NSG 527 FINAL EXAM — WILKES UNIVERSITY Actual
Exam 2026/2027 Complete Questions and Answers |
100% Verified Detailed Rationales - Pass Guaranteed - A+
Graded
TABLE OF CONTENTS
Section 1 | Advanced Pathophysiology Foundations | Q1 – Q10
Section 2 | Cardiovascular and Pulmonary Disorders | Q11 – Q20
Section 3 | Renal, Endocrine, and Metabolic Disorders | Q21 – Q30
Section 4 | Neurologic, Musculoskeletal, and Integumentary Disorders | Q31 – Q40
Section 5 | Multisystem Disorders and Complex Case Integration | Q41 – Q50
══════════════════════════════════════
SECTION 1: ADVANCED PATHOPHYSIOLOGY FOUNDATIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 58-year-old male with a history of hypertension presents to the clinic complaining of
fatigue and occasional dizziness. Laboratory studies reveal a hemoglobin of 10.2 g/dL,
MCV of 88 fL, and ferritin of 45 ng/mL. The nurse practitioner recognizes these findings
as most consistent with:
A. Iron deficiency anemia, which typically presents with low MCV and low ferritin
B. Anemia of chronic disease, characterized by normocytic indices and normal or
elevated ferritin with functional iron sequestration ✓ CORRECT
C. Vitamin B12 deficiency, which causes macrocytic anemia with neurological
symptoms
D. Hemolytic anemia, which would show elevated reticulocyte count and bilirubin
Correct Answer: B
,Rationale: Anemia of chronic disease presents with normocytic indices (MCV 80–100
fL) and normal or elevated ferritin due to inflammatory cytokines sequestering iron
within macrophages, reducing iron availability for erythropoiesis despite adequate
stores. Option A is tempting because the patient is anemic with normal MCV, but iron
deficiency would show low ferritin and low MCV, not normal ferritin. Inflammatory
conditions such as chronic infections, autoimmune diseases, and malignancies
commonly cause this anemia through hepcidin-mediated iron trapping.
Question 2 of 50
A 42-year-old female is admitted to the ICU following a motor vehicle accident with
significant blood loss. The trauma team initiates massive transfusion protocol. The
nurse practitioner monitoring her care understands that massive transfusion is most
likely to cause which electrolyte disturbance?
A. Hyperkalemia and hypocalcemia from citrate preservative and potassium leakage
from stored red blood cells ✓ CORRECT
B. Hyponatremia and hypermagnesemia from the saline content in blood products
C. Hypernatremia and hypokalemia from diuretic effects of transfusion
D. Hypochloremia and hyperphosphatemia from metabolic alkalosis
Correct Answer: A
Rationale: Stored red blood cells leak potassium into the plasma over time, causing
hyperkalemia with rapid infusion, while citrate anticoagulant in blood products binds
ionized calcium, causing hypocalcemia that can impair cardiac contractility and
coagulation. Option B misidentifies the primary electrolyte concerns; while volume
expansion occurs, sodium and magnesium disturbances are not the hallmark
complications. The nurse practitioner should monitor ionized calcium levels, watch for
ECG changes, and administer calcium chloride or gluconate if hypocalcemia is
symptomatic.
,Question 3 of 50
A 65-year-old male with a history of chronic obstructive pulmonary disease is found to
have a serum pH of 7.33, PaCO2 of 68 mmHg, and HCO3 of 35 mEq/L. The nurse
practitioner interprets this arterial blood gas as:
A. Acute respiratory acidosis with no metabolic compensation
B. Chronic respiratory acidosis with full metabolic compensation ✓ CORRECT
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer: B
Rationale: The elevated PaCO2 with near-normal pH and elevated bicarbonate indicates
chronic respiratory acidosis where renal compensation has increased bicarbonate
reabsorption over 2–4 days to normalize pH; the bicarbonate of 35 mEq/L reflects
adequate renal compensation. Option A would show a lower pH (typically < 7.30) with
normal or minimally elevated bicarbonate because metabolic compensation requires
time. The nurse practitioner should assess for causes of chronic CO2 retention such as
severe COPD, neuromuscular disease, or chest wall abnormalities.
Question 4 of 50
A 35-year-old female presents with recurrent infections, petechiae, and fatigue.
Laboratory studies reveal a WBC of 2,100/μL, hemoglobin of 8.5 g/dL, and platelets of
45,000/μL. A bone marrow biopsy shows hypocellularity with fatty replacement. The
nurse practitioner recognizes this as:
A. Acute myelogenous leukemia, which would show hypercellular marrow with blast
cells
B. Aplastic anemia, characterized by pancytopenia and hypocellular bone marrow ✓
CORRECT
C. Myelodysplastic syndrome, which typically shows hypercellular marrow with
dysplastic changes
, D. Iron deficiency anemia, which would show microcytic erythrocytes and low ferritin
Correct Answer: B
Rationale: Aplastic anemia is defined by pancytopenia (low WBC, hemoglobin, and
platelets) with a hypocellular or empty bone marrow replaced by fat, resulting from stem
cell failure or immune-mediated destruction of hematopoietic progenitors. Option A is
incorrect because leukemia presents with hypercellular marrow and increased blasts,
the opposite of the hypocellularity described. The nurse practitioner should evaluate for
causes including toxins, medications, viral infections, and autoimmune conditions, and
consider referral for bone marrow transplantation in severe cases.
Question 5 of 50
A 50-year-old male with a history of alcohol use disorder presents with confusion,
ataxia, and ophthalmoplegia. The nurse practitioner suspects Wernicke encephalopathy
and understands that the underlying pathophysiology involves:
A. Thiamine (vitamin B1) deficiency impairing cellular energy metabolism and causing
lactic acidosis ✓ CORRECT
B. Vitamin B12 deficiency causing demyelination of the posterior columns and
corticospinal tracts
C. Folate deficiency interfering with DNA synthesis and causing megaloblastic changes
D. Niacin deficiency leading to pellagra with dermatitis, diarrhea, and dementia
Correct Answer: A
Rationale: Thiamine is an essential cofactor for several enzymes in glucose
metabolism; deficiency impairs ATP production, causes cellular energy failure, and
leads to the classic triad of Wernicke encephalopathy (confusion, ataxia,
ophthalmoplegia) due to neuronal vulnerability to energy deficit. Option B describes
subacute combined degeneration from B12 deficiency, which presents with posterior
column sensory loss and spasticity, not the acute triad seen here. The nurse practitioner
Exam 2026/2027 Complete Questions and Answers |
100% Verified Detailed Rationales - Pass Guaranteed - A+
Graded
TABLE OF CONTENTS
Section 1 | Advanced Pathophysiology Foundations | Q1 – Q10
Section 2 | Cardiovascular and Pulmonary Disorders | Q11 – Q20
Section 3 | Renal, Endocrine, and Metabolic Disorders | Q21 – Q30
Section 4 | Neurologic, Musculoskeletal, and Integumentary Disorders | Q31 – Q40
Section 5 | Multisystem Disorders and Complex Case Integration | Q41 – Q50
══════════════════════════════════════
SECTION 1: ADVANCED PATHOPHYSIOLOGY FOUNDATIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 58-year-old male with a history of hypertension presents to the clinic complaining of
fatigue and occasional dizziness. Laboratory studies reveal a hemoglobin of 10.2 g/dL,
MCV of 88 fL, and ferritin of 45 ng/mL. The nurse practitioner recognizes these findings
as most consistent with:
A. Iron deficiency anemia, which typically presents with low MCV and low ferritin
B. Anemia of chronic disease, characterized by normocytic indices and normal or
elevated ferritin with functional iron sequestration ✓ CORRECT
C. Vitamin B12 deficiency, which causes macrocytic anemia with neurological
symptoms
D. Hemolytic anemia, which would show elevated reticulocyte count and bilirubin
Correct Answer: B
,Rationale: Anemia of chronic disease presents with normocytic indices (MCV 80–100
fL) and normal or elevated ferritin due to inflammatory cytokines sequestering iron
within macrophages, reducing iron availability for erythropoiesis despite adequate
stores. Option A is tempting because the patient is anemic with normal MCV, but iron
deficiency would show low ferritin and low MCV, not normal ferritin. Inflammatory
conditions such as chronic infections, autoimmune diseases, and malignancies
commonly cause this anemia through hepcidin-mediated iron trapping.
Question 2 of 50
A 42-year-old female is admitted to the ICU following a motor vehicle accident with
significant blood loss. The trauma team initiates massive transfusion protocol. The
nurse practitioner monitoring her care understands that massive transfusion is most
likely to cause which electrolyte disturbance?
A. Hyperkalemia and hypocalcemia from citrate preservative and potassium leakage
from stored red blood cells ✓ CORRECT
B. Hyponatremia and hypermagnesemia from the saline content in blood products
C. Hypernatremia and hypokalemia from diuretic effects of transfusion
D. Hypochloremia and hyperphosphatemia from metabolic alkalosis
Correct Answer: A
Rationale: Stored red blood cells leak potassium into the plasma over time, causing
hyperkalemia with rapid infusion, while citrate anticoagulant in blood products binds
ionized calcium, causing hypocalcemia that can impair cardiac contractility and
coagulation. Option B misidentifies the primary electrolyte concerns; while volume
expansion occurs, sodium and magnesium disturbances are not the hallmark
complications. The nurse practitioner should monitor ionized calcium levels, watch for
ECG changes, and administer calcium chloride or gluconate if hypocalcemia is
symptomatic.
,Question 3 of 50
A 65-year-old male with a history of chronic obstructive pulmonary disease is found to
have a serum pH of 7.33, PaCO2 of 68 mmHg, and HCO3 of 35 mEq/L. The nurse
practitioner interprets this arterial blood gas as:
A. Acute respiratory acidosis with no metabolic compensation
B. Chronic respiratory acidosis with full metabolic compensation ✓ CORRECT
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer: B
Rationale: The elevated PaCO2 with near-normal pH and elevated bicarbonate indicates
chronic respiratory acidosis where renal compensation has increased bicarbonate
reabsorption over 2–4 days to normalize pH; the bicarbonate of 35 mEq/L reflects
adequate renal compensation. Option A would show a lower pH (typically < 7.30) with
normal or minimally elevated bicarbonate because metabolic compensation requires
time. The nurse practitioner should assess for causes of chronic CO2 retention such as
severe COPD, neuromuscular disease, or chest wall abnormalities.
Question 4 of 50
A 35-year-old female presents with recurrent infections, petechiae, and fatigue.
Laboratory studies reveal a WBC of 2,100/μL, hemoglobin of 8.5 g/dL, and platelets of
45,000/μL. A bone marrow biopsy shows hypocellularity with fatty replacement. The
nurse practitioner recognizes this as:
A. Acute myelogenous leukemia, which would show hypercellular marrow with blast
cells
B. Aplastic anemia, characterized by pancytopenia and hypocellular bone marrow ✓
CORRECT
C. Myelodysplastic syndrome, which typically shows hypercellular marrow with
dysplastic changes
, D. Iron deficiency anemia, which would show microcytic erythrocytes and low ferritin
Correct Answer: B
Rationale: Aplastic anemia is defined by pancytopenia (low WBC, hemoglobin, and
platelets) with a hypocellular or empty bone marrow replaced by fat, resulting from stem
cell failure or immune-mediated destruction of hematopoietic progenitors. Option A is
incorrect because leukemia presents with hypercellular marrow and increased blasts,
the opposite of the hypocellularity described. The nurse practitioner should evaluate for
causes including toxins, medications, viral infections, and autoimmune conditions, and
consider referral for bone marrow transplantation in severe cases.
Question 5 of 50
A 50-year-old male with a history of alcohol use disorder presents with confusion,
ataxia, and ophthalmoplegia. The nurse practitioner suspects Wernicke encephalopathy
and understands that the underlying pathophysiology involves:
A. Thiamine (vitamin B1) deficiency impairing cellular energy metabolism and causing
lactic acidosis ✓ CORRECT
B. Vitamin B12 deficiency causing demyelination of the posterior columns and
corticospinal tracts
C. Folate deficiency interfering with DNA synthesis and causing megaloblastic changes
D. Niacin deficiency leading to pellagra with dermatitis, diarrhea, and dementia
Correct Answer: A
Rationale: Thiamine is an essential cofactor for several enzymes in glucose
metabolism; deficiency impairs ATP production, causes cellular energy failure, and
leads to the classic triad of Wernicke encephalopathy (confusion, ataxia,
ophthalmoplegia) due to neuronal vulnerability to energy deficit. Option B describes
subacute combined degeneration from B12 deficiency, which presents with posterior
column sensory loss and spasticity, not the acute triad seen here. The nurse practitioner
