MSN 612 Final Exam 2025 with Correct Answers – Advanced
Nursing Practice Review Material
Question 1: A 65-year-old male with a 40‑year history of smoking presents with shortness of breath.
ABG shows: pH 7.32, PaCO₂ 68 mmHg, HCO₃⁻ 32 mEq/L. What is the acid‑base disturbance?
A) Acute Respiratory Acidosis
B) Partially Compensated Metabolic Alkalosis
C) Partially Compensated Respiratory Acidosis
D) Uncompensated Respiratory Alkalosis
Answer: C
Rationale: The pH is low (acidemia) and the PaCO₂ is high (respiratory cause). The HCO₃⁻ is elevated,
indicating metabolic compensation, but it has not returned the pH to normal (7.35–7.45), so the
disturbance is partially compensated respiratory acidosis.
Question 2: In Type 2 Diabetes Mellitus, which cellular mechanism is primarily responsible for insulin
resistance?
A) Autoimmune destruction of beta cells in the islets of Langerhans
B) Downregulation of GLUT‑4 transporters in skeletal muscle and adipose tissue
C) Increased C‑peptide secretion by the pancreas
D) Alpha cell hyperplasia leading to excess glucagon
Answer: B
Rationale: Insulin resistance in Type 2 DM is characterized by impaired translocation of GLUT‑4
transporters to the cell membrane, preventing efficient glucose entry into muscle and fat cells. Option A
describes Type 1 DM.
,Question 3: Which of the following is the most significant risk factor for developing digoxin toxicity?
A) Hypernatremia (Na⁺ 155 mEq/L)
B) Hypokalemia (K⁺ 3.2 mEq/L)
C) Hypercalcemia (Ca⁺ 11.5 mg/dL)
D) Hypermagnesemia (Mg⁺ 3.0 mEq/L)
Answer: B
Rationale: Low serum potassium increases the binding of digoxin to cardiac Na⁺/K⁺-ATPase pumps,
greatly potentiating its effects and leading to toxicity.
Question 4: A patient with septic shock develops laboratory values consistent with disseminated
intravascular coagulation (DIC). Which of the following findings would you expect?
A) Elevated platelet count and elevated fibrinogen
B) Decreased PT/INR and decreased aPTT
C) Decreased fibrinogen and elevated D‑dimer
D) Normal schistocytes on peripheral smear
Answer: C
Rationale: DIC consumes clotting factors and platelets, leading to decreased fibrinogen and elevated
D‑dimer. Schistocytes are often present on the peripheral smear.
Question 5: A patient presents with ECG changes consistent with hyperkalemia (peaked T waves). What
is the priority intervention?
A) Administer IV calcium gluconate
B) Administer IV insulin and dextrose
,C) Administer IV normal saline bolus
D) Prepare for emergent hemodialysis
Answer: A
Rationale: IV calcium gluconate is the priority because it stabilizes the cardiac membrane and protects
against life‑threatening arrhythmias while other measures (insulin/dextrose, etc.) begin to lower the
serum potassium.
Question 6: A young woman presents with sudden onset lower abdominal pain and vaginal spotting.
Transvaginal ultrasound reveals an empty uterus, an adnexal mass, and a hypervascular “ring of fire” on
Doppler. What is the most likely diagnosis?
A) Ovarian cystadenoma
B) Ectopic pregnancy
C) Ruptured corpus luteum cyst
D) Endometrioma
Answer: B
Rationale: A “ring of fire” (hypervascularity around an extrauterine gestational sac) is highly suggestive
of an ectopic pregnancy.
Question 7: A patient on warfarin presents with an INR of 8.5 and a life‑threatening bleed. What is the
reversal agent of choice?
A) Vitamin K (Phytonadione) 10 mg IV
B) Fresh Frozen Plasma (FFP)
C) Prothrombin Complex Concentrate (PCC)
, D) Protamine sulfate
Answer: C
Rationale: PCC (factors II, VII, IX, X) reverses the INR immediately (<15 minutes) and is preferred in
life‑threatening bleeds.
Question 8: Which medication poses a significant risk of serotonin syndrome when combined with
linezolid (an antibiotic)?
A) Bupropion (Wellbutrin)
B) Haloperidol (Haldol)
C) Fluoxetine (Prozac)
D) Olanzapine (Zyprexa)
Answer: C
Rationale: Linezolid is a weak MAOI and when combined with SSRIs (e.g., fluoxetine) can precipitate
serotonin syndrome.
Question 9: Who sets the Scope of Practice (SOP) for Advanced Practice Registered Nurses (APRNs)?
A) The American Nurses Association (ANA)
B) The National Council of State Boards of Nursing (NCSBN)
C) The state nursing board
D) The hospital privileging committee
Answer: C
Nursing Practice Review Material
Question 1: A 65-year-old male with a 40‑year history of smoking presents with shortness of breath.
ABG shows: pH 7.32, PaCO₂ 68 mmHg, HCO₃⁻ 32 mEq/L. What is the acid‑base disturbance?
A) Acute Respiratory Acidosis
B) Partially Compensated Metabolic Alkalosis
C) Partially Compensated Respiratory Acidosis
D) Uncompensated Respiratory Alkalosis
Answer: C
Rationale: The pH is low (acidemia) and the PaCO₂ is high (respiratory cause). The HCO₃⁻ is elevated,
indicating metabolic compensation, but it has not returned the pH to normal (7.35–7.45), so the
disturbance is partially compensated respiratory acidosis.
Question 2: In Type 2 Diabetes Mellitus, which cellular mechanism is primarily responsible for insulin
resistance?
A) Autoimmune destruction of beta cells in the islets of Langerhans
B) Downregulation of GLUT‑4 transporters in skeletal muscle and adipose tissue
C) Increased C‑peptide secretion by the pancreas
D) Alpha cell hyperplasia leading to excess glucagon
Answer: B
Rationale: Insulin resistance in Type 2 DM is characterized by impaired translocation of GLUT‑4
transporters to the cell membrane, preventing efficient glucose entry into muscle and fat cells. Option A
describes Type 1 DM.
,Question 3: Which of the following is the most significant risk factor for developing digoxin toxicity?
A) Hypernatremia (Na⁺ 155 mEq/L)
B) Hypokalemia (K⁺ 3.2 mEq/L)
C) Hypercalcemia (Ca⁺ 11.5 mg/dL)
D) Hypermagnesemia (Mg⁺ 3.0 mEq/L)
Answer: B
Rationale: Low serum potassium increases the binding of digoxin to cardiac Na⁺/K⁺-ATPase pumps,
greatly potentiating its effects and leading to toxicity.
Question 4: A patient with septic shock develops laboratory values consistent with disseminated
intravascular coagulation (DIC). Which of the following findings would you expect?
A) Elevated platelet count and elevated fibrinogen
B) Decreased PT/INR and decreased aPTT
C) Decreased fibrinogen and elevated D‑dimer
D) Normal schistocytes on peripheral smear
Answer: C
Rationale: DIC consumes clotting factors and platelets, leading to decreased fibrinogen and elevated
D‑dimer. Schistocytes are often present on the peripheral smear.
Question 5: A patient presents with ECG changes consistent with hyperkalemia (peaked T waves). What
is the priority intervention?
A) Administer IV calcium gluconate
B) Administer IV insulin and dextrose
,C) Administer IV normal saline bolus
D) Prepare for emergent hemodialysis
Answer: A
Rationale: IV calcium gluconate is the priority because it stabilizes the cardiac membrane and protects
against life‑threatening arrhythmias while other measures (insulin/dextrose, etc.) begin to lower the
serum potassium.
Question 6: A young woman presents with sudden onset lower abdominal pain and vaginal spotting.
Transvaginal ultrasound reveals an empty uterus, an adnexal mass, and a hypervascular “ring of fire” on
Doppler. What is the most likely diagnosis?
A) Ovarian cystadenoma
B) Ectopic pregnancy
C) Ruptured corpus luteum cyst
D) Endometrioma
Answer: B
Rationale: A “ring of fire” (hypervascularity around an extrauterine gestational sac) is highly suggestive
of an ectopic pregnancy.
Question 7: A patient on warfarin presents with an INR of 8.5 and a life‑threatening bleed. What is the
reversal agent of choice?
A) Vitamin K (Phytonadione) 10 mg IV
B) Fresh Frozen Plasma (FFP)
C) Prothrombin Complex Concentrate (PCC)
, D) Protamine sulfate
Answer: C
Rationale: PCC (factors II, VII, IX, X) reverses the INR immediately (<15 minutes) and is preferred in
life‑threatening bleeds.
Question 8: Which medication poses a significant risk of serotonin syndrome when combined with
linezolid (an antibiotic)?
A) Bupropion (Wellbutrin)
B) Haloperidol (Haldol)
C) Fluoxetine (Prozac)
D) Olanzapine (Zyprexa)
Answer: C
Rationale: Linezolid is a weak MAOI and when combined with SSRIs (e.g., fluoxetine) can precipitate
serotonin syndrome.
Question 9: Who sets the Scope of Practice (SOP) for Advanced Practice Registered Nurses (APRNs)?
A) The American Nurses Association (ANA)
B) The National Council of State Boards of Nursing (NCSBN)
C) The state nursing board
D) The hospital privileging committee
Answer: C
