NRNP 6552 MIDTERM EXAM LATEST
2026 /NRNP6552 WEEK 6 MIDTERM
120 QUESTIONS AND ANSWERS|
VERIFIED ANSWERS
1. A 68-year-old with HFrEF presents with worsening dyspnea,
JVD, and crackles. BP 90/60, HR 110. Which is the most
appropriate initial diuretic?
A) Hydrochlorothiazide 25 mg PO
B) Spironolactone 25 mg PO
C) Furosemide 40 mg IV
D) Metolazone 5 mg PO
Answer: C – IV furosemide provides rapid diuresis in acute
decompensated HF with congestion. Hypotension suggests need
for cautious but necessary diuresis; PO options are too slow.
2. In a patient with cirrhosis and new ascites, the most
appropriate diagnostic paracentesis finding that indicates
spontaneous bacterial peritonitis (SBP) is:
A) PMN count < 250 cells/mm³
B) PMN count > 250 cells/mm³
C) Lymphocyte predominance
D) Glucose > 70 mg/dL
,Answer: B – SBP is defined by PMN ≥ 250/mm³ in ascitic fluid
without an intra-abdominal source.
3. A 72-year-old with COPD presents with increased sputum
purulence and dyspnea. Which antibiotic regimen is first-line
if no risk factors for Pseudomonas?
A) Doxycycline
B) Amoxicillin-clavulanate
C) Ciprofloxacin
D) Azithromycin alone
Answer: B – Amoxicillin-clavulanate or a respiratory
fluoroquinolone (levofloxacin) is recommended for AECOPD with
purulent sputum. Doxycycline is alternative but less broad. Avoid
ciprofloxacin due to poor pneumococcal coverage.
4. Which lab finding is most suggestive of iron deficiency
anemia in an elderly patient?
A) Low ferritin
B) High ferritin
C) High TIBC
D) Both A and C
Answer: D – Low ferritin (absolute iron deficiency) and high TIBC
(compensatory) are classic. In inflammation, ferritin may be falsely
normal/high.
5. A patient with CKD stage 4 has Hb 8.5 g/dL, ferritin 800
ng/mL, TSAT 15%. Next step:
A) Oral ferrous sulfate
, B) IV iron
C) Erythropoiesis-stimulating agent alone
D) Blood transfusion
Answer: B – IV iron is indicated when TSAT < 20% and ferritin <
500-800 (guidelines vary). This patient has functional iron
deficiency despite high ferritin.
6. Which finding on CXR in a COVID-19 patient is most
typical?
A) Lobar consolidation
B) Cavitary lesion
C) Peripheral ground-glass opacities
D) Pleural effusion
Answer: C – Peripheral, bilateral ground-glass opacities are
hallmark of COVID-19 pneumonia.
7. A diabetic patient with foot ulcer, erythema, and purulence.
Wound culture grows MRSA. Appropriate oral antibiotic:
A) Cephalexin
B) Clindamycin
C) Trimethoprim-sulfamethoxazole
D) Amoxicillin
Answer: C – TMP-SMX is active against MRSA. Clindamycin has
variable susceptibility; TMP-SMX is preferred for mild-moderate
MRSA skin infections.
8. Most common electrolyte abnormality in patients taking
loop diuretics:
, A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
Answer: B – Loop diuretics cause potassium wasting in the thick
ascending limb.
9. A patient with sudden-onset severe headache, vomiting,
and nuchal rigidity. Immediate next step:
A) CT head without contrast
B) Lumbar puncture
C) MRI brain
D) EEG
Answer: A – CT head first to rule out mass effect or bleed before
LP. In suspected subarachnoid hemorrhage, non-contrast CT is
sensitive within 6 hours.
10. Which medication is first-line for stable angina with no
contraindications?
A) Amlodipine
B) Metoprolol
C) Isosorbide mononitrate
D) Ranolazine
Answer: B – Beta-blockers are first-line to reduce myocardial
oxygen demand, improving survival post-MI and symptom
control.
2026 /NRNP6552 WEEK 6 MIDTERM
120 QUESTIONS AND ANSWERS|
VERIFIED ANSWERS
1. A 68-year-old with HFrEF presents with worsening dyspnea,
JVD, and crackles. BP 90/60, HR 110. Which is the most
appropriate initial diuretic?
A) Hydrochlorothiazide 25 mg PO
B) Spironolactone 25 mg PO
C) Furosemide 40 mg IV
D) Metolazone 5 mg PO
Answer: C – IV furosemide provides rapid diuresis in acute
decompensated HF with congestion. Hypotension suggests need
for cautious but necessary diuresis; PO options are too slow.
2. In a patient with cirrhosis and new ascites, the most
appropriate diagnostic paracentesis finding that indicates
spontaneous bacterial peritonitis (SBP) is:
A) PMN count < 250 cells/mm³
B) PMN count > 250 cells/mm³
C) Lymphocyte predominance
D) Glucose > 70 mg/dL
,Answer: B – SBP is defined by PMN ≥ 250/mm³ in ascitic fluid
without an intra-abdominal source.
3. A 72-year-old with COPD presents with increased sputum
purulence and dyspnea. Which antibiotic regimen is first-line
if no risk factors for Pseudomonas?
A) Doxycycline
B) Amoxicillin-clavulanate
C) Ciprofloxacin
D) Azithromycin alone
Answer: B – Amoxicillin-clavulanate or a respiratory
fluoroquinolone (levofloxacin) is recommended for AECOPD with
purulent sputum. Doxycycline is alternative but less broad. Avoid
ciprofloxacin due to poor pneumococcal coverage.
4. Which lab finding is most suggestive of iron deficiency
anemia in an elderly patient?
A) Low ferritin
B) High ferritin
C) High TIBC
D) Both A and C
Answer: D – Low ferritin (absolute iron deficiency) and high TIBC
(compensatory) are classic. In inflammation, ferritin may be falsely
normal/high.
5. A patient with CKD stage 4 has Hb 8.5 g/dL, ferritin 800
ng/mL, TSAT 15%. Next step:
A) Oral ferrous sulfate
, B) IV iron
C) Erythropoiesis-stimulating agent alone
D) Blood transfusion
Answer: B – IV iron is indicated when TSAT < 20% and ferritin <
500-800 (guidelines vary). This patient has functional iron
deficiency despite high ferritin.
6. Which finding on CXR in a COVID-19 patient is most
typical?
A) Lobar consolidation
B) Cavitary lesion
C) Peripheral ground-glass opacities
D) Pleural effusion
Answer: C – Peripheral, bilateral ground-glass opacities are
hallmark of COVID-19 pneumonia.
7. A diabetic patient with foot ulcer, erythema, and purulence.
Wound culture grows MRSA. Appropriate oral antibiotic:
A) Cephalexin
B) Clindamycin
C) Trimethoprim-sulfamethoxazole
D) Amoxicillin
Answer: C – TMP-SMX is active against MRSA. Clindamycin has
variable susceptibility; TMP-SMX is preferred for mild-moderate
MRSA skin infections.
8. Most common electrolyte abnormality in patients taking
loop diuretics:
, A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
Answer: B – Loop diuretics cause potassium wasting in the thick
ascending limb.
9. A patient with sudden-onset severe headache, vomiting,
and nuchal rigidity. Immediate next step:
A) CT head without contrast
B) Lumbar puncture
C) MRI brain
D) EEG
Answer: A – CT head first to rule out mass effect or bleed before
LP. In suspected subarachnoid hemorrhage, non-contrast CT is
sensitive within 6 hours.
10. Which medication is first-line for stable angina with no
contraindications?
A) Amlodipine
B) Metoprolol
C) Isosorbide mononitrate
D) Ranolazine
Answer: B – Beta-blockers are first-line to reduce myocardial
oxygen demand, improving survival post-MI and symptom
control.
