprilysin, it
prevents the breakdown of natriuretic peptides, leading to vasodilation and natriuresis.
2. In a patient with chronic kidney disease, which hormone deficiency primarily leads to renal
anemia?
A. Renin
B. Erythropoietin
C. Calcitriol
,D. Aldosterone
Answer: B
Conceptual Explanation: The kidneys produce erythropoietin (EPO), which stimulates red
blood cell production in the bone marrow. CKD reduces EPO production, causing anemia.
3. A patient presents with a pH of 7.25, PaCO2 of 55 mmHg, and HCO3- of 26 mEq/L. Which
acid-base imbalance is present?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Answer: D
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
indicates a respiratory cause for the acidosis.
4. Which of the following cytochrome P450 enzymes is responsible for the metabolism of the
majority of clinically used drugs?
A. CYP3A4
B. CYP1A2
C. CYP2C19
D. CYP2D6
, Answer: A
Conceptual Explanation: CYP3A4 is the most abundant CYP enzyme in the liver and is
involved in the metabolism of approximately 50% of all prescribed drugs.
5. In Myasthenia Gravis, the autoantibodies are primarily directed against which structure?
A. Voltage-gated calcium channels
B. Pre-synaptic vesicle proteins
C. Post-synaptic acetylcholine receptors
D. Myelin basic protein
Answer: C
Conceptual Explanation: Myasthenia Gravis is characterized by antibodies against the
nicotinic acetylcholine receptors at the neuromuscular junction.
6. Which clinical finding is most diagnostic of Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)?
A. Serum osmolality < 275 mOsm/kg with concentrated urine
B. Urine osmolality < 100 mOsm/kg
C. Serum sodium > 145 mEq/L
D. Hypervolemia with peripheral edema
Answer: A
