NSG 527 Final Exam -Wilkes Questions
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Expert-Verified Explanation 2026\2027
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1. A 45-year-old patient presents with fatigue, weight loss, and a nontender
lymphadenopathy. A biopsy reveals Reed-Sternberg cells. Which diagnosis is
most consistent with these findings?
A. Non-Hodgkin lymphoma
B. Hodgkin lymphoma
C. Acute lymphoblastic leukemia
D. Multiple myeloma
Correct Answer: B
Expert Explanation: Reed-Sternberg cells (large, binucleated or multilobated
cells with prominent nucleoli – "owl-eye" appearance) are the diagnostic
hallmark of Hodgkin lymphoma. They are derived from germinal center B cells.
Patients typically present with painless lymphadenopathy (often cervical or
mediastinal), fever, night sweats, weight loss (B symptoms), and fatigue. Non-
Hodgkin lymphoma does not have Reed-Sternberg cells. Acute lymphoblastic
leukemia presents with blasts in blood/marrow. Multiple myeloma presents
with lytic bone lesions, anemia, renal failure, and monoclonal gammopathy.
2. A patient with type 1 diabetes mellitus is found unconscious. Serum glucose
is 650 mg/dL, pH 7.20, HCO3 12, and serum ketones are positive. Which acid-
base disturbance is present?
A. Metabolic alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis
Correct Answer: C
Expert Explanation: This patient has diabetic ketoacidosis (DKA),
characterized by hyperglycemia, ketonemia, and a high anion gap metabolic
acidosis. The low pH (<7.35) and low bicarbonate (<22) indicate metabolic
acidosis. The anion gap is elevated due to accumulation of ketoacids
,(acetoacetate, beta-hydroxybutyrate). Respiratory acidosis would have elevated
PaCO2. Metabolic alkalosis would have elevated HCO3. Respiratory alkalosis
would have low PaCO2. Treatment includes IV fluids, insulin, and electrolyte
replacement.
3. A 60-year-old with a history of hypertension presents with sudden onset of
severe "tearing" chest pain radiating to the back. Blood pressure is 180/100
mm Hg in the right arm and 100/60 mm Hg in the left arm. Which condition is
most likely?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Expert Explanation: Aortic dissection presents with sudden, severe "tearing"
or "ripping" chest pain that may radiate to the back between the scapulae. Key
finding: differential blood pressures between arms (difference >20 mm Hg) due
to involvement of the subclavian arteries. Myocardial infarction typically
presents with substernal chest pain that may radiate to the jaw/left arm, but
without differential BP. Pulmonary embolism causes dyspnea, pleuritic chest
pain, and hypoxia. Pericarditis pain is sharp, pleuritic, and improves with
leaning forward. Aortic dissection is a surgical emergency requiring immediate
blood pressure control (beta-blockers) and surgical consultation.
4. A patient with chronic kidney disease has a hemoglobin of 7.2 g/dL. Which
pathophysiologic mechanism is the primary cause of this anemia?
A. Iron deficiency from poor intake
B. Decreased erythropoietin production by the kidneys
C. Hemolysis from uremic toxins
D. Vitamin B12 deficiency
Correct Answer: B
Expert Explanation: The primary cause of anemia in chronic kidney disease
(CKD) is insufficient production of erythropoietin (EPO) by the damaged
kidneys. EPO is a glycoprotein hormone produced by interstitial fibroblasts in
the renal cortex that stimulates red blood cell production in the bone marrow.
As CKD progresses, EPO levels fall, leading to normocytic, normochromic
anemia. Iron deficiency may coexist but is not the primary cause. Hemolysis is
, not typical in CKD. Vitamin B12 deficiency causes macrocytic anemia. Treatment
includes erythropoiesis-stimulating agents (epoetin alfa, darbepoetin) and iron
supplementation.
5. A 72-year-old with a history of heart failure is admitted with progressive
dyspnea, orthopnea, and bilateral crackles. Which pathophysiologic process is
most directly responsible for these symptoms?
A. Decreased systemic vascular resistance
B. Increased left ventricular filling pressure with pulmonary congestion
C. Right ventricular failure with systemic edema
D. Decreased cardiac output and renal perfusion
Correct Answer: B
Expert Explanation: Left-sided heart failure leads to increased left ventricular
end-diastolic pressure (preload). This pressure is transmitted backward into the
left atrium and then into the pulmonary veins and capillaries, causing
pulmonary congestion. The resulting transudation of fluid into the interstitium
and alveoli produces crackles (rales), dyspnea, orthopnea, and paroxysmal
nocturnal dyspnea. Decreased SVR is not characteristic. Right ventricular failure
causes systemic congestion (JVD, hepatomegaly, peripheral edema). Decreased
cardiac output is a consequence but does not directly cause crackles.
6. A patient with cirrhosis develops asterixis (liver flap) and confusion. Which
laboratory abnormality is the primary cause of this hepatic encephalopathy?
A. Elevated serum ammonia
B. Hyperbilirubinemia
C. Hypoalbuminemia
D. Elevated alkaline phosphatase
Correct Answer: A
Expert Explanation: Hepatic encephalopathy is primarily caused by elevated
ammonia levels. The failing liver cannot convert ammonia (produced by gut
bacteria from protein digestion) to urea. Ammonia crosses the blood-brain
barrier and causes astrocyte swelling, altered neurotransmitter function
(increased glutamine, altered GABA), and cerebral edema. Asterixis (flapping
tremor) is a classic sign of metabolic encephalopathy. Hyperbilirubinemia
causes jaundice but not encephalopathy. Hypoalbuminemia contributes to
ascites. Elevated alkaline phosphatase indicates cholestasis. Treatment includes
lactulose (acidifies colon, traps ammonia as ammonium) and rifaximin.
and Ansẉers with
Expert-Verified Explanation 2026\2027
update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
Expert-Verified Explanation
, Verified ẉith trusted textbooks
───────────────────────────────────────────────────────
─
1. A 45-year-old patient presents with fatigue, weight loss, and a nontender
lymphadenopathy. A biopsy reveals Reed-Sternberg cells. Which diagnosis is
most consistent with these findings?
A. Non-Hodgkin lymphoma
B. Hodgkin lymphoma
C. Acute lymphoblastic leukemia
D. Multiple myeloma
Correct Answer: B
Expert Explanation: Reed-Sternberg cells (large, binucleated or multilobated
cells with prominent nucleoli – "owl-eye" appearance) are the diagnostic
hallmark of Hodgkin lymphoma. They are derived from germinal center B cells.
Patients typically present with painless lymphadenopathy (often cervical or
mediastinal), fever, night sweats, weight loss (B symptoms), and fatigue. Non-
Hodgkin lymphoma does not have Reed-Sternberg cells. Acute lymphoblastic
leukemia presents with blasts in blood/marrow. Multiple myeloma presents
with lytic bone lesions, anemia, renal failure, and monoclonal gammopathy.
2. A patient with type 1 diabetes mellitus is found unconscious. Serum glucose
is 650 mg/dL, pH 7.20, HCO3 12, and serum ketones are positive. Which acid-
base disturbance is present?
A. Metabolic alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis
Correct Answer: C
Expert Explanation: This patient has diabetic ketoacidosis (DKA),
characterized by hyperglycemia, ketonemia, and a high anion gap metabolic
acidosis. The low pH (<7.35) and low bicarbonate (<22) indicate metabolic
acidosis. The anion gap is elevated due to accumulation of ketoacids
,(acetoacetate, beta-hydroxybutyrate). Respiratory acidosis would have elevated
PaCO2. Metabolic alkalosis would have elevated HCO3. Respiratory alkalosis
would have low PaCO2. Treatment includes IV fluids, insulin, and electrolyte
replacement.
3. A 60-year-old with a history of hypertension presents with sudden onset of
severe "tearing" chest pain radiating to the back. Blood pressure is 180/100
mm Hg in the right arm and 100/60 mm Hg in the left arm. Which condition is
most likely?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Expert Explanation: Aortic dissection presents with sudden, severe "tearing"
or "ripping" chest pain that may radiate to the back between the scapulae. Key
finding: differential blood pressures between arms (difference >20 mm Hg) due
to involvement of the subclavian arteries. Myocardial infarction typically
presents with substernal chest pain that may radiate to the jaw/left arm, but
without differential BP. Pulmonary embolism causes dyspnea, pleuritic chest
pain, and hypoxia. Pericarditis pain is sharp, pleuritic, and improves with
leaning forward. Aortic dissection is a surgical emergency requiring immediate
blood pressure control (beta-blockers) and surgical consultation.
4. A patient with chronic kidney disease has a hemoglobin of 7.2 g/dL. Which
pathophysiologic mechanism is the primary cause of this anemia?
A. Iron deficiency from poor intake
B. Decreased erythropoietin production by the kidneys
C. Hemolysis from uremic toxins
D. Vitamin B12 deficiency
Correct Answer: B
Expert Explanation: The primary cause of anemia in chronic kidney disease
(CKD) is insufficient production of erythropoietin (EPO) by the damaged
kidneys. EPO is a glycoprotein hormone produced by interstitial fibroblasts in
the renal cortex that stimulates red blood cell production in the bone marrow.
As CKD progresses, EPO levels fall, leading to normocytic, normochromic
anemia. Iron deficiency may coexist but is not the primary cause. Hemolysis is
, not typical in CKD. Vitamin B12 deficiency causes macrocytic anemia. Treatment
includes erythropoiesis-stimulating agents (epoetin alfa, darbepoetin) and iron
supplementation.
5. A 72-year-old with a history of heart failure is admitted with progressive
dyspnea, orthopnea, and bilateral crackles. Which pathophysiologic process is
most directly responsible for these symptoms?
A. Decreased systemic vascular resistance
B. Increased left ventricular filling pressure with pulmonary congestion
C. Right ventricular failure with systemic edema
D. Decreased cardiac output and renal perfusion
Correct Answer: B
Expert Explanation: Left-sided heart failure leads to increased left ventricular
end-diastolic pressure (preload). This pressure is transmitted backward into the
left atrium and then into the pulmonary veins and capillaries, causing
pulmonary congestion. The resulting transudation of fluid into the interstitium
and alveoli produces crackles (rales), dyspnea, orthopnea, and paroxysmal
nocturnal dyspnea. Decreased SVR is not characteristic. Right ventricular failure
causes systemic congestion (JVD, hepatomegaly, peripheral edema). Decreased
cardiac output is a consequence but does not directly cause crackles.
6. A patient with cirrhosis develops asterixis (liver flap) and confusion. Which
laboratory abnormality is the primary cause of this hepatic encephalopathy?
A. Elevated serum ammonia
B. Hyperbilirubinemia
C. Hypoalbuminemia
D. Elevated alkaline phosphatase
Correct Answer: A
Expert Explanation: Hepatic encephalopathy is primarily caused by elevated
ammonia levels. The failing liver cannot convert ammonia (produced by gut
bacteria from protein digestion) to urea. Ammonia crosses the blood-brain
barrier and causes astrocyte swelling, altered neurotransmitter function
(increased glutamine, altered GABA), and cerebral edema. Asterixis (flapping
tremor) is a classic sign of metabolic encephalopathy. Hyperbilirubinemia
causes jaundice but not encephalopathy. Hypoalbuminemia contributes to
ascites. Elevated alkaline phosphatase indicates cholestasis. Treatment includes
lactulose (acidifies colon, traps ammonia as ammonium) and rifaximin.
