NR546 / NR 546 ACTUAL MIDTERM EXAM 2024 QUESTIONS
AND ANSWERS
Course
NR 546 (NR546)
1. A patient with chronic kidney disease (CKD) is prescribed an angiotensin-converting
enzyme (ACE) inhibitor. Which laboratory value should be closely monitored?
A. Hemoglobin
B. Potassium
C. White blood cell count
D. Calcium
Answer: B. Potassium
Rationale: ACE inhibitors (e.g., lisinopril) can cause hyperkalemia by inhibiting aldosterone,
leading to potassium retention. Patients with CKD are already at risk for elevated potassium
levels, making monitoring essential.
2. A nurse is administering warfarin to a patient with atrial fibrillation. Which laboratory
value best determines therapeutic effectiveness?
A. Platelet count
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Fibrinogen levels
Answer: C. International normalized ratio (INR)
Rationale: INR is the standard measure for monitoring warfarin therapy. The therapeutic range
is typically 2.0 to 3.0 for most patients.
3. A patient with type 2 diabetes is started on metformin. Which patient condition would
require immediate discontinuation of the drug?
A. Hypertension
B. Elevated liver enzymes
C. Acute kidney injury
D. Hyperthyroidism
,Answer: C. Acute kidney injury
Rationale: Metformin is contraindicated in renal impairment due to the risk of lactic acidosis, a
life-threatening condition.
4. A 70-year-old patient is prescribed amitriptyline for depression. What is the most
concerning side effect in this population?
A. Insomnia
B. Dry mouth
C. Orthostatic hypotension
D. Weight gain
Answer: C. Orthostatic hypotension
Rationale: Tricyclic antidepressants (TCAs) like amitriptyline can cause orthostatic
hypotension, increasing the risk of falls in elderly patients.
5. Which drug is most appropriate for initial treatment of mild persistent asthma?
A. Albuterol
B. Montelukast
C. Inhaled corticosteroid
D. Theophylline
Answer: C. Inhaled corticosteroid
Rationale: Inhaled corticosteroids (e.g., fluticasone) are the first-line treatment for mild
persistent asthma as they reduce airway inflammation.
6. A nurse is teaching a patient about digoxin therapy. Which symptom requires immediate
medical attention?
A. Nausea and vomiting
B. Increased appetite
C. Elevated blood pressure
D. Runny nose
Answer: A. Nausea and vomiting
,Rationale: Nausea and vomiting are early signs of digoxin toxicity, which can lead to life-
threatening arrhythmias.
7. A nurse is caring for a patient with heart failure prescribed furosemide. Which
electrolyte imbalance is most concerning?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Answer: B. Hypokalemia
Rationale: Loop diuretics like furosemide cause potassium loss, increasing the risk of
arrhythmias.
8. Which statement by a patient taking prednisone for rheumatoid arthritis indicates a
need for further teaching?
A. "I should take this medication with food."
B. "I should not stop taking this drug suddenly."
C. "I can stop the medication once my symptoms improve."
D. "I may be at increased risk for infections."
Answer: C. "I can stop the medication once my symptoms improve."
Rationale: Steroids must be tapered gradually to prevent adrenal insufficiency. Patients should
never stop taking them abruptly.
9. A patient is prescribed an opioid for pain management. Which intervention is most
important to prevent common side effects?
A. Encourage high-protein foods
B. Increase fluid and fiber intake
C. Monitor blood glucose levels
D. Avoid dairy products
Answer: B. Increase fluid and fiber intake
, Rationale: Opioids cause constipation due to decreased GI motility. Increased fiber and
hydration help prevent this side effect.
10. A patient with hypertension is prescribed losartan. What is the primary advantage of
this medication over ACE inhibitors?
A. Lower cost
B. Less risk of hyperkalemia
C. No cough as a side effect
D. Stronger antihypertensive effect
Answer: C. No cough as a side effect
Rationale: Angiotensin II receptor blockers (ARBs) like losartan do not cause the dry cough
associated with ACE inhibitors.
11. A nurse is educating a patient about levothyroxine for hypothyroidism. Which
statement indicates the need for further teaching?
A. "I will take my medication in the morning on an empty stomach."
B. "I can stop taking this medication once my symptoms improve."
C. "I should not take calcium supplements at the same time as my medication."
D. "It may take a few weeks to see full effects of this medication."
Answer: B. "I can stop taking this medication once my symptoms improve."
Rationale: Levothyroxine is a lifelong medication for most patients with hypothyroidism.
Stopping the drug can lead to worsening symptoms and complications.
12. A nurse is monitoring a patient receiving heparin therapy for a deep vein thrombosis
(DVT). Which lab value should be checked to ensure therapeutic dosing?
A. INR
B. aPTT
C. Platelet count
D. D-dimer
Answer: B. aPTT
Rationale: Activated partial thromboplastin time (aPTT) is used to monitor heparin therapy.
The goal is typically 1.5 to 2.5 times the normal value.
AND ANSWERS
Course
NR 546 (NR546)
1. A patient with chronic kidney disease (CKD) is prescribed an angiotensin-converting
enzyme (ACE) inhibitor. Which laboratory value should be closely monitored?
A. Hemoglobin
B. Potassium
C. White blood cell count
D. Calcium
Answer: B. Potassium
Rationale: ACE inhibitors (e.g., lisinopril) can cause hyperkalemia by inhibiting aldosterone,
leading to potassium retention. Patients with CKD are already at risk for elevated potassium
levels, making monitoring essential.
2. A nurse is administering warfarin to a patient with atrial fibrillation. Which laboratory
value best determines therapeutic effectiveness?
A. Platelet count
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Fibrinogen levels
Answer: C. International normalized ratio (INR)
Rationale: INR is the standard measure for monitoring warfarin therapy. The therapeutic range
is typically 2.0 to 3.0 for most patients.
3. A patient with type 2 diabetes is started on metformin. Which patient condition would
require immediate discontinuation of the drug?
A. Hypertension
B. Elevated liver enzymes
C. Acute kidney injury
D. Hyperthyroidism
,Answer: C. Acute kidney injury
Rationale: Metformin is contraindicated in renal impairment due to the risk of lactic acidosis, a
life-threatening condition.
4. A 70-year-old patient is prescribed amitriptyline for depression. What is the most
concerning side effect in this population?
A. Insomnia
B. Dry mouth
C. Orthostatic hypotension
D. Weight gain
Answer: C. Orthostatic hypotension
Rationale: Tricyclic antidepressants (TCAs) like amitriptyline can cause orthostatic
hypotension, increasing the risk of falls in elderly patients.
5. Which drug is most appropriate for initial treatment of mild persistent asthma?
A. Albuterol
B. Montelukast
C. Inhaled corticosteroid
D. Theophylline
Answer: C. Inhaled corticosteroid
Rationale: Inhaled corticosteroids (e.g., fluticasone) are the first-line treatment for mild
persistent asthma as they reduce airway inflammation.
6. A nurse is teaching a patient about digoxin therapy. Which symptom requires immediate
medical attention?
A. Nausea and vomiting
B. Increased appetite
C. Elevated blood pressure
D. Runny nose
Answer: A. Nausea and vomiting
,Rationale: Nausea and vomiting are early signs of digoxin toxicity, which can lead to life-
threatening arrhythmias.
7. A nurse is caring for a patient with heart failure prescribed furosemide. Which
electrolyte imbalance is most concerning?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Answer: B. Hypokalemia
Rationale: Loop diuretics like furosemide cause potassium loss, increasing the risk of
arrhythmias.
8. Which statement by a patient taking prednisone for rheumatoid arthritis indicates a
need for further teaching?
A. "I should take this medication with food."
B. "I should not stop taking this drug suddenly."
C. "I can stop the medication once my symptoms improve."
D. "I may be at increased risk for infections."
Answer: C. "I can stop the medication once my symptoms improve."
Rationale: Steroids must be tapered gradually to prevent adrenal insufficiency. Patients should
never stop taking them abruptly.
9. A patient is prescribed an opioid for pain management. Which intervention is most
important to prevent common side effects?
A. Encourage high-protein foods
B. Increase fluid and fiber intake
C. Monitor blood glucose levels
D. Avoid dairy products
Answer: B. Increase fluid and fiber intake
, Rationale: Opioids cause constipation due to decreased GI motility. Increased fiber and
hydration help prevent this side effect.
10. A patient with hypertension is prescribed losartan. What is the primary advantage of
this medication over ACE inhibitors?
A. Lower cost
B. Less risk of hyperkalemia
C. No cough as a side effect
D. Stronger antihypertensive effect
Answer: C. No cough as a side effect
Rationale: Angiotensin II receptor blockers (ARBs) like losartan do not cause the dry cough
associated with ACE inhibitors.
11. A nurse is educating a patient about levothyroxine for hypothyroidism. Which
statement indicates the need for further teaching?
A. "I will take my medication in the morning on an empty stomach."
B. "I can stop taking this medication once my symptoms improve."
C. "I should not take calcium supplements at the same time as my medication."
D. "It may take a few weeks to see full effects of this medication."
Answer: B. "I can stop taking this medication once my symptoms improve."
Rationale: Levothyroxine is a lifelong medication for most patients with hypothyroidism.
Stopping the drug can lead to worsening symptoms and complications.
12. A nurse is monitoring a patient receiving heparin therapy for a deep vein thrombosis
(DVT). Which lab value should be checked to ensure therapeutic dosing?
A. INR
B. aPTT
C. Platelet count
D. D-dimer
Answer: B. aPTT
Rationale: Activated partial thromboplastin time (aPTT) is used to monitor heparin therapy.
The goal is typically 1.5 to 2.5 times the normal value.
