NUR 634 FINAL EXAM NEWEST ACTUAL EXAM COMPLETE
ALL 200 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
Question 1
A 68-year-old client with a history of hypertension and hyperlipidemia
presents to the emergency department with sudden onset of "the worst
headache of my life" and nuchal rigidity. Which of the following is the most
critical initial diagnostic study to consider?
A) Magnetic Resonance Imaging (MRI) of the brain
B) Lumbar puncture
C) Computed Tomography (CT) scan of the head without contrast
D) Electroencephalogram (EEG)
E) Carotid ultrasound
Correct Answer: C) Computed Tomography (CT) scan of the head
without contrast
Rationale: The client's presentation (sudden, severe headache,
nuchal rigidity) is highly suggestive of a subarachnoid hemorrhage
(SAH). A non-contrast CT scan of the head is the most rapid and
effective initial diagnostic tool to detect acute intracranial bleeding.
Lumbar puncture may be considered if the CT is negative but
suspicion remains high. MRI is less rapid for acute hemorrhage
detection.
Question 2
A 55-year-old client with type 2 diabetes mellitus is prescribed metformin.
Which of the following laboratory values should the advanced practice nurse
(APN) monitor closely, especially in a client with compromised renal function?
A) Serum potassium
B) Liver enzymes (ALT, AST)
C) Blood urea nitrogen (BUN) and creatinine
D) Hemoglobin A1C
E) Thyroid-stimulating hormone (TSH)
Correct Answer: C) Blood urea nitrogen (BUN) and creatinine
Rationale: Metformin is primarily excreted by the kidneys. In clients
with renal impairment, metformin can accumulate, leading to an
increased risk of lactic acidosis. Therefore, monitoring BUN and
creatinine (indicators of renal function) is crucial to assess kidney
function and guide metformin dosing.
Question 3
Which of the following is the primary mechanism of action of ACE inhibitors
(e.g., lisinopril) in treating hypertension?
,A) Decreases heart rate and myocardial contractility.
B) Directly causes vasodilation by acting on smooth muscle.
C) Inhibits the conversion of angiotensin I to angiotensin II, leading to
vasodilation and decreased aldosterone secretion.
D) Increases the excretion of sodium and water in the kidneys.
E) Blocks alpha-1 adrenergic receptors, causing peripheral vasodilation.
Correct Answer: C) Inhibits the conversion of angiotensin I to
angiotensin II, leading to vasodilation and decreased aldosterone
secretion.
Rationale: ACE inhibitors block the angiotensin-converting enzyme,
which prevents the formation of the potent vasoconstrictor
angiotensin II and reduces aldosterone secretion. This leads to
systemic vasodilation, reduced preload and afterload, and
decreased fluid retention, lowering blood pressure.
Question 4
A 70-year-old client with a history of heart failure presents with increasing
shortness of breath, orthopnea, and bilateral crackles on lung auscultation.
The APN suspects acute pulmonary edema. What is the priority initial
intervention?
A) Administer a rapid IV fluid bolus.
B) Administer IV furosemide and consider positive pressure ventilation
(CPAP/BiPAP).
C) Administer IV norepinephrine.
D) Prepare for immediate cardioversion.
E) Administer oral beta-blockers.
Correct Answer: B) Administer IV furosemide and consider positive
pressure ventilation (CPAP/BiPAP).
Rationale: Acute pulmonary edema requires rapid reduction of fluid
volume (IV diuretics like furosemide) and improvement of
oxygenation/ventilation. Positive pressure ventilation (CPAP/BiPAP)
helps recruit alveoli, reduce preload, and decrease the work of
breathing. A rapid IV fluid bolus would worsen the condition, and
norepinephrine would increase afterload.
Question 5
When assessing a client with suspected acute appendicitis, which of the
following physical findings is most indicative?
A) Right upper quadrant pain radiating to the shoulder.
B) Generalized abdominal pain that suddenly subsides.
C) Rebound tenderness at McBurney's point.
,D) Left lower quadrant pain with palpable mass.
E) Mid-epigastric pain radiating to the back.
Correct Answer: C) Rebound tenderness at McBurney's point.
Rationale: Acute appendicitis is classically characterized by pain that
starts periumbilically and then localizes to the right lower quadrant,
with rebound tenderness (pain upon release of pressure) at
McBurney's point. A sudden subsidence of pain after initial severe
pain could indicate rupture.
Question 6
A 45-year-old client presents with complaints of persistent heartburn,
regurgitation, and a sour taste in their mouth, especially after meals and
when lying down. What is the most likely diagnosis?
A) Peptic ulcer disease (PUD)
B) Gastritis
C) Cholelithiasis
D) Gastroesophageal Reflux Disease (GERD)
E) Irritable Bowel Syndrome (IBS)
Correct Answer: D) Gastroesophageal Reflux Disease (GERD)
Rationale: The classic symptoms of GERD include heartburn (pyrosis),
regurgitation of stomach contents, and a sour taste in the mouth,
often worse post-prandially and in the supine position due to reflux
of gastric acid into the esophagus.
Question 7
Which of the following is the most common cause of community-acquired
pneumonia (CAP) in adults?
A) Staphylococcus aureus
B) Klebsiella pneumoniae
C) Pseudomonas aeruginosa
D) Streptococcus pneumoniae
E) Mycoplasma pneumoniae
Correct Answer: D) *Streptococcus pneumoniae*
Rationale: Streptococcus pneumoniae (pneumococcus) is the most
common bacterial cause of community-acquired pneumonia in
adults. While other pathogens cause CAP, S. pneumoniae is
consistently the leading culprit.
Question 8
A client with type 1 diabetes mellitus is experiencing diabetic ketoacidosis
(DKA). The APN notes a potassium level of 2.9 mEq/L. What is the most
, appropriate initial management step regarding potassium?
A) Administer a rapid insulin bolus immediately.
B) Hold insulin and administer intravenous potassium supplementation.
C) Administer sodium bicarbonate.
D) Increase intravenous fluid rate to 500 mL/hr.
E) Prepare for emergency hemodialysis.
Correct Answer: B) Hold insulin and administer intravenous potassium
supplementation.
Rationale: Although clients with DKA often have total body potassium
depletion, serum potassium can be normal or elevated due to
acidosis. However, once insulin is administered, potassium rapidly
shifts into cells, potentially causing life-threatening hypokalemia. If
serum potassium is below 3.3-3.5 mEq/L, insulin should be held, and
potassium should be administered until the level is within a safe
range, while ensuring adequate urine output.
Question 9
Which of the following findings is most indicative of a tension pneumothorax?
A) Tracheal deviation towards the affected side.
B) Increased breath sounds on the affected side.
C) Jugular venous distension, hypotension, and tracheal deviation away from
the affected side.
D) Clear breath sounds bilaterally.
E) Bradypnea and hypertension.
Correct Answer: C) Jugular venous distension, hypotension, and
tracheal deviation away from the affected side.
Rationale: Tension pneumothorax is a life-threatening condition
where air accumulates in the pleural space, compressing the lung
and shifting the mediastinum. Classic (though often late) signs
include absent breath sounds on the affected side, jugular venous
distension (JVD), hypotension, and tracheal deviation away from the
affected side.
Question 10
A 60-year-old client with a history of chronic kidney disease (CKD) presents
with fatigue, generalized itching (pruritus), and muscle cramps. Which of the
following electrolyte imbalances is most likely contributing to these
symptoms?
A) Hypokalemia
B) Hypernatremia
C) Hyperphosphatemia
ALL 200 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
Question 1
A 68-year-old client with a history of hypertension and hyperlipidemia
presents to the emergency department with sudden onset of "the worst
headache of my life" and nuchal rigidity. Which of the following is the most
critical initial diagnostic study to consider?
A) Magnetic Resonance Imaging (MRI) of the brain
B) Lumbar puncture
C) Computed Tomography (CT) scan of the head without contrast
D) Electroencephalogram (EEG)
E) Carotid ultrasound
Correct Answer: C) Computed Tomography (CT) scan of the head
without contrast
Rationale: The client's presentation (sudden, severe headache,
nuchal rigidity) is highly suggestive of a subarachnoid hemorrhage
(SAH). A non-contrast CT scan of the head is the most rapid and
effective initial diagnostic tool to detect acute intracranial bleeding.
Lumbar puncture may be considered if the CT is negative but
suspicion remains high. MRI is less rapid for acute hemorrhage
detection.
Question 2
A 55-year-old client with type 2 diabetes mellitus is prescribed metformin.
Which of the following laboratory values should the advanced practice nurse
(APN) monitor closely, especially in a client with compromised renal function?
A) Serum potassium
B) Liver enzymes (ALT, AST)
C) Blood urea nitrogen (BUN) and creatinine
D) Hemoglobin A1C
E) Thyroid-stimulating hormone (TSH)
Correct Answer: C) Blood urea nitrogen (BUN) and creatinine
Rationale: Metformin is primarily excreted by the kidneys. In clients
with renal impairment, metformin can accumulate, leading to an
increased risk of lactic acidosis. Therefore, monitoring BUN and
creatinine (indicators of renal function) is crucial to assess kidney
function and guide metformin dosing.
Question 3
Which of the following is the primary mechanism of action of ACE inhibitors
(e.g., lisinopril) in treating hypertension?
,A) Decreases heart rate and myocardial contractility.
B) Directly causes vasodilation by acting on smooth muscle.
C) Inhibits the conversion of angiotensin I to angiotensin II, leading to
vasodilation and decreased aldosterone secretion.
D) Increases the excretion of sodium and water in the kidneys.
E) Blocks alpha-1 adrenergic receptors, causing peripheral vasodilation.
Correct Answer: C) Inhibits the conversion of angiotensin I to
angiotensin II, leading to vasodilation and decreased aldosterone
secretion.
Rationale: ACE inhibitors block the angiotensin-converting enzyme,
which prevents the formation of the potent vasoconstrictor
angiotensin II and reduces aldosterone secretion. This leads to
systemic vasodilation, reduced preload and afterload, and
decreased fluid retention, lowering blood pressure.
Question 4
A 70-year-old client with a history of heart failure presents with increasing
shortness of breath, orthopnea, and bilateral crackles on lung auscultation.
The APN suspects acute pulmonary edema. What is the priority initial
intervention?
A) Administer a rapid IV fluid bolus.
B) Administer IV furosemide and consider positive pressure ventilation
(CPAP/BiPAP).
C) Administer IV norepinephrine.
D) Prepare for immediate cardioversion.
E) Administer oral beta-blockers.
Correct Answer: B) Administer IV furosemide and consider positive
pressure ventilation (CPAP/BiPAP).
Rationale: Acute pulmonary edema requires rapid reduction of fluid
volume (IV diuretics like furosemide) and improvement of
oxygenation/ventilation. Positive pressure ventilation (CPAP/BiPAP)
helps recruit alveoli, reduce preload, and decrease the work of
breathing. A rapid IV fluid bolus would worsen the condition, and
norepinephrine would increase afterload.
Question 5
When assessing a client with suspected acute appendicitis, which of the
following physical findings is most indicative?
A) Right upper quadrant pain radiating to the shoulder.
B) Generalized abdominal pain that suddenly subsides.
C) Rebound tenderness at McBurney's point.
,D) Left lower quadrant pain with palpable mass.
E) Mid-epigastric pain radiating to the back.
Correct Answer: C) Rebound tenderness at McBurney's point.
Rationale: Acute appendicitis is classically characterized by pain that
starts periumbilically and then localizes to the right lower quadrant,
with rebound tenderness (pain upon release of pressure) at
McBurney's point. A sudden subsidence of pain after initial severe
pain could indicate rupture.
Question 6
A 45-year-old client presents with complaints of persistent heartburn,
regurgitation, and a sour taste in their mouth, especially after meals and
when lying down. What is the most likely diagnosis?
A) Peptic ulcer disease (PUD)
B) Gastritis
C) Cholelithiasis
D) Gastroesophageal Reflux Disease (GERD)
E) Irritable Bowel Syndrome (IBS)
Correct Answer: D) Gastroesophageal Reflux Disease (GERD)
Rationale: The classic symptoms of GERD include heartburn (pyrosis),
regurgitation of stomach contents, and a sour taste in the mouth,
often worse post-prandially and in the supine position due to reflux
of gastric acid into the esophagus.
Question 7
Which of the following is the most common cause of community-acquired
pneumonia (CAP) in adults?
A) Staphylococcus aureus
B) Klebsiella pneumoniae
C) Pseudomonas aeruginosa
D) Streptococcus pneumoniae
E) Mycoplasma pneumoniae
Correct Answer: D) *Streptococcus pneumoniae*
Rationale: Streptococcus pneumoniae (pneumococcus) is the most
common bacterial cause of community-acquired pneumonia in
adults. While other pathogens cause CAP, S. pneumoniae is
consistently the leading culprit.
Question 8
A client with type 1 diabetes mellitus is experiencing diabetic ketoacidosis
(DKA). The APN notes a potassium level of 2.9 mEq/L. What is the most
, appropriate initial management step regarding potassium?
A) Administer a rapid insulin bolus immediately.
B) Hold insulin and administer intravenous potassium supplementation.
C) Administer sodium bicarbonate.
D) Increase intravenous fluid rate to 500 mL/hr.
E) Prepare for emergency hemodialysis.
Correct Answer: B) Hold insulin and administer intravenous potassium
supplementation.
Rationale: Although clients with DKA often have total body potassium
depletion, serum potassium can be normal or elevated due to
acidosis. However, once insulin is administered, potassium rapidly
shifts into cells, potentially causing life-threatening hypokalemia. If
serum potassium is below 3.3-3.5 mEq/L, insulin should be held, and
potassium should be administered until the level is within a safe
range, while ensuring adequate urine output.
Question 9
Which of the following findings is most indicative of a tension pneumothorax?
A) Tracheal deviation towards the affected side.
B) Increased breath sounds on the affected side.
C) Jugular venous distension, hypotension, and tracheal deviation away from
the affected side.
D) Clear breath sounds bilaterally.
E) Bradypnea and hypertension.
Correct Answer: C) Jugular venous distension, hypotension, and
tracheal deviation away from the affected side.
Rationale: Tension pneumothorax is a life-threatening condition
where air accumulates in the pleural space, compressing the lung
and shifting the mediastinum. Classic (though often late) signs
include absent breath sounds on the affected side, jugular venous
distension (JVD), hypotension, and tracheal deviation away from the
affected side.
Question 10
A 60-year-old client with a history of chronic kidney disease (CKD) presents
with fatigue, generalized itching (pruritus), and muscle cramps. Which of the
following electrolyte imbalances is most likely contributing to these
symptoms?
A) Hypokalemia
B) Hypernatremia
C) Hyperphosphatemia
