NR 547 Midterm Exam Study Pack | Verified Questions
Correct Answers & Detailed Rationales | Latest Update
Question: What is the provider’s initial hypothesis in a differential diagnosis?
Answer: ✓ A working list of potential problems that may be associated with the initial or chief
complaint
Question: What does the DSM-5-TR provide?
Answer: ✓ Guidance for identifying psychiatric diagnoses
1. A patient with chronic kidney disease has a serum potassium of 6.5 mEq/L. Which is the
nurse’s priority action?
A. Administer potassium supplement
B. Place the patient on a cardiac monitor
C. Encourage high-potassium foods
D. Obtain an order for IV fluids
Answer: B. Place the patient on a cardiac monitor
Rationale: Hyperkalemia can cause life-threatening arrhythmias; continuous cardiac
monitoring is essential before any intervention.
2. Which mechanism explains metabolic acidosis in diabetic ketoacidosis (DKA)?
,A. Loss of bicarbonate through kidneys
B. Accumulation of ketone bodies
C. Hypoventilation
D. Excess sodium retention
Answer: B. Accumulation of ketone bodies
Rationale: Ketones are acidic; their accumulation decreases blood pH, causing metabolic
acidosis.
3. A patient with cirrhosis develops confusion and asterixis. Which lab value supports hepatic
encephalopathy?
A. Serum ammonia 85 µmol/L
B. ALT 25 U/L
C. INR 1.0
D. Creatinine 0.9 mg/dL
Answer: A. Serum ammonia 85 µmol/L
Rationale: Elevated ammonia levels cross the blood-brain barrier, causing neurotoxicity and
encephalopathy.
4. Which antihypertensive class reduces afterload by blocking angiotensin II?
A. Beta-blockers
B. ACE inhibitors
C. Calcium channel blockers
D. Diuretics
Answer: B. ACE inhibitors
Rationale: ACE inhibitors prevent conversion of angiotensin I to II, reducing vasoconstriction
and afterload.
5. A patient with sepsis has BP 88/54, HR 122, and lactate 4.2 mmol/L. What is the immediate
nursing action?
A. Administer IV fluids rapidly
B. Draw blood for cultures only
,C. Give acetaminophen
D. Start antibiotics in 12 hours
Answer: A. Administer IV fluids rapidly
Rationale: Early fluid resuscitation is critical in septic shock to restore perfusion; lactate >4
indicates tissue hypoperfusion.
6. Which pathophysiological change occurs in chronic heart failure?
A. Decreased preload and afterload
B. Ventricular remodeling and dilation
C. Decreased sympathetic activation
D. Increased stroke volume
Answer: B. Ventricular remodeling and dilation
Rationale: Chronic HF leads to structural changes that impair cardiac output and increase risk
for arrhythmias.
7. Which lab abnormality is expected in hyperaldosteronism?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypoglycemia
Answer: B. Hypokalemia
Rationale: Excess aldosterone increases renal K⁺ excretion and sodium reabsorption, leading
to hypokalemia.
8. A patient on furosemide reports muscle cramps. Which electrolyte abnormality is likely?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Answer: B. Hypokalemia
Rationale: Loop diuretics promote K⁺ excretion, increasing the risk of hypokalemia.
, 9. Which assessment indicates early left-sided heart failure?
A. Jugular vein distension
B. Pulmonary crackles
C. Peripheral edema
D. Hepatomegaly
Answer: B. Pulmonary crackles
Rationale: Left-sided HF causes pulmonary congestion first, leading to crackles and dyspnea.
10. The nurse knows that norepinephrine increases BP primarily through which mechanism?
A. Beta-1 stimulation increasing heart rate
B. Alpha-1 stimulation causing vasoconstriction
C. Beta-2 stimulation causing bronchodilation
D. Antagonism of acetylcholine
Answer: B. Alpha-1 stimulation causing vasoconstriction
Rationale: Norepinephrine’s alpha-1 effects increase systemic vascular resistance, raising BP.
11. Which lab finding is consistent with primary hyperparathyroidism?
A. Low calcium, low PTH
B. High calcium, high PTH
C. Low calcium, high PTH
D. High calcium, low PTH
Answer: B. High calcium, high PTH
Rationale: Primary hyperparathyroidism increases PTH secretion, causing hypercalcemia.
12. Which pathophysiological mechanism is responsible for ARDS?
A. Surfactant overproduction
B. Alveolar-capillary membrane damage
C. Hyperventilation
D. Pulmonary vasodilation
Correct Answers & Detailed Rationales | Latest Update
Question: What is the provider’s initial hypothesis in a differential diagnosis?
Answer: ✓ A working list of potential problems that may be associated with the initial or chief
complaint
Question: What does the DSM-5-TR provide?
Answer: ✓ Guidance for identifying psychiatric diagnoses
1. A patient with chronic kidney disease has a serum potassium of 6.5 mEq/L. Which is the
nurse’s priority action?
A. Administer potassium supplement
B. Place the patient on a cardiac monitor
C. Encourage high-potassium foods
D. Obtain an order for IV fluids
Answer: B. Place the patient on a cardiac monitor
Rationale: Hyperkalemia can cause life-threatening arrhythmias; continuous cardiac
monitoring is essential before any intervention.
2. Which mechanism explains metabolic acidosis in diabetic ketoacidosis (DKA)?
,A. Loss of bicarbonate through kidneys
B. Accumulation of ketone bodies
C. Hypoventilation
D. Excess sodium retention
Answer: B. Accumulation of ketone bodies
Rationale: Ketones are acidic; their accumulation decreases blood pH, causing metabolic
acidosis.
3. A patient with cirrhosis develops confusion and asterixis. Which lab value supports hepatic
encephalopathy?
A. Serum ammonia 85 µmol/L
B. ALT 25 U/L
C. INR 1.0
D. Creatinine 0.9 mg/dL
Answer: A. Serum ammonia 85 µmol/L
Rationale: Elevated ammonia levels cross the blood-brain barrier, causing neurotoxicity and
encephalopathy.
4. Which antihypertensive class reduces afterload by blocking angiotensin II?
A. Beta-blockers
B. ACE inhibitors
C. Calcium channel blockers
D. Diuretics
Answer: B. ACE inhibitors
Rationale: ACE inhibitors prevent conversion of angiotensin I to II, reducing vasoconstriction
and afterload.
5. A patient with sepsis has BP 88/54, HR 122, and lactate 4.2 mmol/L. What is the immediate
nursing action?
A. Administer IV fluids rapidly
B. Draw blood for cultures only
,C. Give acetaminophen
D. Start antibiotics in 12 hours
Answer: A. Administer IV fluids rapidly
Rationale: Early fluid resuscitation is critical in septic shock to restore perfusion; lactate >4
indicates tissue hypoperfusion.
6. Which pathophysiological change occurs in chronic heart failure?
A. Decreased preload and afterload
B. Ventricular remodeling and dilation
C. Decreased sympathetic activation
D. Increased stroke volume
Answer: B. Ventricular remodeling and dilation
Rationale: Chronic HF leads to structural changes that impair cardiac output and increase risk
for arrhythmias.
7. Which lab abnormality is expected in hyperaldosteronism?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypoglycemia
Answer: B. Hypokalemia
Rationale: Excess aldosterone increases renal K⁺ excretion and sodium reabsorption, leading
to hypokalemia.
8. A patient on furosemide reports muscle cramps. Which electrolyte abnormality is likely?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Answer: B. Hypokalemia
Rationale: Loop diuretics promote K⁺ excretion, increasing the risk of hypokalemia.
, 9. Which assessment indicates early left-sided heart failure?
A. Jugular vein distension
B. Pulmonary crackles
C. Peripheral edema
D. Hepatomegaly
Answer: B. Pulmonary crackles
Rationale: Left-sided HF causes pulmonary congestion first, leading to crackles and dyspnea.
10. The nurse knows that norepinephrine increases BP primarily through which mechanism?
A. Beta-1 stimulation increasing heart rate
B. Alpha-1 stimulation causing vasoconstriction
C. Beta-2 stimulation causing bronchodilation
D. Antagonism of acetylcholine
Answer: B. Alpha-1 stimulation causing vasoconstriction
Rationale: Norepinephrine’s alpha-1 effects increase systemic vascular resistance, raising BP.
11. Which lab finding is consistent with primary hyperparathyroidism?
A. Low calcium, low PTH
B. High calcium, high PTH
C. Low calcium, high PTH
D. High calcium, low PTH
Answer: B. High calcium, high PTH
Rationale: Primary hyperparathyroidism increases PTH secretion, causing hypercalcemia.
12. Which pathophysiological mechanism is responsible for ARDS?
A. Surfactant overproduction
B. Alveolar-capillary membrane damage
C. Hyperventilation
D. Pulmonary vasodilation
