NUR 432 EXAM 2 QUESTIONS AND ANSWERS WITH 100% CORRECT ANSWERS LATEST
UPDATE ALREADY GRADED A+ UNIVERSITY-LEVEL COMPREHENSIVE EXAMINATION
SECTION A: ADVANCED PATHOPHYSIOLOGY AND DISEASE MANAGEMENT (Questions
1–35)
1. A patient presents with acute decompensated heart failure. Which compensatory
mechanism initially maintains cardiac output but eventually worsens heart failure?
(A) Parasympathetic activation
(B) Renin-angiotensin-aldosterone system activation
(C) Vagal stimulation
(D) Baroreceptor-mediated bradycardia
Answer: (B) Renin-angiotensin-aldosterone system activation
Rationale: RAAS activation increases preload and afterload through sodium and water
retention and vasoconstriction, initially maintaining perfusion but ultimately exacerbating
cardiac workload and failure.
2. Which electrolyte imbalance is most commonly associated with prolonged
furosemide therapy?
(A) Hyperkalemia
(B) Hypokalemia
(C) Hypernatremia
(D) Hypercalcemia
Answer: (B) Hypokalemia
Rationale: Loop diuretics like furosemide increase potassium excretion in the distal tubule,
leading to hypokalemia, which can precipitate dysrhythmias.
3. A patient with chronic obstructive pulmonary disease retains carbon dioxide. Which
oxygen delivery method is most appropriate?
(A) High-flow nasal cannula at 15 L/min
(B) Non-rebreather mask at 100%
(C) Venturi mask at 24–28%
(D) Simple face mask at 10 L/min
,Answer: (C) Venturi mask at 24–28%
Rationale: Controlled low-flow oxygen prevents suppression of the hypoxic drive in CO2
retainers while maintaining adequate oxygenation.
4. Which finding is most indicative of early acute kidney injury?
(A) Serum creatinine increase of 0.3 mg/dL within 48 hours
(B) Hemoglobin of 10 g/dL
(C) Urine output of 1.5 mL/kg/hr
(D) Blood urea nitrogen of 10 mg/dL
Answer: (A) Serum creatinine increase of 0.3 mg/dL within 48 hours
Rationale: KDIGO criteria define AKI as an increase in serum creatinine of at least 0.3
mg/dL within 48 hours or 1.5 times baseline within 7 days.
5. In diabetic ketoacidosis, which acid-base disturbance is expected?
(A) Metabolic alkalosis
(B) Respiratory alkalosis
(C) High anion gap metabolic acidosis
(D) Normal anion gap metabolic acidosis
Answer: (C) High anion gap metabolic acidosis
Rationale: Ketone bodies are acidic and accumulate, causing a high anion gap metabolic
acidosis with compensatory respiratory alkalosis (Kussmaul respirations).
6. Which medication is first-line for status epilepticus?
(A) Oral phenytoin
(B) Intravenous lorazepam
(C) Oral carbamazepine
(D) Intramuscular haloperidol
Answer: (B) Intravenous lorazepam
Rationale: Benzodiazepines such as IV lorazepam are first-line for terminating seizure
activity in status epilepticus due to rapid onset.
7. A patient with sepsis has a lactate level of 4 mmol/L. What does this indicate?
(A) Adequate tissue perfusion
(B) Anaerobic metabolism and tissue hypoperfusion
(C) Respiratory alkalosis
(D) Hyperglycemia
Answer: (B) Anaerobic metabolism and tissue hypoperfusion
Rationale: Elevated lactate indicates cellular hypoxia and anaerobic metabolism, a
hallmark of sepsis-induced hypoperfusion.
,8. Which condition presents with a "cherry-red" skin discoloration?
(A) Carbon monoxide poisoning
(B) Cyanide poisoning
(C) Methemoglobinemia
(D) Iron toxicity
Answer: (A) Carbon monoxide poisoning
Rationale: Carboxyhemoglobin produces a cherry-red appearance of the skin and mucous
membranes in CO poisoning.
9. Which assessment finding is most consistent with increased intracranial pressure?
(A) Bradycardia, hypertension, and irregular respirations
(B) Tachycardia, hypotension, and tachypnea
(C) Hyperreflexia and clonus
(D) Polyuria and polydipsia
Answer: (A) Bradycardia, hypertension, and irregular respirations
Rationale: Cushing's triad consists of bradycardia, systolic hypertension with widened
pulse pressure, and irregular respirations, indicating increased ICP.
10. A patient with acute pancreatitis is most at risk for which electrolyte abnormality?
(A) Hypercalcemia
(B) Hypocalcemia
(C) Hypernatremia
(D) Hyperkalemia
Answer: (B) Hypocalcemia
Rationale: Saponification of calcium in necrotic fat deposits leads to hypocalcemia in
acute pancreatitis.
11. Which vaccine is contraindicated in immunocompromised patients?
(A) Inactivated influenza vaccine
(B) Live attenuated influenza vaccine
(C) Tetanus toxoid
(D) Hepatitis B vaccine
Answer: (B) Live attenuated influenza vaccine
Rationale: Live vaccines can cause disseminated infection in immunocompromised
individuals and are contraindicated.
12. Which finding is characteristic of nephrotic syndrome?
(A) Hematuria and hypertension
(B) Proteinuria greater than 3.5 g/day
(C) Elevated BUN with normal protein
, (D) Oliguria with hematuria
Answer: (B) Proteinuria greater than 3.5 g/day
Rationale: Nephrotic syndrome is defined by heavy proteinuria, hypoalbuminemia, edema,
and hyperlipidemia.
13. A patient on heparin therapy develops a sudden drop in platelets. What is the
priority action?
(A) Continue heparin and monitor
(B) Stop heparin immediately and notify the provider
(C) Administer vitamin K
(D) Increase heparin dose
Answer: (B) Stop heparin immediately and notify the provider
Rationale: Heparin-induced thrombocytopenia (HIT) is a life-threatening immune reaction
requiring immediate discontinuation of heparin.
14. Which acid-base imbalance is expected in a patient with severe vomiting?
(A) Metabolic acidosis
(B) Metabolic alkalosis
(C) Respiratory acidosis
(D) Respiratory alkalosis
Answer: (B) Metabolic alkalosis
Rationale: Loss of gastric hydrochloric acid leads to metabolic alkalosis with
hypochloremia and hypokalemia.
15. Which medication is used to reverse opioid overdose?
(A) Flumazenil
(B) Naloxone
(C) Atropine
(D) Protamine sulfate
Answer: (B) Naloxone
Rationale: Naloxone is a competitive opioid receptor antagonist that rapidly reverses
opioid-induced respiratory depression.
16. Which condition is characterized by a "steal" phenomenon affecting the
intestines?
(A) Mesenteric ischemia
(B) Peptic ulcer disease
(C) Diverticulitis
(D) Irritable bowel syndrome
Answer: (A) Mesenteric ischemia
UPDATE ALREADY GRADED A+ UNIVERSITY-LEVEL COMPREHENSIVE EXAMINATION
SECTION A: ADVANCED PATHOPHYSIOLOGY AND DISEASE MANAGEMENT (Questions
1–35)
1. A patient presents with acute decompensated heart failure. Which compensatory
mechanism initially maintains cardiac output but eventually worsens heart failure?
(A) Parasympathetic activation
(B) Renin-angiotensin-aldosterone system activation
(C) Vagal stimulation
(D) Baroreceptor-mediated bradycardia
Answer: (B) Renin-angiotensin-aldosterone system activation
Rationale: RAAS activation increases preload and afterload through sodium and water
retention and vasoconstriction, initially maintaining perfusion but ultimately exacerbating
cardiac workload and failure.
2. Which electrolyte imbalance is most commonly associated with prolonged
furosemide therapy?
(A) Hyperkalemia
(B) Hypokalemia
(C) Hypernatremia
(D) Hypercalcemia
Answer: (B) Hypokalemia
Rationale: Loop diuretics like furosemide increase potassium excretion in the distal tubule,
leading to hypokalemia, which can precipitate dysrhythmias.
3. A patient with chronic obstructive pulmonary disease retains carbon dioxide. Which
oxygen delivery method is most appropriate?
(A) High-flow nasal cannula at 15 L/min
(B) Non-rebreather mask at 100%
(C) Venturi mask at 24–28%
(D) Simple face mask at 10 L/min
,Answer: (C) Venturi mask at 24–28%
Rationale: Controlled low-flow oxygen prevents suppression of the hypoxic drive in CO2
retainers while maintaining adequate oxygenation.
4. Which finding is most indicative of early acute kidney injury?
(A) Serum creatinine increase of 0.3 mg/dL within 48 hours
(B) Hemoglobin of 10 g/dL
(C) Urine output of 1.5 mL/kg/hr
(D) Blood urea nitrogen of 10 mg/dL
Answer: (A) Serum creatinine increase of 0.3 mg/dL within 48 hours
Rationale: KDIGO criteria define AKI as an increase in serum creatinine of at least 0.3
mg/dL within 48 hours or 1.5 times baseline within 7 days.
5. In diabetic ketoacidosis, which acid-base disturbance is expected?
(A) Metabolic alkalosis
(B) Respiratory alkalosis
(C) High anion gap metabolic acidosis
(D) Normal anion gap metabolic acidosis
Answer: (C) High anion gap metabolic acidosis
Rationale: Ketone bodies are acidic and accumulate, causing a high anion gap metabolic
acidosis with compensatory respiratory alkalosis (Kussmaul respirations).
6. Which medication is first-line for status epilepticus?
(A) Oral phenytoin
(B) Intravenous lorazepam
(C) Oral carbamazepine
(D) Intramuscular haloperidol
Answer: (B) Intravenous lorazepam
Rationale: Benzodiazepines such as IV lorazepam are first-line for terminating seizure
activity in status epilepticus due to rapid onset.
7. A patient with sepsis has a lactate level of 4 mmol/L. What does this indicate?
(A) Adequate tissue perfusion
(B) Anaerobic metabolism and tissue hypoperfusion
(C) Respiratory alkalosis
(D) Hyperglycemia
Answer: (B) Anaerobic metabolism and tissue hypoperfusion
Rationale: Elevated lactate indicates cellular hypoxia and anaerobic metabolism, a
hallmark of sepsis-induced hypoperfusion.
,8. Which condition presents with a "cherry-red" skin discoloration?
(A) Carbon monoxide poisoning
(B) Cyanide poisoning
(C) Methemoglobinemia
(D) Iron toxicity
Answer: (A) Carbon monoxide poisoning
Rationale: Carboxyhemoglobin produces a cherry-red appearance of the skin and mucous
membranes in CO poisoning.
9. Which assessment finding is most consistent with increased intracranial pressure?
(A) Bradycardia, hypertension, and irregular respirations
(B) Tachycardia, hypotension, and tachypnea
(C) Hyperreflexia and clonus
(D) Polyuria and polydipsia
Answer: (A) Bradycardia, hypertension, and irregular respirations
Rationale: Cushing's triad consists of bradycardia, systolic hypertension with widened
pulse pressure, and irregular respirations, indicating increased ICP.
10. A patient with acute pancreatitis is most at risk for which electrolyte abnormality?
(A) Hypercalcemia
(B) Hypocalcemia
(C) Hypernatremia
(D) Hyperkalemia
Answer: (B) Hypocalcemia
Rationale: Saponification of calcium in necrotic fat deposits leads to hypocalcemia in
acute pancreatitis.
11. Which vaccine is contraindicated in immunocompromised patients?
(A) Inactivated influenza vaccine
(B) Live attenuated influenza vaccine
(C) Tetanus toxoid
(D) Hepatitis B vaccine
Answer: (B) Live attenuated influenza vaccine
Rationale: Live vaccines can cause disseminated infection in immunocompromised
individuals and are contraindicated.
12. Which finding is characteristic of nephrotic syndrome?
(A) Hematuria and hypertension
(B) Proteinuria greater than 3.5 g/day
(C) Elevated BUN with normal protein
, (D) Oliguria with hematuria
Answer: (B) Proteinuria greater than 3.5 g/day
Rationale: Nephrotic syndrome is defined by heavy proteinuria, hypoalbuminemia, edema,
and hyperlipidemia.
13. A patient on heparin therapy develops a sudden drop in platelets. What is the
priority action?
(A) Continue heparin and monitor
(B) Stop heparin immediately and notify the provider
(C) Administer vitamin K
(D) Increase heparin dose
Answer: (B) Stop heparin immediately and notify the provider
Rationale: Heparin-induced thrombocytopenia (HIT) is a life-threatening immune reaction
requiring immediate discontinuation of heparin.
14. Which acid-base imbalance is expected in a patient with severe vomiting?
(A) Metabolic acidosis
(B) Metabolic alkalosis
(C) Respiratory acidosis
(D) Respiratory alkalosis
Answer: (B) Metabolic alkalosis
Rationale: Loss of gastric hydrochloric acid leads to metabolic alkalosis with
hypochloremia and hypokalemia.
15. Which medication is used to reverse opioid overdose?
(A) Flumazenil
(B) Naloxone
(C) Atropine
(D) Protamine sulfate
Answer: (B) Naloxone
Rationale: Naloxone is a competitive opioid receptor antagonist that rapidly reverses
opioid-induced respiratory depression.
16. Which condition is characterized by a "steal" phenomenon affecting the
intestines?
(A) Mesenteric ischemia
(B) Peptic ulcer disease
(C) Diverticulitis
(D) Irritable bowel syndrome
Answer: (A) Mesenteric ischemia
