Western Governors University
CCN: NURS 3119
Course Number: D446
Course Title: Adult Health II
Exam: Final Assessment
Date:2026
A 58-year-old male with chronic heart failure presents with worsening dyspnea and orthopnea. Which diagnostic
finding most strongly supports fluid overload?
• A. Elevated BNP
• B. Decreased serum creatinine
• C. Increased hemoglobin
• D. Low potassium
Answer: A. Elevated BNP
Rationale: BNP rises in response to ventricular stretch and volume overload, confirming heart failure
exacerbation.
A patient with COPD develops acute respiratory distress. ABG shows pH 7.30, PaCO₂ 60 mmHg, HCO₃⁻ 28 mEq/L.
What is the primary disturbance?
• A. Metabolic acidosis
• B. Respiratory acidosis with partial compensation
• C. Metabolic alkalosis
• D. Respiratory alkalosis
Answer: B. Respiratory acidosis with partial compensation
Rationale: Elevated PaCO₂ with low pH indicates respiratory acidosis; elevated HCO₃⁻ shows renal
compensation.
A 72-year-old with atrial fibrillation is prescribed warfarin. Which lab value requires immediate intervention?
• A. INR 2.5
• B. INR 1.8
• C. INR 4.5
1
, • D. INR 2.0
Answer: C. INR 4.5
Rationale: INR >4 increases bleeding risk; therapeutic range is 2–3 for atrial fibrillation.
A patient with cirrhosis presents with confusion and asterixis. Which intervention is most appropriate?
• A. Administer lactulose
• B. Restrict fluids
• C. Provide high-protein diet
• D. Give NSAIDs for pain
Answer: A. Administer lactulose
Rationale: Lactulose reduces ammonia absorption, treating hepatic encephalopathy.
A patient with diabetic nephropathy has proteinuria and hypertension. Which medication is most protective of renal
function?
• A. Beta-blocker
• B. ACE inhibitor
• C. Calcium channel blocker
• D. Loop diuretic
Answer: B. ACE inhibitor
Rationale: ACE inhibitors reduce intraglomerular pressure and proteinuria, slowing nephropathy progression.
True/False
Patients with peripheral arterial disease should elevate legs above heart level to relieve pain.
Answer: False
Rationale: Elevation worsens ischemia; dependent positioning improves perfusion.
In acute pancreatitis, serum amylase and lipase are typically elevated.
Answer: True
Rationale: Pancreatic enzyme leakage raises serum levels, aiding diagnosis.
Continuous bladder irrigation is indicated after TURP to prevent clot retention.
Answer: True
Rationale: Irrigation maintains catheter patency and prevents obstruction.
Patients with chronic kidney disease often develop metabolic alkalosis due to bicarbonate retention.
Answer: False
Rationale: CKD usually causes metabolic acidosis from impaired acid excretion.
In rheumatoid arthritis, morning stiffness lasting more than 30 minutes is a hallmark symptom.
Answer: True
Rationale: Prolonged stiffness is characteristic of inflammatory arthritis.
Fill in the Blank
2
,The hallmark ECG change in hyperkalemia is __________.
Answer: Peaked T waves
Rationale: Elevated potassium alters cardiac conduction, producing tall, peaked T waves.
The gold standard diagnostic test for pulmonary embolism is __________.
Answer: CT pulmonary angiography
Rationale: Provides direct visualization of emboli in pulmonary vasculature.
In hypothyroidism, the most sensitive lab test is __________.
Answer: TSH
Rationale: TSH rises before T4 falls, making it the earliest indicator.
The primary treatment for myasthenia gravis involves administration of __________.
Answer: Acetylcholinesterase inhibitors (e.g., pyridostigmine)
Rationale: These improve neuromuscular transmission by increasing acetylcholine availability.
The first-line therapy for acute ischemic stroke within 4.5 hours of onset is __________.
Answer: IV alteplase (tPA)
Rationale: Timely thrombolysis restores perfusion and reduces disability.
Additional Case-Study Mix
A patient with sepsis develops hypotension unresponsive to fluids. Which drug is indicated?
• Answer: Norepinephrine
• Rationale: First-line vasopressor for septic shock.
A patient with chronic kidney disease has pruritus and bone pain. Which imbalance is most likely?
• Answer: Hyperphosphatemia with hypocalcemia
• Rationale: CKD disrupts phosphate and calcium metabolism, leading to renal osteodystrophy.
True/False: In multiple sclerosis, demyelination primarily affects peripheral nerves.
• Answer: False
• Rationale: MS affects central nervous system myelin.
Fill in the Blank: The antidote for opioid overdose is __________.
• Answer: Naloxone
• Rationale: Competitive antagonist at opioid receptors.
MCQ: A patient with DKA presents with fruity breath odor. Which lab finding confirms diagnosis?
• A. Serum glucose 120 mg/dL
• B. Serum ketones positive
• C. Serum sodium 140 mEq/L
3
, • D. Serum calcium 9 mg/dL
Answer: B. Serum ketones positive
Rationale: Ketone accumulation is diagnostic of DKA.
A
A 58‑year‑old male with a history of diabetes mellitus and hypertension is admitted with sudden onset of right‑sided hemiparesis
and expressive aphasia. CT scan shows no evidence of hemorrhage.
Question: Which thrombolytic intervention is most appropriate if the patient is eligible?
a) Administer tissue plasminogen activator (alteplase) within 4.5 hours of symptom onset
b) Start aspirin 325 mg orally immediately
c) Begin heparin infusion after 24 hours
d) Perform mechanical thrombectomy only after 72 hours
Correct Answer: a) Administer tissue plasminogen activator (alteplase) within 4.5 hours of symptom onset
Rationale: For acute ischemic stroke without hemorrhage, IV alteplase given within 3–4.5 hours of symptom onset improves
functional outcomes. Aspirin is secondary prevention; anticoagulation and delayed thrombectomy are time‑dependent and
protocol‑driven.
B
A 65‑year‑old female with chronic kidney disease stage 5 on hemodialysis develops hyperkalemia with peaked T waves on ECG.
Question: Which sequence of interventions is most appropriate?
a) IV calcium gluconate, then insulin with dextrose, then sodium polystyrene sulfonate
b) Oral potassium chloride followed by oral kayexalate
c) Start a beta‑blocker to reduce myocardial excitability
d) Begin hemodialysis only after 24 hours
Correct Answer: a) IV calcium gluconate, then insulin with dextrose, then sodium polystyrene sulfonate
4
CCN: NURS 3119
Course Number: D446
Course Title: Adult Health II
Exam: Final Assessment
Date:2026
A 58-year-old male with chronic heart failure presents with worsening dyspnea and orthopnea. Which diagnostic
finding most strongly supports fluid overload?
• A. Elevated BNP
• B. Decreased serum creatinine
• C. Increased hemoglobin
• D. Low potassium
Answer: A. Elevated BNP
Rationale: BNP rises in response to ventricular stretch and volume overload, confirming heart failure
exacerbation.
A patient with COPD develops acute respiratory distress. ABG shows pH 7.30, PaCO₂ 60 mmHg, HCO₃⁻ 28 mEq/L.
What is the primary disturbance?
• A. Metabolic acidosis
• B. Respiratory acidosis with partial compensation
• C. Metabolic alkalosis
• D. Respiratory alkalosis
Answer: B. Respiratory acidosis with partial compensation
Rationale: Elevated PaCO₂ with low pH indicates respiratory acidosis; elevated HCO₃⁻ shows renal
compensation.
A 72-year-old with atrial fibrillation is prescribed warfarin. Which lab value requires immediate intervention?
• A. INR 2.5
• B. INR 1.8
• C. INR 4.5
1
, • D. INR 2.0
Answer: C. INR 4.5
Rationale: INR >4 increases bleeding risk; therapeutic range is 2–3 for atrial fibrillation.
A patient with cirrhosis presents with confusion and asterixis. Which intervention is most appropriate?
• A. Administer lactulose
• B. Restrict fluids
• C. Provide high-protein diet
• D. Give NSAIDs for pain
Answer: A. Administer lactulose
Rationale: Lactulose reduces ammonia absorption, treating hepatic encephalopathy.
A patient with diabetic nephropathy has proteinuria and hypertension. Which medication is most protective of renal
function?
• A. Beta-blocker
• B. ACE inhibitor
• C. Calcium channel blocker
• D. Loop diuretic
Answer: B. ACE inhibitor
Rationale: ACE inhibitors reduce intraglomerular pressure and proteinuria, slowing nephropathy progression.
True/False
Patients with peripheral arterial disease should elevate legs above heart level to relieve pain.
Answer: False
Rationale: Elevation worsens ischemia; dependent positioning improves perfusion.
In acute pancreatitis, serum amylase and lipase are typically elevated.
Answer: True
Rationale: Pancreatic enzyme leakage raises serum levels, aiding diagnosis.
Continuous bladder irrigation is indicated after TURP to prevent clot retention.
Answer: True
Rationale: Irrigation maintains catheter patency and prevents obstruction.
Patients with chronic kidney disease often develop metabolic alkalosis due to bicarbonate retention.
Answer: False
Rationale: CKD usually causes metabolic acidosis from impaired acid excretion.
In rheumatoid arthritis, morning stiffness lasting more than 30 minutes is a hallmark symptom.
Answer: True
Rationale: Prolonged stiffness is characteristic of inflammatory arthritis.
Fill in the Blank
2
,The hallmark ECG change in hyperkalemia is __________.
Answer: Peaked T waves
Rationale: Elevated potassium alters cardiac conduction, producing tall, peaked T waves.
The gold standard diagnostic test for pulmonary embolism is __________.
Answer: CT pulmonary angiography
Rationale: Provides direct visualization of emboli in pulmonary vasculature.
In hypothyroidism, the most sensitive lab test is __________.
Answer: TSH
Rationale: TSH rises before T4 falls, making it the earliest indicator.
The primary treatment for myasthenia gravis involves administration of __________.
Answer: Acetylcholinesterase inhibitors (e.g., pyridostigmine)
Rationale: These improve neuromuscular transmission by increasing acetylcholine availability.
The first-line therapy for acute ischemic stroke within 4.5 hours of onset is __________.
Answer: IV alteplase (tPA)
Rationale: Timely thrombolysis restores perfusion and reduces disability.
Additional Case-Study Mix
A patient with sepsis develops hypotension unresponsive to fluids. Which drug is indicated?
• Answer: Norepinephrine
• Rationale: First-line vasopressor for septic shock.
A patient with chronic kidney disease has pruritus and bone pain. Which imbalance is most likely?
• Answer: Hyperphosphatemia with hypocalcemia
• Rationale: CKD disrupts phosphate and calcium metabolism, leading to renal osteodystrophy.
True/False: In multiple sclerosis, demyelination primarily affects peripheral nerves.
• Answer: False
• Rationale: MS affects central nervous system myelin.
Fill in the Blank: The antidote for opioid overdose is __________.
• Answer: Naloxone
• Rationale: Competitive antagonist at opioid receptors.
MCQ: A patient with DKA presents with fruity breath odor. Which lab finding confirms diagnosis?
• A. Serum glucose 120 mg/dL
• B. Serum ketones positive
• C. Serum sodium 140 mEq/L
3
, • D. Serum calcium 9 mg/dL
Answer: B. Serum ketones positive
Rationale: Ketone accumulation is diagnostic of DKA.
A
A 58‑year‑old male with a history of diabetes mellitus and hypertension is admitted with sudden onset of right‑sided hemiparesis
and expressive aphasia. CT scan shows no evidence of hemorrhage.
Question: Which thrombolytic intervention is most appropriate if the patient is eligible?
a) Administer tissue plasminogen activator (alteplase) within 4.5 hours of symptom onset
b) Start aspirin 325 mg orally immediately
c) Begin heparin infusion after 24 hours
d) Perform mechanical thrombectomy only after 72 hours
Correct Answer: a) Administer tissue plasminogen activator (alteplase) within 4.5 hours of symptom onset
Rationale: For acute ischemic stroke without hemorrhage, IV alteplase given within 3–4.5 hours of symptom onset improves
functional outcomes. Aspirin is secondary prevention; anticoagulation and delayed thrombectomy are time‑dependent and
protocol‑driven.
B
A 65‑year‑old female with chronic kidney disease stage 5 on hemodialysis develops hyperkalemia with peaked T waves on ECG.
Question: Which sequence of interventions is most appropriate?
a) IV calcium gluconate, then insulin with dextrose, then sodium polystyrene sulfonate
b) Oral potassium chloride followed by oral kayexalate
c) Start a beta‑blocker to reduce myocardial excitability
d) Begin hemodialysis only after 24 hours
Correct Answer: a) IV calcium gluconate, then insulin with dextrose, then sodium polystyrene sulfonate
4
