NRNP 6552 Midterm Exam (Week 6) – 2025 Updated Test Bank | 150
Verified Questions & Answers with Rationales
Q1. A 58-year-old man with a 40-pack-year smoking history presents with progressive dyspnea
and a chronic productive cough. Which finding on spirometry is most consistent with COPD?
A. Normal FEV1/FVC ratio
B. Increased FEV1 after bronchodilator
C. Persistent FEV1/FVC < 0.70 post-bronchodilator
D. Isolated reduction in FVC
Answer: C
Rationale: COPD is diagnosed by persistent airflow limitation with post-bronchodilator
FEV1/FVC < 0.70.
Q2. A patient with type 2 diabetes on metformin has an eGFR of 28 mL/min/1.73m². What is the
best action regarding metformin?
A. Continue at same dose
B. Increase dose for glucose control
C. Hold or discontinue metformin
D. Switch to insulin immediately
Answer: C
Rationale: Metformin is contraindicated or should be held when eGFR <30 due to lactic acidosis
risk.
Q3. A 25-year-old woman presents with sudden onset pleuritic chest pain and dyspnea; exam
shows decreased breath sounds on the right, hyperresonance. Most likely diagnosis?
A. Pulmonary embolism
B. Tension pneumothorax
C. Spontaneous pneumothorax
,D. Pleural effusion
Answer: C
Rationale: Sudden pleuritic pain, dyspnea, hyperresonance, and decreased breath sounds
suggest spontaneous pneumothorax.
Q4. Which medication is first-line for acute asthma exacerbation in the ED?
A. Inhaled corticosteroid
B. Short-acting beta2-agonist (albuterol) via nebulizer
C. Long-acting beta2-agonist (salmeterol)
D. Oral montelukast
Answer: B
Rationale: Short-acting beta2-agonists delivered rapidly (nebulizer or MDI) are first-line for
acute bronchospasm.
Q5. A 72-year-old female with new-onset atrial fibrillation is at high stroke risk (CHA2DS2-VASc =
5). Which is preferred for stroke prevention?
A. Aspirin alone
B. Warfarin with INR goal 2–3 or DOAC
C. No anticoagulation due to age
D. Subcutaneous heparin daily
Answer: B
Rationale: High CHA2DS2-VASc requires oral anticoagulation (warfarin with INR 2–3 or a DOAC)
for stroke prevention.
Q6. In heart failure with reduced ejection fraction (HFrEF), which class of drugs has mortality
benefit?
A. Calcium channel blockers (dihydropyridine)
,B. ACE inhibitors or ARBs
C. Digoxin alone
D. NSAIDs
Answer: B
Rationale: ACE inhibitors (and ARBs when intolerant) reduce mortality in HFrEF.
Q7. A 34-year-old pregnant woman (28 weeks) presents with headaches, visual disturbances,
and BP 160/105 mmHg. Next best step?
A. Immediate delivery regardless of gestation
B. Start magnesium sulfate and antihypertensives; evaluate for severe preeclampsia
C. Reassure and follow-up in one week
D. Prescribe ACE inhibitor
Answer: B
Rationale: Severe preeclampsia signs require stabilization (MgSO4 for seizure prophylaxis) and
BP control; ACE inhibitors are contraindicated in pregnancy.
Q8. Which lab test best screens for hypothyroidism?
A. Total T3
B. Free T4
C. TSH
D. Thyroid peroxidase antibody only
Answer: C
Rationale: TSH is the most sensitive initial screening test for thyroid dysfunction.
Q9. A 45-year-old man with sudden right facial droop, slurred speech, and left-sided weakness
started 1 hour ago. Best immediate action?
A. Order MRI and send home if normal
, B. Initiate thrombolytic therapy after urgent CT to exclude hemorrhage if within window
C. Give aspirin and discharge
D. Delay evaluation until morning
Answer: B
Rationale: For ischemic stroke within thrombolytic window, urgent CT to rule out hemorrhage
followed by tPA if eligible is indicated.
Q10. A patient with chronic kidney disease has hyperkalemia of 6.2 mEq/L with peaked T waves
on ECG. Immediate therapy of choice?
A. Oral potassium binder only
B. IV calcium gluconate to stabilize cardiac membrane, then insulin + dextrose
C. Increase dietary potassium
D. IV magnesium sulfate
Answer: B
Rationale: IV calcium stabilizes myocardium; insulin + dextrose shifts potassium intracellularly—
urgent management for severe hyperkalemia.
Q11. Which vaccine is recommended annually for adults and particularly for healthcare
workers?
A. Tdap
B. Influenza vaccine
C. Varicella vaccine
D. HPV vaccine
Answer: B
Rationale: Annual influenza vaccination is recommended for all adults and healthcare workers.
Verified Questions & Answers with Rationales
Q1. A 58-year-old man with a 40-pack-year smoking history presents with progressive dyspnea
and a chronic productive cough. Which finding on spirometry is most consistent with COPD?
A. Normal FEV1/FVC ratio
B. Increased FEV1 after bronchodilator
C. Persistent FEV1/FVC < 0.70 post-bronchodilator
D. Isolated reduction in FVC
Answer: C
Rationale: COPD is diagnosed by persistent airflow limitation with post-bronchodilator
FEV1/FVC < 0.70.
Q2. A patient with type 2 diabetes on metformin has an eGFR of 28 mL/min/1.73m². What is the
best action regarding metformin?
A. Continue at same dose
B. Increase dose for glucose control
C. Hold or discontinue metformin
D. Switch to insulin immediately
Answer: C
Rationale: Metformin is contraindicated or should be held when eGFR <30 due to lactic acidosis
risk.
Q3. A 25-year-old woman presents with sudden onset pleuritic chest pain and dyspnea; exam
shows decreased breath sounds on the right, hyperresonance. Most likely diagnosis?
A. Pulmonary embolism
B. Tension pneumothorax
C. Spontaneous pneumothorax
,D. Pleural effusion
Answer: C
Rationale: Sudden pleuritic pain, dyspnea, hyperresonance, and decreased breath sounds
suggest spontaneous pneumothorax.
Q4. Which medication is first-line for acute asthma exacerbation in the ED?
A. Inhaled corticosteroid
B. Short-acting beta2-agonist (albuterol) via nebulizer
C. Long-acting beta2-agonist (salmeterol)
D. Oral montelukast
Answer: B
Rationale: Short-acting beta2-agonists delivered rapidly (nebulizer or MDI) are first-line for
acute bronchospasm.
Q5. A 72-year-old female with new-onset atrial fibrillation is at high stroke risk (CHA2DS2-VASc =
5). Which is preferred for stroke prevention?
A. Aspirin alone
B. Warfarin with INR goal 2–3 or DOAC
C. No anticoagulation due to age
D. Subcutaneous heparin daily
Answer: B
Rationale: High CHA2DS2-VASc requires oral anticoagulation (warfarin with INR 2–3 or a DOAC)
for stroke prevention.
Q6. In heart failure with reduced ejection fraction (HFrEF), which class of drugs has mortality
benefit?
A. Calcium channel blockers (dihydropyridine)
,B. ACE inhibitors or ARBs
C. Digoxin alone
D. NSAIDs
Answer: B
Rationale: ACE inhibitors (and ARBs when intolerant) reduce mortality in HFrEF.
Q7. A 34-year-old pregnant woman (28 weeks) presents with headaches, visual disturbances,
and BP 160/105 mmHg. Next best step?
A. Immediate delivery regardless of gestation
B. Start magnesium sulfate and antihypertensives; evaluate for severe preeclampsia
C. Reassure and follow-up in one week
D. Prescribe ACE inhibitor
Answer: B
Rationale: Severe preeclampsia signs require stabilization (MgSO4 for seizure prophylaxis) and
BP control; ACE inhibitors are contraindicated in pregnancy.
Q8. Which lab test best screens for hypothyroidism?
A. Total T3
B. Free T4
C. TSH
D. Thyroid peroxidase antibody only
Answer: C
Rationale: TSH is the most sensitive initial screening test for thyroid dysfunction.
Q9. A 45-year-old man with sudden right facial droop, slurred speech, and left-sided weakness
started 1 hour ago. Best immediate action?
A. Order MRI and send home if normal
, B. Initiate thrombolytic therapy after urgent CT to exclude hemorrhage if within window
C. Give aspirin and discharge
D. Delay evaluation until morning
Answer: B
Rationale: For ischemic stroke within thrombolytic window, urgent CT to rule out hemorrhage
followed by tPA if eligible is indicated.
Q10. A patient with chronic kidney disease has hyperkalemia of 6.2 mEq/L with peaked T waves
on ECG. Immediate therapy of choice?
A. Oral potassium binder only
B. IV calcium gluconate to stabilize cardiac membrane, then insulin + dextrose
C. Increase dietary potassium
D. IV magnesium sulfate
Answer: B
Rationale: IV calcium stabilizes myocardium; insulin + dextrose shifts potassium intracellularly—
urgent management for severe hyperkalemia.
Q11. Which vaccine is recommended annually for adults and particularly for healthcare
workers?
A. Tdap
B. Influenza vaccine
C. Varicella vaccine
D. HPV vaccine
Answer: B
Rationale: Annual influenza vaccination is recommended for all adults and healthcare workers.
