NU664 NURSING EXAM QUESTIONS AND WELL-
EXPLAINED ANSWERS
172 QUESTIONS AND ANSWERS
Question 1: Explain the pathophysiology of heart failure with reduced ejection
fraction (HFrEF) and describe the compensatory mechanisms that occur.
Answer: HFrEF occurs when the left ventricle cannot pump blood effectively,
typically with an ejection fraction <40%. The pathophysiology involves:
• Initial myocardial injury (MI, hypertension, cardiomyopathy)
• Decreased cardiac output triggers compensatory mechanisms
• Sympathetic nervous system activation increases heart rate and
contractility
• Renin-angiotensin-aldosterone system (RAAS) activation causes
vasoconstriction and fluid retention
• Ventricular remodeling occurs with hypertrophy and dilation
• Progressive decline in cardiac function despite compensatory
mechanisms
Question 2: What is the difference between Type 1 and Type 2 diabetes
mellitus in terms of pathophysiology?
Answer:
• Type 1 DM: Autoimmune destruction of pancreatic beta cells leading to
absolute insulin deficiency. Usually occurs in childhood/adolescence.
Requires insulin therapy.
• Type 2 DM: Insulin resistance combined with relative insulin deficiency.
Beta cells initially compensate by producing more insulin, but eventually
fail. Associated with obesity, sedentary lifestyle, and genetic factors. Can
often be managed with lifestyle changes and oral medications initially.
,Pharmacology
Question 3: A patient is prescribed lisinopril 10mg daily. Explain the
mechanism of action, therapeutic effects, and important nursing
considerations.
Answer:
• Mechanism: ACE inhibitor that blocks conversion of angiotensin I to
angiotensin II, reducing vasoconstriction and aldosterone release
• Therapeutic effects: Reduces blood pressure, decreases cardiac
workload, prevents diabetic nephropathy progression
• Nursing considerations: Monitor blood pressure, potassium levels, and
kidney function; assess for dry cough; educate about orthostatic
hypotension; avoid in pregnancy
Question 4: What are the key differences between warfarin and newer oral
anticoagulants (NOACs) like apixaban?
Answer:
• Warfarin: Vitamin K antagonist, requires regular INR monitoring,
multiple drug/food interactions, reversible with vitamin K
• NOACs (Apixaban): Direct factor Xa inhibitor, predictable dosing, fewer
interactions, no routine monitoring required, specific reversal agents
available
Clinical Assessment
Question 5: Describe the components of a comprehensive cardiovascular
assessment.
Answer:
• History: Chest pain, dyspnea, palpitations, syncope, family history, risk
factors
• Inspection: Skin color, jugular venous distension, edema, respiratory
effort
• Palpation: Pulses (rate, rhythm, quality), point of maximal impulse,
peripheral edema
, • Auscultation: Heart sounds (S1, S2, murmurs, gallops), lung sounds
• Vital signs: Blood pressure in both arms, heart rate, respiratory rate,
oxygen saturation
Question 6: What are the key components of a neurological assessment for a
patient with suspected stroke?
Answer:
• NIH Stroke Scale: Assesses consciousness, gaze, visual fields, facial palsy,
motor function, ataxia, sensation, language, dysarthria, neglect
• Vital signs: Blood pressure, heart rate, temperature, oxygen saturation
• Glasgow Coma Scale: Eye opening, verbal response, motor response
• Pupil assessment: Size, reactivity, equality
• Time of symptom onset: Critical for treatment decisions
Evidence-Based Practice
Question 7: Explain the hierarchy of evidence and how it applies to nursing
practice.
Answer: The hierarchy from strongest to weakest evidence:
1. Systematic reviews/meta-analyses: Comprehensive analysis of multiple
studies
2. Randomized controlled trials (RCTs): Gold standard for intervention
effectiveness
3. Cohort studies: Observational studies following groups over time
4. Case-control studies: Compare cases with controls retrospectively
5. Case studies/expert opinion: Lowest level of evidence
Application: Use highest available evidence to guide clinical decisions, develop
protocols, and improve patient outcomes.
Question 8: What is the PICO framework and how is it used in evidence-based
practice?
Answer:
• P (Population): Specific patient population or problem
, • I (Intervention): Treatment or intervention being considered
• C (Comparison): Alternative intervention or control
• O (Outcome): Desired outcome or result
Used to formulate focused clinical questions that guide literature searches and
evidence evaluation for practice improvements.
Leadership and Management
Question 9: Describe the key principles of transformational leadership in
nursing.
Answer:
• Idealized influence: Serving as a role model, gaining respect and trust
• Inspirational motivation: Creating compelling visions and enthusiasm
• Intellectual stimulation: Encouraging innovation and critical thinking
• Individualized consideration: Coaching and mentoring individual team
members
• Promotes: Professional growth, job satisfaction, improved patient
outcomes
Question 10: What are the components of effective delegation in nursing?
Answer:
• Right task: Appropriate for delegation based on stability and complexity
• Right person: Competent individual with appropriate training
• Right direction: Clear, specific instructions and expectations
• Right supervision: Appropriate monitoring and follow-up
• Right evaluation: Assessment of outcomes and feedback
Patient Safety and Quality
Question 11: Explain the concept of a "never event" and provide examples
relevant to nursing practice.
Answer: Never events are serious, preventable adverse events that should
never occur in healthcare settings:
EXPLAINED ANSWERS
172 QUESTIONS AND ANSWERS
Question 1: Explain the pathophysiology of heart failure with reduced ejection
fraction (HFrEF) and describe the compensatory mechanisms that occur.
Answer: HFrEF occurs when the left ventricle cannot pump blood effectively,
typically with an ejection fraction <40%. The pathophysiology involves:
• Initial myocardial injury (MI, hypertension, cardiomyopathy)
• Decreased cardiac output triggers compensatory mechanisms
• Sympathetic nervous system activation increases heart rate and
contractility
• Renin-angiotensin-aldosterone system (RAAS) activation causes
vasoconstriction and fluid retention
• Ventricular remodeling occurs with hypertrophy and dilation
• Progressive decline in cardiac function despite compensatory
mechanisms
Question 2: What is the difference between Type 1 and Type 2 diabetes
mellitus in terms of pathophysiology?
Answer:
• Type 1 DM: Autoimmune destruction of pancreatic beta cells leading to
absolute insulin deficiency. Usually occurs in childhood/adolescence.
Requires insulin therapy.
• Type 2 DM: Insulin resistance combined with relative insulin deficiency.
Beta cells initially compensate by producing more insulin, but eventually
fail. Associated with obesity, sedentary lifestyle, and genetic factors. Can
often be managed with lifestyle changes and oral medications initially.
,Pharmacology
Question 3: A patient is prescribed lisinopril 10mg daily. Explain the
mechanism of action, therapeutic effects, and important nursing
considerations.
Answer:
• Mechanism: ACE inhibitor that blocks conversion of angiotensin I to
angiotensin II, reducing vasoconstriction and aldosterone release
• Therapeutic effects: Reduces blood pressure, decreases cardiac
workload, prevents diabetic nephropathy progression
• Nursing considerations: Monitor blood pressure, potassium levels, and
kidney function; assess for dry cough; educate about orthostatic
hypotension; avoid in pregnancy
Question 4: What are the key differences between warfarin and newer oral
anticoagulants (NOACs) like apixaban?
Answer:
• Warfarin: Vitamin K antagonist, requires regular INR monitoring,
multiple drug/food interactions, reversible with vitamin K
• NOACs (Apixaban): Direct factor Xa inhibitor, predictable dosing, fewer
interactions, no routine monitoring required, specific reversal agents
available
Clinical Assessment
Question 5: Describe the components of a comprehensive cardiovascular
assessment.
Answer:
• History: Chest pain, dyspnea, palpitations, syncope, family history, risk
factors
• Inspection: Skin color, jugular venous distension, edema, respiratory
effort
• Palpation: Pulses (rate, rhythm, quality), point of maximal impulse,
peripheral edema
, • Auscultation: Heart sounds (S1, S2, murmurs, gallops), lung sounds
• Vital signs: Blood pressure in both arms, heart rate, respiratory rate,
oxygen saturation
Question 6: What are the key components of a neurological assessment for a
patient with suspected stroke?
Answer:
• NIH Stroke Scale: Assesses consciousness, gaze, visual fields, facial palsy,
motor function, ataxia, sensation, language, dysarthria, neglect
• Vital signs: Blood pressure, heart rate, temperature, oxygen saturation
• Glasgow Coma Scale: Eye opening, verbal response, motor response
• Pupil assessment: Size, reactivity, equality
• Time of symptom onset: Critical for treatment decisions
Evidence-Based Practice
Question 7: Explain the hierarchy of evidence and how it applies to nursing
practice.
Answer: The hierarchy from strongest to weakest evidence:
1. Systematic reviews/meta-analyses: Comprehensive analysis of multiple
studies
2. Randomized controlled trials (RCTs): Gold standard for intervention
effectiveness
3. Cohort studies: Observational studies following groups over time
4. Case-control studies: Compare cases with controls retrospectively
5. Case studies/expert opinion: Lowest level of evidence
Application: Use highest available evidence to guide clinical decisions, develop
protocols, and improve patient outcomes.
Question 8: What is the PICO framework and how is it used in evidence-based
practice?
Answer:
• P (Population): Specific patient population or problem
, • I (Intervention): Treatment or intervention being considered
• C (Comparison): Alternative intervention or control
• O (Outcome): Desired outcome or result
Used to formulate focused clinical questions that guide literature searches and
evidence evaluation for practice improvements.
Leadership and Management
Question 9: Describe the key principles of transformational leadership in
nursing.
Answer:
• Idealized influence: Serving as a role model, gaining respect and trust
• Inspirational motivation: Creating compelling visions and enthusiasm
• Intellectual stimulation: Encouraging innovation and critical thinking
• Individualized consideration: Coaching and mentoring individual team
members
• Promotes: Professional growth, job satisfaction, improved patient
outcomes
Question 10: What are the components of effective delegation in nursing?
Answer:
• Right task: Appropriate for delegation based on stability and complexity
• Right person: Competent individual with appropriate training
• Right direction: Clear, specific instructions and expectations
• Right supervision: Appropriate monitoring and follow-up
• Right evaluation: Assessment of outcomes and feedback
Patient Safety and Quality
Question 11: Explain the concept of a "never event" and provide examples
relevant to nursing practice.
Answer: Never events are serious, preventable adverse events that should
never occur in healthcare settings:
