NUR 635 MIDTERM EXAM / ACTUAL NUR 635 MIDTERM
EXAM 2026/2027 ACCURATE EXAM REAL QUESTIONS AND
CORRECT DETAILED ANSWERS WITH RATIONALES (100%
CORRECT VERIFIED SOLUTIONS) LATEST UPDATED
VERSION |GUARANTEED PASS A+ (BRAND NEW!) FULL
REVISED NUR 635 MIDTERM EXAM
1. A 58-year-old male with a history of hypertension presents with a blood
pressure of 152/94 mm Hg on two separate visits. His current medications include
lisinopril 20 mg daily. Which medication should be added as second-line therapy
according to the Eighth Joint National Committee (JNC 8) guidelines?
A) Hydrochlorothiazide 12.5 mg daily
B) CORRECT ANSWER Amlodipine 5 mg daily
C) Metoprolol 50 mg daily
D) Doxazosin 2 mg daily
Rationale: JNC 8 recommends adding a thiazide diuretic or a calcium channel
blocker (CCB) to an ACE inhibitor if target BP is not achieved. Amlodipine (CCB)
is preferred due to synergistic effects with lisinopril and fewer metabolic side
effects compared to thiazides in non-African American patients.
2. A 72-year-old woman with stage 3 chronic kidney disease (eGFR 35 mL/min) is
started on a new medication for heart failure with reduced ejection fraction. Which
drug requires dose adjustment based on her renal function?
A) Carvedilol
B) CORRECT ANSWER Spironolactone
C) Hydralazine
D) Digoxin
,Rationale: Spironolactone (aldosterone antagonist) can cause life-threatening
hyperkalemia in patients with eGFR <45 mL/min. Carvedilol and hydralazine are
safe without dose adjustment. Digoxin needs monitoring but not primarily dose
adjustment at this eGFR.
3. A 45-year-old obese female reports dull, aching pain in the right upper quadrant
that radiates to the right shoulder, worse after fatty meals. Murphy’s sign is
positive. What is the most appropriate initial imaging study?
A) Abdominal CT with contrast
B) CORRECT ANSWER Right upper quadrant ultrasound
C) HIDA scan
D) Plain abdominal X-ray
Rationale: Ultrasound is the gold standard initial test for suspected
cholelithiasis/cholecystitis (high sensitivity and specificity, no radiation, low cost).
CT has lower sensitivity for gallstones; HIDA is for cystic duct obstruction but not
first line.
4. A 30-year-old male with no past medical history presents with acute-onset
dyspnea, pleuritic chest pain, and tachycardia after a 14-hour flight. He is hypoxic
to 88% on room air. What is the most likely diagnosis and next step?
A) Myocardial infarction – obtain troponin
B) CORRECT ANSWER Pulmonary embolism – obtain CTA chest
C) Pneumothorax – obtain chest X-ray
D) Pericarditis – obtain echocardiogram
Rationale: Long travel + hypoxia + pleuritic pain + tachycardia = high suspicion
for pulmonary embolism. CTA chest is the diagnostic study of choice. Troponin
may be elevated but is not diagnostic.
,5. Which laboratory finding is most characteristic of syndrome of inappropriate
antidiuretic hormone (SIADH)?
A) Hypernatremia and high serum osmolality
B) Hypokalemia and high urine output
C) CORRECT ANSWER Hyponatremia with high urine osmolality (>100
mOsm/kg)
D) Hypercalcemia and low urine sodium
Rationale: SIADH causes euvolemic hyponatremia due to excess ADH → water
retention → dilutional hyponatremia. Urine osmolality is inappropriately elevated
(>100 mOsm/kg) despite low serum osmolality.
6. A 65-year-old diabetic man presents with a non-healing ulcer on his left great
toe for 3 weeks. Exam shows 2 cm ulcer with yellow slough, surrounding
erythema, and no bone exposure. Pedal pulses are palpable. What is the most
appropriate initial wound care?
A) Wet-to-dry dressings with normal saline
B) CORRECT ANSWER Sharp debridement and moist wound healing with
hydrocolloid dressing
C) Topical antibiotic ointment only
D) Surgical consultation for amputation
Rationale: Non-healing diabetic ulcer requires debridement to remove necrotic
tissue and promote granulation. Moist wound healing (hydrocolloid/hydrogel) is
evidence-based. Wet-to-dry is non-selective and painful. Amputation is premature.
, 7. A 55-year-old female with rheumatoid arthritis on methotrexate and prednisone
develops sudden-onset shortness of breath, fever, and hypoxemia one week after
starting sulfasalazine. What is the most likely adverse effect?
A) Methotrexate-induced pulmonary fibrosis
B) Prednisone-induced opportunistic infection
C) CORRECT ANSWER Sulfasalazine-induced hypersensitivity pneumonitis
D) Rheumatoid arthritis-related interstitial lung disease
Rationale: Sulfasalazine can cause a hypersensitivity pneumonitis within weeks of
initiation, presenting with fever, cough, dyspnea, and hypoxemia. Methotrexate
typically causes chronic pneumonitis after months to years.
8. Which medication is contraindicated in a patient with a history of anaphylaxis to
aspirin?
A) Acetaminophen
B) Tramadol
C) Celecoxib
D) CORRECT ANSWER Ibuprofen
Rationale: Aspirin and ibuprofen are both NSAIDs and cross-reactivity exists in
aspirin-sensitive patients (risk of anaphylaxis). Celecoxib (COX-2 selective) has
lower but not zero cross-reactivity. Acetaminophen and tramadol are safe.
9. A 28-year-old pregnant woman at 32 weeks gestation presents with blood
pressure 158/96 mm Hg and 2+ proteinuria. She denies headache or visual
changes. What is the most appropriate management?
A) Labetalol 200 mg orally now and discharge with follow-up
B) CORRECT ANSWER Admit for fetal monitoring, blood pressure control, and
magnesium sulfate seizure prophylaxis
EXAM 2026/2027 ACCURATE EXAM REAL QUESTIONS AND
CORRECT DETAILED ANSWERS WITH RATIONALES (100%
CORRECT VERIFIED SOLUTIONS) LATEST UPDATED
VERSION |GUARANTEED PASS A+ (BRAND NEW!) FULL
REVISED NUR 635 MIDTERM EXAM
1. A 58-year-old male with a history of hypertension presents with a blood
pressure of 152/94 mm Hg on two separate visits. His current medications include
lisinopril 20 mg daily. Which medication should be added as second-line therapy
according to the Eighth Joint National Committee (JNC 8) guidelines?
A) Hydrochlorothiazide 12.5 mg daily
B) CORRECT ANSWER Amlodipine 5 mg daily
C) Metoprolol 50 mg daily
D) Doxazosin 2 mg daily
Rationale: JNC 8 recommends adding a thiazide diuretic or a calcium channel
blocker (CCB) to an ACE inhibitor if target BP is not achieved. Amlodipine (CCB)
is preferred due to synergistic effects with lisinopril and fewer metabolic side
effects compared to thiazides in non-African American patients.
2. A 72-year-old woman with stage 3 chronic kidney disease (eGFR 35 mL/min) is
started on a new medication for heart failure with reduced ejection fraction. Which
drug requires dose adjustment based on her renal function?
A) Carvedilol
B) CORRECT ANSWER Spironolactone
C) Hydralazine
D) Digoxin
,Rationale: Spironolactone (aldosterone antagonist) can cause life-threatening
hyperkalemia in patients with eGFR <45 mL/min. Carvedilol and hydralazine are
safe without dose adjustment. Digoxin needs monitoring but not primarily dose
adjustment at this eGFR.
3. A 45-year-old obese female reports dull, aching pain in the right upper quadrant
that radiates to the right shoulder, worse after fatty meals. Murphy’s sign is
positive. What is the most appropriate initial imaging study?
A) Abdominal CT with contrast
B) CORRECT ANSWER Right upper quadrant ultrasound
C) HIDA scan
D) Plain abdominal X-ray
Rationale: Ultrasound is the gold standard initial test for suspected
cholelithiasis/cholecystitis (high sensitivity and specificity, no radiation, low cost).
CT has lower sensitivity for gallstones; HIDA is for cystic duct obstruction but not
first line.
4. A 30-year-old male with no past medical history presents with acute-onset
dyspnea, pleuritic chest pain, and tachycardia after a 14-hour flight. He is hypoxic
to 88% on room air. What is the most likely diagnosis and next step?
A) Myocardial infarction – obtain troponin
B) CORRECT ANSWER Pulmonary embolism – obtain CTA chest
C) Pneumothorax – obtain chest X-ray
D) Pericarditis – obtain echocardiogram
Rationale: Long travel + hypoxia + pleuritic pain + tachycardia = high suspicion
for pulmonary embolism. CTA chest is the diagnostic study of choice. Troponin
may be elevated but is not diagnostic.
,5. Which laboratory finding is most characteristic of syndrome of inappropriate
antidiuretic hormone (SIADH)?
A) Hypernatremia and high serum osmolality
B) Hypokalemia and high urine output
C) CORRECT ANSWER Hyponatremia with high urine osmolality (>100
mOsm/kg)
D) Hypercalcemia and low urine sodium
Rationale: SIADH causes euvolemic hyponatremia due to excess ADH → water
retention → dilutional hyponatremia. Urine osmolality is inappropriately elevated
(>100 mOsm/kg) despite low serum osmolality.
6. A 65-year-old diabetic man presents with a non-healing ulcer on his left great
toe for 3 weeks. Exam shows 2 cm ulcer with yellow slough, surrounding
erythema, and no bone exposure. Pedal pulses are palpable. What is the most
appropriate initial wound care?
A) Wet-to-dry dressings with normal saline
B) CORRECT ANSWER Sharp debridement and moist wound healing with
hydrocolloid dressing
C) Topical antibiotic ointment only
D) Surgical consultation for amputation
Rationale: Non-healing diabetic ulcer requires debridement to remove necrotic
tissue and promote granulation. Moist wound healing (hydrocolloid/hydrogel) is
evidence-based. Wet-to-dry is non-selective and painful. Amputation is premature.
, 7. A 55-year-old female with rheumatoid arthritis on methotrexate and prednisone
develops sudden-onset shortness of breath, fever, and hypoxemia one week after
starting sulfasalazine. What is the most likely adverse effect?
A) Methotrexate-induced pulmonary fibrosis
B) Prednisone-induced opportunistic infection
C) CORRECT ANSWER Sulfasalazine-induced hypersensitivity pneumonitis
D) Rheumatoid arthritis-related interstitial lung disease
Rationale: Sulfasalazine can cause a hypersensitivity pneumonitis within weeks of
initiation, presenting with fever, cough, dyspnea, and hypoxemia. Methotrexate
typically causes chronic pneumonitis after months to years.
8. Which medication is contraindicated in a patient with a history of anaphylaxis to
aspirin?
A) Acetaminophen
B) Tramadol
C) Celecoxib
D) CORRECT ANSWER Ibuprofen
Rationale: Aspirin and ibuprofen are both NSAIDs and cross-reactivity exists in
aspirin-sensitive patients (risk of anaphylaxis). Celecoxib (COX-2 selective) has
lower but not zero cross-reactivity. Acetaminophen and tramadol are safe.
9. A 28-year-old pregnant woman at 32 weeks gestation presents with blood
pressure 158/96 mm Hg and 2+ proteinuria. She denies headache or visual
changes. What is the most appropriate management?
A) Labetalol 200 mg orally now and discharge with follow-up
B) CORRECT ANSWER Admit for fetal monitoring, blood pressure control, and
magnesium sulfate seizure prophylaxis
