NAP 1 2025

1. Which of the following statements regarding the heart is incorrect?

A. The heart is a hollow, muscular organ located in the left side of the thorax.

B. It weighs approximately 300 g, but weight is influenced by age, gender, and body weight.

C. The heart pumps blood to the tissues, supplying them with oxygen and other nutrients.

D. The pumping action of the heart is accomplished by rhythmic contraction and relaxation of its muscular wall.

A. The heart is a hollow, muscular organ located in the left side of the thorax.

Rationale: A normal adult heart is a hollow muscular organ in the thorax, weighs roughly 250-350 g, pumps blood to the tissues, and contracts rhythmically.

2. The pericardial space is located between the layers of the pericardium. It is filled by fluid at about:

A. 10 mL

B. 30 mL

C. 50 mL

D. 70 mL

B. 30 mL

Rationale: The normal pericardial space contains a small amount of serous fluid, commonly described as roughly 15-50 mL. Among the choices, 30 mL fits this range.

3. When taking a client's apical pulse, the nurse should place the stethoscope:

A. Just to the left of the median point of the sternum

B. In the fifth intercostal space at the left midclavicular line

C. Between the sixth and seventh ribs at the left midaxillary line

D. Between the third and fourth ribs and to the left of the sternum

B. In the fifth intercostal space at the left midclavicular line

Rationale: The adult apical impulse is normally auscultated at the fifth left intercostal space along the midclavicular line.

4. A client's pulse pressure is decreasing. This would be evaluated by calculating the:

A. Force exerted against an arterial wall

B. Difference between the apical and radial rates

C. Difference between systolic and diastolic readings

D. Degree of ventricular contraction in relation to output

C. Difference between systolic and diastolic readings

Rationale: Pulse pressure = systolic blood pressure − diastolic blood pressure.

5. Which structure of the heart receives oxygenated blood from the lungs and pumps it to the aorta?

A. Right atrium

B. Left atrium

C. Right ventricle

D. Left ventricle

D. Left ventricle

Rationale: Oxygenated blood returns from the lungs to the left atrium, enters the left ventricle, and is pumped through the aorta into systemic circulation.

6. The right atrium receives deoxygenated blood from the lower part of the body through the:

A. Superior vena cava

B. Left atrium

C. Inferior vena cava

D. Pulmonary vein

C. Inferior vena cava

Rationale: The inferior vena cava returns deoxygenated blood from the lower body to the right atrium.

7. The following statements are true EXCEPT:

A. The right atrium receives deoxygenated blood via the superior vena cava.

B. The right ventricle receives oxygenated blood from the right atrium.

C. The left atrium receives oxygenated blood from the lungs via the pulmonary veins.

D. The left ventricle pumps oxygenated blood into systemic circulation.

B. The right ventricle receives oxygenated blood from the right atrium.

Rationale: The right ventricle receives deoxygenated blood from the right atrium and pumps it to the lungs. Oxygenated blood is on the left side of the heart.

8. The valve located between the left atrium and left ventricle is called the:

A. Tricuspid valve

B. AV valve

C. Mitral valve

D. Aortic valve

C. Mitral valve

Rationale: The mitral (bicuspid) valve separates the left atrium from the left ventricle. It is also an atrioventricular valve.

9. The second heart sound in "lub-dub" is heard when:

A. The semilunar valves close

B. The semilunar valves open

C. The AV valves collapse

D. The AV valves close

A. The semilunar valves close

Rationale: S2 ("dub") occurs when the aortic and pulmonic semilunar valves close at the beginning of ventricular diastole.

10. Which statement is true regarding the conduction system of the heart?

A. The bundle of His fuses with the SA node to form another pacemaker.

B. If the SA node fails, the heart cannot initiate a heartbeat.

C. The SA node is the normal initiator of every heartbeat.

D. The right and left bundle branches form the Purkinje fibers.

C. The SA node is the normal initiator of every heartbeat.

Rationale: The sinoatrial (SA) node normally acts as the heart's primary pacemaker. Other pacemaker sites can generate impulses if the SA node fails.

11. It is the inner layer of the heart that lines the valves:

A. Pericardium

B. Epicardium

C. Myocardium

D. Endocardium

D. Endocardium

Rationale: The endocardium is the innermost lining of the heart chambers and covers the heart valves.

12. A client's possible stroke volume is about 50 mL. The apical pulse is 55, respiratory rate is 22, and radial pulse is 63. Which condition is appropriate?

A. A decreased respiratory rate

B. A decrease in cardiac output

C. An ineffective breathing pattern

D. A normal condition

B. A decrease in cardiac output

Rationale: The apical pulse is lower than the radial pulse, producing a pulse deficit of 8 beats/min. This can indicate ineffective cardiac contractions and reduced cardiac output.

13. Which heart valve(s) open during the diastolic phase of the cardiac cycle?

A. Pulmonary valve

B. Semilunar valves

C. Tricuspid valve

D. AV valve

D. AV valve

Rationale: During ventricular diastole, the atrioventricular valves open to allow blood to flow from the atria into the ventricles. The tricuspid valve is one of the AV valves.

14. It is a part of the circulatory system where gas exchange occurs:

A. Pulmonary capillaries

B. Systemic capillaries

C. Both A and B

D. None of the above

C. Both A and B

Rationale: Gas exchange occurs in pulmonary capillaries between blood and alveoli, and in systemic capillaries between blood and body tissues.

15. It is the part of the heart that receives deoxygenated blood from the periphery:

A. Right atrium

B. Right ventricle

C. Atria

D. Ventricles

A. Right atrium

Rationale: Systemic veins return deoxygenated blood to the right atrium, primarily through the superior and inferior venae cavae.

15 (duplicate). Which statement regarding the relationship between the branches of the autonomic nervous system is correct?

A. The parasympathetic branch excites all systems and the sympathetic inhibits all systems.

B. The parasympathetic excites most systems except the gastrointestinal tract and urinary bladder, and the sympathetic has the opposite effect.

C. The sympathetic branch stimulates most systems but inhibits the gastrointestinal tract and urinary bladder; the parasympathetic branch inhibits most systems but stimulates the gastrointestinal tract and urinary bladder.

D. There is no relationship between the two branches.

C. The sympathetic branch stimulates most systems but inhibits the gastrointestinal tract and urinary bladder; the parasympathetic branch inhibits most systems but stimulates the gastrointestinal tract and urinary bladder.

Rationale: Sympathetic activity supports the fight-or-flight response, increasing cardiovascular activity and reducing GI/urinary activity. Parasympathetic activity promotes rest-and-digest functions, including GI activity.

16. What is the function of the Purkinje fibers in heart muscle?

A. To initiate an impulse in response to a stimulus

B. To transmit electrical impulses that are received

C. To respond to a stimulus only after repolarization

D. To spontaneously and repetitively initiate an impulse

B. To transmit electrical impulses that are received

Rationale: Purkinje fibers rapidly conduct the electrical impulse through the ventricular myocardium, coordinating ventricular contraction.

17. A client's heart disease has resulted in a reduced stroke volume. What physiologic change is expected to help maintain normal cardiac output?

A. Mean arterial pressure would increase.

B. Mean arterial pressure would decrease.

C. Heart rate would increase.

D. Heart rate would decrease.

C. Heart rate would increase.

Rationale: Cardiac output = heart rate × stroke volume. When stroke volume falls, increasing heart rate can help maintain cardiac output.

18. A female client with a cardiac problem asks why she should not bear down or strain during a bowel movement. This would trigger:

A. Vagus nerve stimulation, causing a decrease in heart rate and cardiac contractility.

B. Vagus nerve stimulation, causing an increase in heart rate and cardiac contractility.

C. Sympathetic nerve stimulation, causing an increase in heart rate and cardiac contractility.

D. Sympathetic nerve stimulation, causing a decrease in heart rate and cardiac contractility.

A. Vagus nerve stimulation, causing a decrease in heart rate and cardiac contractility.

Rationale: Bearing down produces a Valsalva maneuver, which can increase vagal influence and temporarily decrease heart rate and cardiac output.

19. The layer/structure of the heart responsible for preventing friction during heart contraction is the:

A. Pericardium

B. Epicardium

C. Fibrous layer

D. Myocardium

A. Pericardium

Rationale: The pericardial sac and its serous fluid reduce friction as the heart beats within the thorax.

20. The term used to describe the degree of stretch of cardiac muscle fibers at the end of diastole is:

A. Preload

B. Afterload

C. Ejection fraction

D. Contractility

A. Preload

Rationale: Preload refers to ventricular fiber stretch at the end of diastole and is related to ventricular filling.

21. When auscultating the carotid arteries, what sound would the nurse expect if a bruit is present?

A. A swishing sound caused by turbulent blood flow

B. A pulsating sound caused by increased arterial pressure

C. A whistling sound caused by a stiff noncompliant artery

D. A gurgling sound caused by blood bypassing an aneurysm

A. A swishing sound caused by turbulent blood flow

Rationale: A bruit is a blowing or swishing sound produced by turbulent blood flow, often associated with arterial narrowing.

22. In an ECG reading, the T wave represents:

A. Ventricular depolarization

B. End of ventricular depolarization

C. Ventricular repolarization

D. Atrial depolarization

C. Ventricular repolarization

Rationale: The T wave represents ventricular repolarization.

23. Which of the following represents ventricular depolarization?

A. T wave

B. QRS complex

C. ST segment

D. PR interval

B. QRS complex

Rationale: The QRS complex represents ventricular depolarization, which precedes ventricular contraction.

24. What is the normal PR interval on an ECG?

A. Greater than 0.20 sec

B. 0.20 sec

C. 0.12-0.20 sec

D. Less than 0.10 sec

C. 0.12-0.20 sec

Rationale: The normal PR interval is 0.12-0.20 seconds, representing conduction from the atria through the AV node to the ventricles.

25. A blockage is present in the large coronary vessel that supplies the anterior wall of the left ventricle. Which artery is involved?

A. Left anterior descending coronary artery (LAD)

B. Right coronary artery (RCA)

C. Circumflex coronary artery

D. Posterior descending coronary artery (PDA)

A. Left anterior descending coronary artery (LAD)

Rationale: The LAD supplies much of the anterior wall of the left ventricle and the anterior interventricular septum.

1. The right of enforcing an obligation in a court of justice is called:

A. Juris tantum

B. Vinculum juris

C. Mala in se

D. Mala prohibita

E. Epikia

B. Vinculum juris

Rationale: Vinculum juris is the legal bond or enforceable obligation between parties.

2. A legal presumption that may be rebutted or contradicted by other evidence is:

A. Juris tantum

B. Vinculum juris

C. Mala in se

D. Mala prohibita

E. Epikia

A. Juris tantum

Rationale: Juris tantum means a presumption accepted as true until rebutted by evidence.

3. "The exception to the rule" refers to:

A. Juris tantum

B. Vinculum juris

C. Mala in se

D. Mala prohibita

E. Epikia

E. Epikia

Rationale: Epikia refers to equitable interpretation or an exception applied to avoid an unjust result.

4. Intentional felonies are classified as:

A. Juris tantum

B. Vinculum juris

C. Mala in se

D. Mala prohibita

E. Epikia

C. Mala in se

Rationale: Mala in se acts are wrong in themselves, such as intentional acts that are inherently wrongful.

5. Acts punished by special laws are called:

A. Juris tantum

B. Vinculum juris

C. Mala in se

D. Mala prohibita

E. Epikia

E. Epikia

Rationale: Mala prohibita acts are wrong because they are prohibited by law.

6. A nurse continues collecting a patient's surgical-site secretions despite the patient's refusal. The nurse could be liable for:

A. Slander

B. Assault

C. Battery

D. Invasion of privacy

C. Battery

Rationale: Battery is intentional, unauthorized physical contact. Performing a procedure without consent can constitute battery.

7. A security guard is reading the chart of a meningococcemia suspect. What should the nurse do?

A. Tell him that this is not allowed for those not directly involved in care.

B. Ask the guard if he needs to know something.

C. Inform the supervisor about what she saw.

D. Ignore it.

A. Tell him that this is not allowed for those not directly involved in care.

Rationale: Patient records are confidential and access should be limited to authorized personnel with a legitimate need to know.

8. A patient confides that his companion is not his legal wife. If the nurse divulges this information, what liability may result?

A. Slander

B. Libel

C. Breach of confidentiality

D. Assault

C. Breach of confidentiality

Rationale: Private patient information must not be disclosed to unauthorized persons.

9. Calling another nurse "lazybones," "incompetent," and "pain in the neck" within hearing distance of others may constitute:

A. Libel

B. Incompetence

C. Slander

D. Negligence

C. Slander

Rationale: Slander is defamatory spoken communication; libel is written or otherwise recorded defamation.

10. If the same accusations are written in the hospital newsletter, the liability is:

A. Malpractice

B. Assault

C. Libel

D. Slander

C. Libel

Rationale: Libel is defamatory communication in written or recorded form.

11. If a nurse poisons an NGT feeding to end a patient's suffering, the criminal liability may be:

A. Justified

B. Exempted

C. Mitigated

D. Aggravated

D. Aggravated

Rationale: The intentional killing of a patient is not justified merely because the nurse believes it ends suffering; the circumstances may increase criminal liability.

12. A person with epilepsy has a seizure while causing injury to another. This circumstance may make criminal liability:

A. Justified

B. Exempted

C. Mitigated

D. Aggravated

B. Exempted

Rationale: A seizure can involve loss of voluntary control; criminal liability depends on the legally recognized circumstances and capacity at the time.

13. Which is a justifying circumstance?

A. Performance of a duty

B. Accidental killing

C. Offender is deaf and dumb

D. Performance of a lawful act

A. Performance of a duty

Rationale: A lawful performance of a duty can be a justifying circumstance when legal requirements are met.

14. Which is an exempting circumstance?

A. Obedience to a superior

B. Psychiatric disorder

C. Treachery

D. [scan unclear]

B. Psychiatric disorder

Rationale: The source identifies psychiatric disorder as the exempting circumstance; legally, the effect depends on the nature and degree of incapacity.

15. Relationship, intoxication and education are classified as what kind of circumstances in the source?

A. Aggravating

B. Justifying

C. Exempting

D. Mitigating

D. Mitigating

Rationale: The source groups these under circumstances that may lessen criminal liability.

1. What is the initial step in conducting research?

A. Observe health practices

B. Identify the problem/focus of the study

C. Determine the variables

D. Survey common ward problems

B. Identify the problem/focus of the study

Rationale: Research begins by identifying and clearly defining the problem or area of inquiry.

2. Which research-problem criterion is addressed by determining whether adequate resources are available?

A. Significance

B. Researchability

C. Feasibility

D. Interest to the researcher

C. Feasibility

Rationale: Feasibility asks whether the study can realistically be completed with available time, resources, subjects, and funding.

3. Which factor is least considered when determining whether a problem is feasible?

A. Time allotment

B. Importance to the profession

C. Available subjects

D. Cost of the study

B. Importance to the profession

Rationale: Feasibility focuses on practical resources and constraints; professional importance is more closely related to significance.

4. The degree to which a measure is independent of opinion, biases, and beliefs is:

A. Subjectivity

B. Reliability

C. Objectivity

D. Accuracy

C. Objectivity

Rationale: Objectivity means the measurement is not dependent on the researcher's personal opinions or biases.

5. Terms that do not include how concepts are used or measured in a study are called:

A. Concepts

B. Variables

C. Operational definitions

D. Conceptual definitions

D. Conceptual definitions

Rationale: A conceptual definition describes the general meaning of a concept; an operational definition explains how it is measured or used in the study.

6. Which process is NOT part of reviewing related literature?

A. Locating and identifying resources

B. Reading and recording notes

C. Clarifying a research problem

D. Using the library and internet

C. Clarifying a research problem

7. The primary purpose of a review of related literature is to:

A. Organize prospective materials

B. Generate a broad background and understanding of information related to the problem

C. Select topics

D. Gather current knowledge only

B. Generate a broad background and understanding of information related to the problem

Rationale: A literature review establishes the background, existing knowledge, gaps, and context of the research problem.

8. "Married women will have a more effective pregnancy than unmarried women" represents a:

A. Paradigm

B. Hypothesis

C. Conceptual framework

D. Theoretical framework

B. Hypothesis

Rationale: A hypothesis is a testable statement predicting a relationship or difference between variables.

9. Which is the appropriate research hypothesis for the proposed study?

A. What is the response of staff nurses to health values?

B. How is health value perceived?

C. Is there a significant relationship between health values and health-promotion activities of staff nurses?

D. How do health values affect health-promotion activities?

C. Is there a significant relationship between health values and health-promotion activities of staff nurses?

Rationale: The study is described as examining a relationship between two variables, so the hypothesis should directly state that relationship.

10. What is the appropriate null hypothesis for the study on timing of psychological support and well-being?

A. There is no relationship between timing of psychological support and feelings of well-being among terminally ill patients.

B. Feelings are similar in all groups.

C. Factors are not appropriate.

D. None

A. There is no relationship between timing of psychological support and feelings of well-being among terminally ill patients.

Rationale: A null hypothesis states that no statistically significant relationship or difference exists.

1. Where is intracellular fluid normally found?

A. In the interstitial space/extracellular fluid

B. In the intravascular space/intracellular fluid

C. In the intravascular space/extracellular fluid

D. In the interstitial space, intracellular fluid

D. In the interstitial space, intracellular fluid

Rationale: Intracellular fluid is the fluid inside cells.

2. The primary cation found inside cells is:

A. Sodium

B. Potassium

C. Calcium

D. Magnesium

B. Potassium

Rationale: Potassium is the major intracellular cation.

3. The primary extracellular anion is:

A. Potassium

B. Phosphate

C. Chloride

D. Bicarbonate

C. Chloride

Rationale: Chloride is the major extracellular anion.

4. A hypertonic solution causes red blood cells to:

A. Remain unchanged

B. Swell and lyse

C. Shrink as water leaves the cells

D. Activate ATP to move nutrients into cells

C. Shrink as water leaves the cells

Rationale: A hypertonic extracellular solution draws water out of cells by osmosis.

5. Giving hypotonic saline to a client with increased intracranial pressure causes fluid to:

A. Move from extracellular space into cells

B. Move from cells into extracellular space

C. Move from intravascular to interstitial space

D. Move from interstitial to intravascular space

A. Move from extracellular space into cells

Rationale: Hypotonic fluid lowers extracellular osmolality and shifts water into cells, which can worsen cerebral edema.

6. A fluid compartment whose primary anion is phosphate is:

A. Intracellular fluid

B. Extracellular fluid

C. Intravascular fluid

D. Interstitial fluid

A. Intracellular fluid

Rationale: Phosphate is a major intracellular anion.

7. Edema in nephrotic syndrome is primarily related to:

A. Decreased serum osmolality from sodium loss

B. Increased serum osmolality causing hypertension

C. Increased colloid oncotic pressure

D. Loss of albumin causing decreased plasma colloid oncotic pressure

D. Loss of albumin causing decreased plasma colloid oncotic pressure

Rationale: Protein loss in nephrotic syndrome lowers plasma oncotic pressure, allowing fluid to move into tissues.

8. A client with hyperosmolar hyperglycemic state should anticipate which intervention?

A. Give diuretics

B. Administer insulin

C. Withhold fluids

D. Address dehydration

D. Address dehydration

Rationale: HHS causes profound water loss; fluid replacement is a major initial treatment while insulin is also used.

9. The most appropriate nursing diagnosis for diabetes insipidus is:

A. Fluid Volume Excess

B. Imbalanced Nutrition

C. Fluid Volume Deficit

D. Ineffective Tissue Perfusion

C. Fluid Volume Deficit

Rationale: Diabetes insipidus causes excessive dilute urine output and can produce severe dehydration.

10. Hyperaldosteronism results in:

A. Increased sodium excretion and potassium retention

B. Decreased potassium and increased sodium

C. Decreased sodium and increased potassium

D. Decreased reabsorption of both sodium and potassium

B. Decreased potassium and increased sodium

Rationale: Aldosterone promotes sodium and water retention while increasing potassium excretion.

11. In SIADH, confusion and muscle weakness are associated with:

A. Increased serum osmolality from sodium retention

B. Decreased serum osmolality from excess water retention

C. Increased osmolality from water loss

D. Decreased osmolality from excess water loss

B. Decreased serum osmolality from excess water retention

Rationale: Excess ADH causes water retention, producing dilutional hyponatremia and low serum osmolality.

12. A client with acute renal failure has very low urine output despite IV fluids. If uncorrected, which complication is most likely?

A. Hypertension

B. Bradycardia

C. Flat neck veins

D. Weight loss

A. Hypertension

Rationale: Oliguria with continued fluid administration can cause fluid volume overload and hypertension.

13. COPD-related respiratory acidosis is caused primarily by:

A. Decreased oxygen saturation

B. Increased carbon dioxide in the blood

C. Increased carbon dioxide removal

D. Decreased oxygen intake only

B. Increased carbon dioxide in the blood

Rationale: Hypoventilation and impaired CO₂ elimination cause CO₂ retention and respiratory acidosis.

14. A 5-lb weight loss approximately represents how much fluid loss?

A. 1 L

B. 2 L

C. 6 L

D. 5 L

B. 2 L

15. Which combination most promotes edema formation?

A. Increased colloid oncotic pressure + increased hydrostatic pressure

B. Increased colloid oncotic pressure + decreased hydrostatic pressure

C. Decreased colloid oncotic pressure + decreased hydrostatic pressure

D. Decreased colloid oncotic pressure + increased hydrostatic pressure

D. Decreased colloid oncotic pressure + increased hydrostatic pressure

Rationale: Both low plasma oncotic pressure and high capillary hydrostatic pressure push fluid into the interstitial space.

16. The first line of physiologic adaptation to a pH shift is:

A. Metabolic mechanism

B. Respiratory mechanism

C. Renal mechanism

D. Nothing; the pH remains unchanged

B. Respiratory mechanism

Rationale: The respiratory system can alter CO₂ quickly, making it the rapid physiologic response to acid-base disturbances.

17. The most important buffer system for acid-base homeostasis is the:

A. Phosphate buffer

B. Hemoglobin buffer

C. Bicarbonate buffer

D. Protein-only buffer

C. Bicarbonate buffer

Rationale: The carbonic acid-bicarbonate system is the major extracellular buffer and is closely regulated by the lungs and kidneys.

18. Hematocrit reflects the:

A. Formed elements only

B. Percentage of blood volume occupied by red blood cells

C. Dissolved gases only

D. Plasma protein concentration

B. Percentage of blood volume occupied by red blood cells

Rationale: Hematocrit is the proportion of whole blood made up of RBCs.

19. Aldosterone is produced by the adrenal cortex and causes:

A. Sodium excretion and water retention

B. Sodium retention and potassium excretion

C. Water excretion only

D. Vasoconstriction and water retention only

B. Sodium retention and potassium excretion

Rationale: Aldosterone increases renal sodium reabsorption and potassium secretion; water follows sodium.

20. Which electrolyte value in the source is clearly abnormal?

A. Potassium 4.5 mEq/L

B. Chloride 88 mEq/L

C. Phosphate 3 mEq/L

D. [scan unclear]

B. Chloride 88 mEq/L

Rationale: A chloride level of 88 mEq/L is below the usual adult reference range.

21. A postoperative patient is diagnosed with fluid volume excess. Which finding supports this diagnosis?

A. Decreased hematocrit

B. Increased serum osmolality

C. Weight loss

D. Dry mucous membranes

A. Decreased hematocrit

Rationale: Fluid volume excess can dilute blood components, causing a decreased hematocrit; weight gain and edema are also expected.

22. BUN is a product of:

A. Ammonia conversion

B. Muscle metabolism

C. Thyroid metabolism

D. Bone metabolism

A. Ammonia conversion

Rationale: Urea is produced by the liver from ammonia generated during protein metabolism.

1. The hypothalamus releases the hormone that initiates production of TSH in the anterior pituitary:

A. Thyroid hormone

B. Thyrotropin-releasing hormone

C. Growth hormone

D. Thyroid-stimulating hormone

B. Thyrotropin-releasing hormone

Rationale: TRH from the hypothalamus stimulates the anterior pituitary to release TSH.

2. High serum PTH levels lead to:

A. Hypercalcemia and hyperphosphatemia

B. Hypercalcemia and hypophosphatemia

C. Hypocalcemia and hyperphosphatemia

D. Hypocalcemia and hypophosphatemia

B. Hypercalcemia and hypophosphatemia

Rationale: PTH raises serum calcium and promotes renal phosphate excretion.

3. After removal of the parathyroid glands, calcium is required because PTH normally tends to:

A. Decrease blood calcium

B. Promote bone breakdown with release of calcium into blood

C. Increase phosphate and decrease calcium

D. Remove calcium from blood

B. Promote bone breakdown with release of calcium into blood

Rationale: PTH raises serum calcium partly by increasing bone resorption.

4. Insulin is produced by which pancreatic cells?

A. Acinar cells

B. Beta cells of the islets

C. Cortical cells

D. Parietal cells

B. Beta cells of the islets

Rationale: Pancreatic beta cells produce insulin.

5. Which statement needs correction?

A. Glucagon raises blood glucose

B. Insulin lowers blood glucose

C. Glycogenolysis is activated when blood glucose is low

D. Glycogenesis is activated when blood glucose is low

D. Glycogenesis is activated when blood glucose is low

Rationale: Glycogenesis stores glucose as glycogen and is favored when glucose is available; low glucose promotes glycogenolysis and gluconeogenesis.

6. Which hormones can alter insulin activity? Select all that apply.

A. Glucagon

B. Cortisol

C. Growth hormone

D. Somatostatin

Answer: A, B, C and D

Rationale: All listed hormones can influence insulin secretion or glucose metabolism.

7. Gluconeogenesis occurs with:

A. Low insulin levels

B. High blood glucose

C. High insulin levels

D. None of the above

A. Low insulin levels

Rationale: Low insulin and counter-regulatory hormones promote hepatic glucose production.

8. Glucagon is produced by the:

A. Alpha islet cells

B. Beta islet cells

C. Delta cells

D. Acinar cells

A. Alpha islet cells

Rationale: Pancreatic alpha cells secrete glucagon.

9. Glucagon reverses hypoglycemia primarily by:

A. Increasing glycogen breakdown

B. Increasing insulin secretion only

C. Blocking glucose release

D. Replacing oral glucose

A. Increasing glycogen breakdown

Rationale: Glucagon stimulates hepatic glycogenolysis and also supports gluconeogenesis, raising blood glucose.

10. ADH/vasopressin is stored and released from the:

A. Anterior pituitary

B. Kidney

C. Posterior pituitary

D. Thyroid

C. Posterior pituitary

Rationale: ADH is synthesized in the hypothalamus and stored/released by the posterior pituitary.

11. Nipple stimulation during labor causes uterine contractions through:

A. Prolactin

B. Oxytocin

C. Cortisol

D. Aldosterone

B. Oxytocin

Rationale: Nipple stimulation increases oxytocin release, which promotes uterine contraction.

12. Catecholamines important during major blood loss include:

A. Somatostatin and somatotropin

B. Epinephrine and norepinephrine

C. Vasopressin and serotonin

D. Angiotensin I and II

B. Epinephrine and norepinephrine

Rationale: These catecholamines support the sympathetic response by increasing cardiovascular activity and maintaining perfusion.

13. Sympathetic activation during stress causes:

A. Pupillary dilation

B. Bronchoconstriction

C. Decreased cardiac rate

D. Increased vagal stimulation

A. Pupillary dilation

Rationale: Sympathetic stimulation produces mydriasis, increases heart rate, and promotes bronchodilation.

14. Vagal activation causes:

A. Increased peristalsis and decreased secretions

B. Increased peristalsis and increased secretions

C. Decreased peristalsis and decreased secretions

D. Decreased peristalsis and increased secretions

B. Increased peristalsis and increased secretions

Rationale: Parasympathetic/vagal activity supports rest-and-digest functions.

15. Which statement is correct?

A. Prolactin stimulates milk production; oxytocin causes milk ejection

B. Oxytocin stimulates milk production; prolactin causes milk ejection

C. Prostaglandin stimulates milk production

D. Both hormones only cause milk ejection

A. Prolactin stimulates milk production; oxytocin causes milk ejection

Rationale: Prolactin supports milk synthesis, while oxytocin causes milk let-down/ejection.

16. Aldosterone is particularly synthesized in which adrenal-cortex layer?

A. Zona glomerulosa

B. Zona fasciculata

C. Zona reticularis

D. Zona

A. Zona glomerulosa

Rationale: The zona glomerulosa produces mineralocorticoids, chiefly aldosterone.

17. Addison's disease is:

A. Primary hyperaldosteronism

B. Secondary hypercortisolism

C. Primary hypoadrenalism

D. Secondary hypoadrenalism

C. Primary hypoadrenalism

Rationale: Addison disease is primary adrenal insufficiency, causing inadequate adrenal cortex hormones.

1. A COVID-19 patient has chills and gooseflesh. In what stage of fever is the patient?

A. Fastigium

B. Onset/chill stage

C. Crisis

D. Lysis

B. Onset/chill stage

Rationale: The chill stage occurs as the body temperature set point rises and the patient feels cold and shivers.

2. A fever that fluctuates by more than 2°C over 24 hours is:

A. Continuous

B. Intermittent

C. Remittent

D. Relapsing

C. Remittent

Rationale: A remittent fever varies during the day but does not return to normal; the item describes a fluctuation greater than 2°C.

3. Which position is best for assessing respiratory status?

A. Prone

B. Fowler's

C. Side-lying

D. Supine

B. Fowler's

Rationale: An upright or semi-upright position promotes lung expansion and makes respiratory assessment easier.

4. Dyspnea means:

A. Shallow respirations

B. Wheezing

C. Shortness of breath

D. Hemoptysis

C. Shortness of breath

Rationale: Dyspnea is the subjective sensation of difficult or uncomfortable breathing.

5. A patient is NPO for 10 hours before surgery and has an oral temperature of 99.8°F (37.7°C). This may indicate:

A. Infection

B. Hypothermia

C. Anxiety

D. Dehydration

D. Dehydration

Rationale: Preoperative fasting can contribute to dehydration; the temperature is only mildly elevated.

6. A 38-year-old has axillary temperature 99.6°F, pulse 88, respirations 30. Which finding should be reported?

A. Respiratory rate only

B. Temperature only

C. Pulse and temperature

D. Temperature and respiratory rate

D. Temperature and respiratory rate

Rationale: A respiratory rate of 30/min is elevated for an adult, and the temperature is mildly elevated.

7. All can cause tachycardia EXCEPT:

A. Fever

B. Exercise

C. Sympathetic stimulation

D. Parasympathetic stimulation

D. Parasympathetic stimulation

Rationale: Parasympathetic/vagal activity generally slows the heart.

8. Palpating the midclavicular line is associated with assessment of the:

A. Baseline vital signs

B. Systolic BP

C. Respiratory rate

D. Apical pulse

D. Apical pulse

Rationale: The apical impulse is normally located at the fifth left intercostal space near the midclavicular line.

9. Absence of which pulse may not be a significant finding on admission?

A. Apical

B. Radial

C. Pedal

D. Femoral

C. Pedal

Rationale: A pedal pulse can be difficult to palpate in some healthy people; the other pulses are more central/essential to assess.

10. The primary respiratory center is located in the:

A. Medulla oblongata

B. Hypothalamus

C. Pons

D. Cerebellum

A. Medulla oblongata

Rationale: The medulla contains the primary respiratory rhythm centers; the pons modifies breathing.