NU 650 Midterm Exam Study Guide
2026 questions with correct
answers in bold and rationales
graded A+
Section 1: Advanced Pathophysiology (25 Questions)
1. Which of the following is the primary cause of Type 1 Diabetes Mellitus?
A) Insulin resistance
B) Autoimmune destruction of pancreatic beta cells
C) Chronic pancreatitis
D) Excessive glucose intake
Correct Answer: B) Autoimmune destruction of pancreatic beta cells
Rationale: Type 1 DM is an autoimmune disorder where the immune system attacks and destroys
insulin-producing beta cells in the pancreas, leading to absolute insulin deficiency.
2. A patient presents with hypertension, hypokalemia, and metabolic alkalosis. Which condition is
most likely?
A) Cushing’s syndrome
B) Conn’s syndrome (Primary Hyperaldosteronism)
C) Pheochromocytoma
D) Addison’s disease
Correct Answer: B) Conn’s syndrome (Primary Hyperaldosteronism)
Rationale: Primary hyperaldosteronism (Conn’s syndrome) is characterized by excess aldosterone
production, leading to hypertension, hypokalemia, and metabolic alkalosis due to sodium retention
and potassium wasting.
3. Which cytokine is primarily responsible for the acute-phase response in inflammation?
,A) Interleukin-1 (IL-1)
B) Tumor necrosis factor-alpha (TNF-α)
C) Interferon-gamma (IFN-γ)
D) Transforming growth factor-beta (TGF-β)
Correct Answer: A) Interleukin-1 (IL-1)
Rationale: IL-1 is a key pro-inflammatory cytokine that triggers the acute-phase response, including
fever, leukocytosis, and increased C-reactive protein (CRP).
4. A patient with chronic kidney disease (CKD) develops secondary hyperparathyroidism. Which
electrolyte imbalance is most responsible?
A) Hypercalcemia
B) Hypocalcemia
C) Hyperphosphatemia
D) Hypophosphatemia
Correct Answer: B) Hypocalcemia
Rationale: In CKD, phosphate retention and decreased vitamin D activation lead to hypocalcemia,
stimulating parathyroid hormone (PTH) release (secondary hyperparathyroidism).
5. Which of the following is a hallmark of Alzheimer’s disease pathology?
A) Lewy bodies
B) Amyloid plaques and neurofibrillary tangles
C) Demyelination of neurons
D) Dopamine deficiency
Correct Answer: B) Amyloid plaques and neurofibrillary tangles
Rationale: Alzheimer’s disease is characterized by extracellular amyloid-beta plaques and
intracellular tau neurofibrillary tangles, leading to neuronal degeneration.
(Continue with 20 more pathophysiology questions—let me know if you'd like the full 25.)
,Section 2: Advanced Pharmacology (25 Questions)
26. Which drug class is first-line for treating hypertension in patients with diabetes to prevent
nephropathy?
A) Thiazide diuretics
B) ACE inhibitors
C) Calcium channel blockers
D) Beta-blockers
Correct Answer: B) ACE inhibitors
Rationale: ACE inhibitors (e.g., lisinopril) reduce intraglomerular pressure and protect against
diabetic nephropathy by decreasing proteinuria and slowing kidney damage.
27. A patient on warfarin develops bleeding. Which reversal agent should be administered?
A) Protamine sulfate
B) Vitamin K
C) Fresh frozen plasma (FFP)
D) Both B and C
Correct Answer: D) Both B and C
Rationale: Vitamin K reverses warfarin’s effect by promoting clotting factor synthesis, while FFP
provides immediate clotting factors in severe bleeding.
28. Which insulin type has the fastest onset of action?
A) NPH insulin
B) Regular insulin
C) Insulin glargine
D) Insulin lispro
Correct Answer: D) Insulin lispro
Rationale: Rapid-acting insulins (e.g., lispro, aspart, glulisine) have an onset of 10-15 minutes, peak
at 1-2 hours, and last 3-5 hours, making them ideal for mealtime coverage.
, 29. Which antibiotic is contraindicated in a patient with a penicillin allergy?
A) Azithromycin
B) Cephalexin
C) Ciprofloxacin
D) Doxycycline
Correct Answer: B) Cephalexin
Rationale: Cephalosporins (e.g., cephalexin) have a cross-sensitivity risk with penicillins (5-10%), so
they should be avoided in patients with severe penicillin allergies.
30. Which drug is used to treat opioid overdose?
A) Flumazenil
B) Naloxone
C) Atropine
D) N-acetylcysteine
Correct Answer: B) Naloxone
Rationale: Naloxone is a pure opioid antagonist that reverses respiratory depression caused by
opioid overdose by displacing opioids from mu receptors.
(Continue with 20 more pharmacology questions—let me know if you'd like the full 25.)
Section 3: Health Assessment & Clinical Decision-Making (25 Questions)
51. Which finding is most indicative of left-sided heart failure?
A) Jugular venous distension (JVD)
B) Peripheral edema
C) Bibasilar crackles on lung auscultation
D) Hepatomegaly
Correct Answer: C) Bibasilar crackles on lung auscultation
Rationale: Left-sided heart failure leads to pulmonary congestion, causing crackles (rales) in the
lung bases due to fluid accumulation in the alveoli.
2026 questions with correct
answers in bold and rationales
graded A+
Section 1: Advanced Pathophysiology (25 Questions)
1. Which of the following is the primary cause of Type 1 Diabetes Mellitus?
A) Insulin resistance
B) Autoimmune destruction of pancreatic beta cells
C) Chronic pancreatitis
D) Excessive glucose intake
Correct Answer: B) Autoimmune destruction of pancreatic beta cells
Rationale: Type 1 DM is an autoimmune disorder where the immune system attacks and destroys
insulin-producing beta cells in the pancreas, leading to absolute insulin deficiency.
2. A patient presents with hypertension, hypokalemia, and metabolic alkalosis. Which condition is
most likely?
A) Cushing’s syndrome
B) Conn’s syndrome (Primary Hyperaldosteronism)
C) Pheochromocytoma
D) Addison’s disease
Correct Answer: B) Conn’s syndrome (Primary Hyperaldosteronism)
Rationale: Primary hyperaldosteronism (Conn’s syndrome) is characterized by excess aldosterone
production, leading to hypertension, hypokalemia, and metabolic alkalosis due to sodium retention
and potassium wasting.
3. Which cytokine is primarily responsible for the acute-phase response in inflammation?
,A) Interleukin-1 (IL-1)
B) Tumor necrosis factor-alpha (TNF-α)
C) Interferon-gamma (IFN-γ)
D) Transforming growth factor-beta (TGF-β)
Correct Answer: A) Interleukin-1 (IL-1)
Rationale: IL-1 is a key pro-inflammatory cytokine that triggers the acute-phase response, including
fever, leukocytosis, and increased C-reactive protein (CRP).
4. A patient with chronic kidney disease (CKD) develops secondary hyperparathyroidism. Which
electrolyte imbalance is most responsible?
A) Hypercalcemia
B) Hypocalcemia
C) Hyperphosphatemia
D) Hypophosphatemia
Correct Answer: B) Hypocalcemia
Rationale: In CKD, phosphate retention and decreased vitamin D activation lead to hypocalcemia,
stimulating parathyroid hormone (PTH) release (secondary hyperparathyroidism).
5. Which of the following is a hallmark of Alzheimer’s disease pathology?
A) Lewy bodies
B) Amyloid plaques and neurofibrillary tangles
C) Demyelination of neurons
D) Dopamine deficiency
Correct Answer: B) Amyloid plaques and neurofibrillary tangles
Rationale: Alzheimer’s disease is characterized by extracellular amyloid-beta plaques and
intracellular tau neurofibrillary tangles, leading to neuronal degeneration.
(Continue with 20 more pathophysiology questions—let me know if you'd like the full 25.)
,Section 2: Advanced Pharmacology (25 Questions)
26. Which drug class is first-line for treating hypertension in patients with diabetes to prevent
nephropathy?
A) Thiazide diuretics
B) ACE inhibitors
C) Calcium channel blockers
D) Beta-blockers
Correct Answer: B) ACE inhibitors
Rationale: ACE inhibitors (e.g., lisinopril) reduce intraglomerular pressure and protect against
diabetic nephropathy by decreasing proteinuria and slowing kidney damage.
27. A patient on warfarin develops bleeding. Which reversal agent should be administered?
A) Protamine sulfate
B) Vitamin K
C) Fresh frozen plasma (FFP)
D) Both B and C
Correct Answer: D) Both B and C
Rationale: Vitamin K reverses warfarin’s effect by promoting clotting factor synthesis, while FFP
provides immediate clotting factors in severe bleeding.
28. Which insulin type has the fastest onset of action?
A) NPH insulin
B) Regular insulin
C) Insulin glargine
D) Insulin lispro
Correct Answer: D) Insulin lispro
Rationale: Rapid-acting insulins (e.g., lispro, aspart, glulisine) have an onset of 10-15 minutes, peak
at 1-2 hours, and last 3-5 hours, making them ideal for mealtime coverage.
, 29. Which antibiotic is contraindicated in a patient with a penicillin allergy?
A) Azithromycin
B) Cephalexin
C) Ciprofloxacin
D) Doxycycline
Correct Answer: B) Cephalexin
Rationale: Cephalosporins (e.g., cephalexin) have a cross-sensitivity risk with penicillins (5-10%), so
they should be avoided in patients with severe penicillin allergies.
30. Which drug is used to treat opioid overdose?
A) Flumazenil
B) Naloxone
C) Atropine
D) N-acetylcysteine
Correct Answer: B) Naloxone
Rationale: Naloxone is a pure opioid antagonist that reverses respiratory depression caused by
opioid overdose by displacing opioids from mu receptors.
(Continue with 20 more pharmacology questions—let me know if you'd like the full 25.)
Section 3: Health Assessment & Clinical Decision-Making (25 Questions)
51. Which finding is most indicative of left-sided heart failure?
A) Jugular venous distension (JVD)
B) Peripheral edema
C) Bibasilar crackles on lung auscultation
D) Hepatomegaly
Correct Answer: C) Bibasilar crackles on lung auscultation
Rationale: Left-sided heart failure leads to pulmonary congestion, causing crackles (rales) in the
lung bases due to fluid accumulation in the alveoli.
