NRNP 6675 Week 6 Midterm Exam Questions and
Revised Correct Answers (2026/ 2027) 100%
Guarantee Pass
Question 1
A 62 year old patient with long standing hypertension presents with
exertional dyspnea and lower extremity edema. Echocardiogram shows
concentric left ventricular hypertrophy with preserved ejection fraction.
The most accurate explanation for this presentation is that chronic
pressure overload has resulted in myocardial wall thickening which
initially preserves systolic function while impairing ventricular
relaxation, leading to diastolic dysfunction and heart failure with
preserved ejection fraction.
Correct answer explanation
Chronic hypertension increases afterload which forces the left ventricle
to generate higher pressures to eject blood. The myocardium adapts
through concentric hypertrophy, increasing wall thickness without
chamber dilation. While this maintains ejection fraction, it reduces
ventricular compliance and impairs diastolic filling. Symptoms such as
dyspnea occur due to elevated filling pressures despite normal systolic
performance.
Question 2
A patient with type 2 diabetes mellitus presents with confusion, severe
dehydration, serum glucose of 920 mg per deciliter, minimal ketones,
and arterial pH of 7.36. The most appropriate initial management
priority is aggressive intravenous fluid resuscitation before insulin
administration.
Correct answer explanation
This presentation is consistent with hyperosmolar hyperglycemic state.
Severe dehydration and hyperosmolarity pose immediate life threatening
risks. Rapid insulin administration before volume correction can worsen
,hypotension and precipitate cerebral edema. Restoring intravascular
volume stabilizes perfusion and allows safer metabolic correction.
Question 3
A patient receiving an ACE inhibitor develops muscle weakness and
peaked T waves on electrocardiogram. The underlying mechanism
responsible for this finding is reduced aldosterone secretion leading to
potassium retention.
Correct answer explanation
ACE inhibitors reduce angiotensin II formation, which decreases
aldosterone release from the adrenal cortex. Aldosterone normally
promotes renal potassium excretion. Reduced aldosterone therefore
leads to hyperkalemia, which alters cardiac conduction and produces
characteristic electrocardiographic changes.
Question 4
A patient with suspected sepsis presents with hypotension, tachycardia,
fever, and altered mental status. The most critical initial intervention is
rapid intravenous crystalloid administration.
Correct answer explanation
Sepsis causes systemic vasodilation and capillary leakage resulting in
intravascular volume depletion. Restoring circulating volume improves
tissue perfusion and oxygen delivery. Antibiotics are essential but
should follow hemodynamic stabilization to prevent progression to
septic shock.
Question 5
A patient reports sudden onset chest pain radiating to the back with
unequal blood pressures between arms. The most concerning diagnosis
is aortic dissection.
Correct answer explanation
Tearing chest pain radiating posteriorly combined with asymmetric
blood pressures strongly suggests dissection of the aortic wall. This
condition is rapidly fatal without prompt recognition and blood pressure
control to reduce shear stress.
,Question 6
A patient with chronic kidney disease presents with anemia, fatigue, and
pallor. The primary mechanism of anemia in this patient is reduced
erythropoietin production by the kidneys.
Correct answer explanation
Healthy kidneys produce erythropoietin which stimulates red blood cell
production. Chronic renal damage reduces erythropoietin synthesis,
leading to decreased erythropoiesis and normocytic normochromic
anemia.
Question 7
A patient with asthma experiences worsening symptoms after starting a
nonselective beta blocker. This occurs because beta two receptor
blockade leads to bronchoconstriction.
Correct answer explanation
Beta two receptors mediate bronchodilation. Nonselective beta blockers
inhibit both beta one and beta two receptors, preventing bronchodilation
and potentially triggering bronchospasm in susceptible individuals.
Question 8
A patient presents with polyuria, polydipsia, weight loss, and elevated
fasting glucose. Autoantibody testing is positive. The most likely
diagnosis is type 1 diabetes mellitus.
Correct answer explanation
Type 1 diabetes results from autoimmune destruction of pancreatic beta
cells, leading to absolute insulin deficiency. Autoantibody presence
confirms immune mediated pathology rather than insulin resistance.
Question 9
A patient with heart failure is prescribed furosemide. The primary
therapeutic effect of this medication is reduction of preload through
increased renal sodium and water excretion.
Correct answer explanation
Loop diuretics inhibit sodium reabsorption in the loop of Henle,
promoting diuresis. This reduces intravascular volume, decreases venous
, return, and lowers preload, relieving pulmonary and systemic
congestion.
Question 10
A patient with long standing GERD develops progressive dysphagia.
Endoscopy reveals columnar epithelium replacing squamous epithelium
in the distal esophagus. This finding is Barrett esophagus.
Correct answer explanation
Chronic acid exposure induces metaplastic transformation of esophageal
epithelium. Barrett esophagus increases the risk of esophageal
adenocarcinoma and requires surveillance.
Question 11
A patient with cirrhosis develops ascites due to portal hypertension
causing increased hydrostatic pressure within the portal venous system.
Correct answer explanation
Portal hypertension leads to fluid transudation from hepatic sinusoids
into the peritoneal cavity. Reduced albumin synthesis further worsens
oncotic pressure imbalance.
Question 12
A patient presents with tremor, weight loss, heat intolerance, and
tachycardia. The most likely hormonal abnormality is excess thyroid
hormone.
Correct answer explanation
Thyroid hormone increases basal metabolic rate and adrenergic
sensitivity. Excess levels cause hypermetabolic symptoms affecting
cardiovascular, neurologic, and thermoregulatory systems.
Question 13
A patient with deep vein thrombosis is treated with anticoagulation. The
primary goal is prevention of clot propagation and pulmonary embolism.
Correct answer explanation
Anticoagulants do not dissolve existing clots but prevent further
thrombus formation and allow endogenous fibrinolytic mechanisms to
act.
Revised Correct Answers (2026/ 2027) 100%
Guarantee Pass
Question 1
A 62 year old patient with long standing hypertension presents with
exertional dyspnea and lower extremity edema. Echocardiogram shows
concentric left ventricular hypertrophy with preserved ejection fraction.
The most accurate explanation for this presentation is that chronic
pressure overload has resulted in myocardial wall thickening which
initially preserves systolic function while impairing ventricular
relaxation, leading to diastolic dysfunction and heart failure with
preserved ejection fraction.
Correct answer explanation
Chronic hypertension increases afterload which forces the left ventricle
to generate higher pressures to eject blood. The myocardium adapts
through concentric hypertrophy, increasing wall thickness without
chamber dilation. While this maintains ejection fraction, it reduces
ventricular compliance and impairs diastolic filling. Symptoms such as
dyspnea occur due to elevated filling pressures despite normal systolic
performance.
Question 2
A patient with type 2 diabetes mellitus presents with confusion, severe
dehydration, serum glucose of 920 mg per deciliter, minimal ketones,
and arterial pH of 7.36. The most appropriate initial management
priority is aggressive intravenous fluid resuscitation before insulin
administration.
Correct answer explanation
This presentation is consistent with hyperosmolar hyperglycemic state.
Severe dehydration and hyperosmolarity pose immediate life threatening
risks. Rapid insulin administration before volume correction can worsen
,hypotension and precipitate cerebral edema. Restoring intravascular
volume stabilizes perfusion and allows safer metabolic correction.
Question 3
A patient receiving an ACE inhibitor develops muscle weakness and
peaked T waves on electrocardiogram. The underlying mechanism
responsible for this finding is reduced aldosterone secretion leading to
potassium retention.
Correct answer explanation
ACE inhibitors reduce angiotensin II formation, which decreases
aldosterone release from the adrenal cortex. Aldosterone normally
promotes renal potassium excretion. Reduced aldosterone therefore
leads to hyperkalemia, which alters cardiac conduction and produces
characteristic electrocardiographic changes.
Question 4
A patient with suspected sepsis presents with hypotension, tachycardia,
fever, and altered mental status. The most critical initial intervention is
rapid intravenous crystalloid administration.
Correct answer explanation
Sepsis causes systemic vasodilation and capillary leakage resulting in
intravascular volume depletion. Restoring circulating volume improves
tissue perfusion and oxygen delivery. Antibiotics are essential but
should follow hemodynamic stabilization to prevent progression to
septic shock.
Question 5
A patient reports sudden onset chest pain radiating to the back with
unequal blood pressures between arms. The most concerning diagnosis
is aortic dissection.
Correct answer explanation
Tearing chest pain radiating posteriorly combined with asymmetric
blood pressures strongly suggests dissection of the aortic wall. This
condition is rapidly fatal without prompt recognition and blood pressure
control to reduce shear stress.
,Question 6
A patient with chronic kidney disease presents with anemia, fatigue, and
pallor. The primary mechanism of anemia in this patient is reduced
erythropoietin production by the kidneys.
Correct answer explanation
Healthy kidneys produce erythropoietin which stimulates red blood cell
production. Chronic renal damage reduces erythropoietin synthesis,
leading to decreased erythropoiesis and normocytic normochromic
anemia.
Question 7
A patient with asthma experiences worsening symptoms after starting a
nonselective beta blocker. This occurs because beta two receptor
blockade leads to bronchoconstriction.
Correct answer explanation
Beta two receptors mediate bronchodilation. Nonselective beta blockers
inhibit both beta one and beta two receptors, preventing bronchodilation
and potentially triggering bronchospasm in susceptible individuals.
Question 8
A patient presents with polyuria, polydipsia, weight loss, and elevated
fasting glucose. Autoantibody testing is positive. The most likely
diagnosis is type 1 diabetes mellitus.
Correct answer explanation
Type 1 diabetes results from autoimmune destruction of pancreatic beta
cells, leading to absolute insulin deficiency. Autoantibody presence
confirms immune mediated pathology rather than insulin resistance.
Question 9
A patient with heart failure is prescribed furosemide. The primary
therapeutic effect of this medication is reduction of preload through
increased renal sodium and water excretion.
Correct answer explanation
Loop diuretics inhibit sodium reabsorption in the loop of Henle,
promoting diuresis. This reduces intravascular volume, decreases venous
, return, and lowers preload, relieving pulmonary and systemic
congestion.
Question 10
A patient with long standing GERD develops progressive dysphagia.
Endoscopy reveals columnar epithelium replacing squamous epithelium
in the distal esophagus. This finding is Barrett esophagus.
Correct answer explanation
Chronic acid exposure induces metaplastic transformation of esophageal
epithelium. Barrett esophagus increases the risk of esophageal
adenocarcinoma and requires surveillance.
Question 11
A patient with cirrhosis develops ascites due to portal hypertension
causing increased hydrostatic pressure within the portal venous system.
Correct answer explanation
Portal hypertension leads to fluid transudation from hepatic sinusoids
into the peritoneal cavity. Reduced albumin synthesis further worsens
oncotic pressure imbalance.
Question 12
A patient presents with tremor, weight loss, heat intolerance, and
tachycardia. The most likely hormonal abnormality is excess thyroid
hormone.
Correct answer explanation
Thyroid hormone increases basal metabolic rate and adrenergic
sensitivity. Excess levels cause hypermetabolic symptoms affecting
cardiovascular, neurologic, and thermoregulatory systems.
Question 13
A patient with deep vein thrombosis is treated with anticoagulation. The
primary goal is prevention of clot propagation and pulmonary embolism.
Correct answer explanation
Anticoagulants do not dissolve existing clots but prevent further
thrombus formation and allow endogenous fibrinolytic mechanisms to
act.
