NURS2180
Physical Assessment
Final Exam Review
(Questions & Solutions)
2025
1
,I. MULTIPLE CHOICE (10 questions)
1. A 68-year-old smoker develops sudden right‐sided weakness. CT
angiography shows an occluded middle cerebral artery. Which
mechanism best explains his infarction?
A) Embolic obstruction of an atherosclerotic plaque
B) Thrombotic occlusion secondary to platelet aggregation on an
ulcerated plaque
C) Vasospasm due to subarachnoid blood
D) Hypoperfusion from cardiac failure
ANS: B
Rationale: Thrombotic stroke arises when atherosclerotic plaques
ulcerate and precipitate local clot formation.
2. A 52-year-old with sepsis has lactic acidosis (lactate 6 mmol/L, pH
7.28). Which best describes its origin?
A) Tissue hypoxia causing pyruvate reduction to lactate
B) Excess bicarbonate loss in diarrhea
C) Ketoacid accumulation in DKA
D) Uremic retention of acids
ANS: A
Rationale: In septic shock, poor perfusion shifts metabolism to anaerobic
glycolysis, elevating lactate.
3. A 30-year-old with acute pancreatitis becomes hypotensive and
tachycardic. Which shock type?
A) Distributive
B) Hypovolemic
C) Cardiogenic
D) Obstructive
ANS: B
Rationale: Third‐spacing of fluids into the inflamed pancreas causes
intravascular volume loss and hypovolemic shock.
2
, 4. In metabolic acidosis, the expected respiratory compensation is
predicted by Winter’s formula: PaCO₂ ≈ 1.5 × [HCO₃⁻] + 8 ±2. A patient’s
HCO₃⁻ is 12 mEq/L. Predicted PaCO₂?
A) 26 mm Hg
B) 50 mm Hg
C) 12 mm Hg
D) 36 mm Hg
ANS: A
Rationale: 1.5×12+8 = 26 ±2 mm Hg approximates the compensatory
PaCO₂.
5. A 65-year-old with prerenal azotemia has BUN ∶ Cr of 25 ∶ 1 and FeNa
0.5%. Which lab supports prerenal injury?
A) Urine osmolality > 500 mOsm/kg
B) Urine sodium > 40 mEq/L
C) FeUrea > 50%
D) Fractional excretion of Na > 2%
ANS: A
Rationale: Prerenal states concentrate urine (osmolality >500) and
conserve sodium (FeNa <1%).
6. A 40-year-old with severe vomiting has pH 7.50, PaCO₂ 50 mm Hg,
HCO₃⁻ 40 mEq/L. Which best describes this acid-base disturbance?
A) Metabolic alkalosis with respiratory compensation
B) Metabolic acidosis
C) Respiratory alkalosis
D) Mixed disorder
ANS: A
Rationale: Alkalemic pH with elevated HCO₃⁻ and elevated PaCO₂
indicates primary metabolic alkalosis with respiratory retention.
7. A patient with DKA has hyperkalemia despite low total body
potassium. Why?
A) Insulin deficiency and acidosis shift K⁺ extracellularly
B) Excessive aldosterone excretion
3
Physical Assessment
Final Exam Review
(Questions & Solutions)
2025
1
,I. MULTIPLE CHOICE (10 questions)
1. A 68-year-old smoker develops sudden right‐sided weakness. CT
angiography shows an occluded middle cerebral artery. Which
mechanism best explains his infarction?
A) Embolic obstruction of an atherosclerotic plaque
B) Thrombotic occlusion secondary to platelet aggregation on an
ulcerated plaque
C) Vasospasm due to subarachnoid blood
D) Hypoperfusion from cardiac failure
ANS: B
Rationale: Thrombotic stroke arises when atherosclerotic plaques
ulcerate and precipitate local clot formation.
2. A 52-year-old with sepsis has lactic acidosis (lactate 6 mmol/L, pH
7.28). Which best describes its origin?
A) Tissue hypoxia causing pyruvate reduction to lactate
B) Excess bicarbonate loss in diarrhea
C) Ketoacid accumulation in DKA
D) Uremic retention of acids
ANS: A
Rationale: In septic shock, poor perfusion shifts metabolism to anaerobic
glycolysis, elevating lactate.
3. A 30-year-old with acute pancreatitis becomes hypotensive and
tachycardic. Which shock type?
A) Distributive
B) Hypovolemic
C) Cardiogenic
D) Obstructive
ANS: B
Rationale: Third‐spacing of fluids into the inflamed pancreas causes
intravascular volume loss and hypovolemic shock.
2
, 4. In metabolic acidosis, the expected respiratory compensation is
predicted by Winter’s formula: PaCO₂ ≈ 1.5 × [HCO₃⁻] + 8 ±2. A patient’s
HCO₃⁻ is 12 mEq/L. Predicted PaCO₂?
A) 26 mm Hg
B) 50 mm Hg
C) 12 mm Hg
D) 36 mm Hg
ANS: A
Rationale: 1.5×12+8 = 26 ±2 mm Hg approximates the compensatory
PaCO₂.
5. A 65-year-old with prerenal azotemia has BUN ∶ Cr of 25 ∶ 1 and FeNa
0.5%. Which lab supports prerenal injury?
A) Urine osmolality > 500 mOsm/kg
B) Urine sodium > 40 mEq/L
C) FeUrea > 50%
D) Fractional excretion of Na > 2%
ANS: A
Rationale: Prerenal states concentrate urine (osmolality >500) and
conserve sodium (FeNa <1%).
6. A 40-year-old with severe vomiting has pH 7.50, PaCO₂ 50 mm Hg,
HCO₃⁻ 40 mEq/L. Which best describes this acid-base disturbance?
A) Metabolic alkalosis with respiratory compensation
B) Metabolic acidosis
C) Respiratory alkalosis
D) Mixed disorder
ANS: A
Rationale: Alkalemic pH with elevated HCO₃⁻ and elevated PaCO₂
indicates primary metabolic alkalosis with respiratory retention.
7. A patient with DKA has hyperkalemia despite low total body
potassium. Why?
A) Insulin deficiency and acidosis shift K⁺ extracellularly
B) Excessive aldosterone excretion
3
