APUS NURS325 Final Exam (pdf) | 2026/2027 | Integrated
Pathophysiology & Clinical Pharmacology Q&A | Pathophysiology
1. A patient newly diagnosed with diabetes is learning about the signs and
symptoms of low blood sugar. Which of the following is NOT considered a
sign of hypoglycemia?
A) Sweating
B) Hunger
C) Increased thirst
D) Pallor
Correct Answer: Increased thirst
Rationale: Increased thirst (polydipsia) is a classic sign of hyperglycemia, not
hypoglycemia. Hypoglycemia (low blood sugar) triggers the release of
epinephrine, leading to symptoms like diaphoresis (sweating), tachycardia,
and pallor, as well as neuroglycopenic symptoms like hunger and confusion.
2. The nurse is assisting a patient who is symptomatic with a blood glucose
of 62 mg/dL. You send the student nurse to the gallery to retrieve a
treatment source. You know the student nurse understands the treatment
when they return with which option?
A) 4 oz can of diet Sprite
B) A package of peanut butter crackers
C) 4 oz cup of apple juice
D) 4 oz cup of 2% milk
Correct Answer: 4 oz cup of apple juice
Rationale: The "Rule of 15" for treating hypoglycemia in a conscious patient
involves administering 15 grams of fast-acting carbohydrate. Apple juice (4
oz) contains approximately 15 grams of simple sugar that is rapidly
absorbed. Diet soda has no sugar, peanut butter crackers contain fat and
protein which slow absorption, and milk contains lactose which is slower to
act.
,3. Which results fit the diagnostic criteria for type 2 diabetes mellitus?
A) Fasting blood glucose of 136 mg/dL
B) Oral glucose tolerance test of 135 mg/dL at 2 hours
C) Hemoglobin A1C of 5.8%
D) Random blood glucose of 101 mg/dL
Correct Answer: Fasting blood glucose of 136 mg/dL
Rationale: The diagnostic criteria for diabetes include a fasting blood glucose
≥126 mg/dL. An oral glucose tolerance test ≥200 mg/dL at 2 hours, an A1C
≥6.5%, or a random glucose ≥200 mg/dL with symptoms are also diagnostic.
4. What is the primary mechanism of action of metformin in the treatment of
type 2 diabetes mellitus?
A) Increasing insulin secretion from pancreatic beta cells
B) Decreasing hepatic glucose production and increasing peripheral glucose
uptake
C) Delaying carbohydrate absorption in the gastrointestinal tract
D) Increasing insulin sensitivity by activating PPAR-gamma receptors
Correct Answer: Decreasing hepatic glucose production and increasing
peripheral glucose uptake
Rationale: Metformin is a biguanide that primarily reduces hepatic
gluconeogenesis (glucose production) and enhances peripheral glucose
uptake in skeletal muscle. It does not increase insulin secretion.
5. The nurse is caring for a patient with heart failure who is prescribed
digoxin. Which of the following findings would indicate potential digoxin
toxicity?
A) Tachycardia and hypertension
B) Anorexia, nausea, and visual disturbances
C) Hyperkalemia and muscle weakness
D) Weight gain and peripheral edema
,Correct Answer: Anorexia, nausea, and visual disturbances
Rationale: Early signs of digoxin toxicity include gastrointestinal symptoms
like anorexia, nausea, and vomiting, as well as visual disturbances such as
blurred vision or yellow-green halos around lights. Cardiac dysrhythmias,
including bradycardia, are also common.
6. A patient with a history of asthma is prescribed a beta-blocker for
hypertension. Which of the following beta-blockers is most appropriate for
this patient?
A) Propranolol
B) Nadolol
C) Metoprolol
D) Timolol
Correct Answer: Metoprolol
Rationale: Metoprolol is a cardioselective (beta-1 selective) beta-blocker. At
low doses, it primarily blocks beta-1 receptors in the heart, with less effect
on beta-2 receptors in the lungs, making it safer in patients with reactive
airway disease. Propranolol, nadolol, and timolol are non-selective.
7. A patient with a documented allergy to penicillin is prescribed an antibiotic
for a skin infection. Which of the following antibiotics should be avoided due
to the risk of cross-reactivity?
A) Azithromycin
B) Cephalexin
C) Doxycycline
D) Vancomycin
Correct Answer: Cephalexin
Rationale: Cephalexin is a first-generation cephalosporin. Cephalosporins
share a beta-lactam ring structure with penicillins, and there is a risk of
cross-reactivity in patients with true penicillin allergies (approximately 5-
10%).
, 8. A patient is prescribed ciprofloxacin for a complicated urinary tract
infection. Which serious adverse effect should the patient be counseled
about?
A) Tendon rupture
B) Hepatotoxicity
C) Cardiotoxicity
D) Nephrotoxicity
Correct Answer: Tendon rupture
Rationale: Fluoroquinolones, such as ciprofloxacin, are associated with an
increased risk of tendonitis and tendon rupture, particularly of the Achilles
tendon. This risk is higher in patients over 60, those taking corticosteroids,
and organ transplant recipients.
9. The nurse is caring for a patient with benign prostatic hyperplasia (BPH)
who is prescribed tamsulosin. What is the primary mechanism of action of
this medication?
A) Inhibition of 5-alpha reductase
B) Alpha-1 adrenergic receptor blockade
C) Phosphodiesterase-5 inhibition
D) Muscarinic receptor antagonism
Correct Answer: Alpha-1 adrenergic receptor blockade
Rationale: Tamsulosin is a selective alpha-1a adrenergic receptor blocker that
relaxes smooth muscle in the prostate and bladder neck, improving urine
flow. This provides symptomatic relief of BPH without significantly affecting
blood pressure.
10. A patient with an overactive bladder is prescribed oxybutynin. What is
the mechanism of action of this medication?
A) Alpha-1 adrenergic receptor blockade
Pathophysiology & Clinical Pharmacology Q&A | Pathophysiology
1. A patient newly diagnosed with diabetes is learning about the signs and
symptoms of low blood sugar. Which of the following is NOT considered a
sign of hypoglycemia?
A) Sweating
B) Hunger
C) Increased thirst
D) Pallor
Correct Answer: Increased thirst
Rationale: Increased thirst (polydipsia) is a classic sign of hyperglycemia, not
hypoglycemia. Hypoglycemia (low blood sugar) triggers the release of
epinephrine, leading to symptoms like diaphoresis (sweating), tachycardia,
and pallor, as well as neuroglycopenic symptoms like hunger and confusion.
2. The nurse is assisting a patient who is symptomatic with a blood glucose
of 62 mg/dL. You send the student nurse to the gallery to retrieve a
treatment source. You know the student nurse understands the treatment
when they return with which option?
A) 4 oz can of diet Sprite
B) A package of peanut butter crackers
C) 4 oz cup of apple juice
D) 4 oz cup of 2% milk
Correct Answer: 4 oz cup of apple juice
Rationale: The "Rule of 15" for treating hypoglycemia in a conscious patient
involves administering 15 grams of fast-acting carbohydrate. Apple juice (4
oz) contains approximately 15 grams of simple sugar that is rapidly
absorbed. Diet soda has no sugar, peanut butter crackers contain fat and
protein which slow absorption, and milk contains lactose which is slower to
act.
,3. Which results fit the diagnostic criteria for type 2 diabetes mellitus?
A) Fasting blood glucose of 136 mg/dL
B) Oral glucose tolerance test of 135 mg/dL at 2 hours
C) Hemoglobin A1C of 5.8%
D) Random blood glucose of 101 mg/dL
Correct Answer: Fasting blood glucose of 136 mg/dL
Rationale: The diagnostic criteria for diabetes include a fasting blood glucose
≥126 mg/dL. An oral glucose tolerance test ≥200 mg/dL at 2 hours, an A1C
≥6.5%, or a random glucose ≥200 mg/dL with symptoms are also diagnostic.
4. What is the primary mechanism of action of metformin in the treatment of
type 2 diabetes mellitus?
A) Increasing insulin secretion from pancreatic beta cells
B) Decreasing hepatic glucose production and increasing peripheral glucose
uptake
C) Delaying carbohydrate absorption in the gastrointestinal tract
D) Increasing insulin sensitivity by activating PPAR-gamma receptors
Correct Answer: Decreasing hepatic glucose production and increasing
peripheral glucose uptake
Rationale: Metformin is a biguanide that primarily reduces hepatic
gluconeogenesis (glucose production) and enhances peripheral glucose
uptake in skeletal muscle. It does not increase insulin secretion.
5. The nurse is caring for a patient with heart failure who is prescribed
digoxin. Which of the following findings would indicate potential digoxin
toxicity?
A) Tachycardia and hypertension
B) Anorexia, nausea, and visual disturbances
C) Hyperkalemia and muscle weakness
D) Weight gain and peripheral edema
,Correct Answer: Anorexia, nausea, and visual disturbances
Rationale: Early signs of digoxin toxicity include gastrointestinal symptoms
like anorexia, nausea, and vomiting, as well as visual disturbances such as
blurred vision or yellow-green halos around lights. Cardiac dysrhythmias,
including bradycardia, are also common.
6. A patient with a history of asthma is prescribed a beta-blocker for
hypertension. Which of the following beta-blockers is most appropriate for
this patient?
A) Propranolol
B) Nadolol
C) Metoprolol
D) Timolol
Correct Answer: Metoprolol
Rationale: Metoprolol is a cardioselective (beta-1 selective) beta-blocker. At
low doses, it primarily blocks beta-1 receptors in the heart, with less effect
on beta-2 receptors in the lungs, making it safer in patients with reactive
airway disease. Propranolol, nadolol, and timolol are non-selective.
7. A patient with a documented allergy to penicillin is prescribed an antibiotic
for a skin infection. Which of the following antibiotics should be avoided due
to the risk of cross-reactivity?
A) Azithromycin
B) Cephalexin
C) Doxycycline
D) Vancomycin
Correct Answer: Cephalexin
Rationale: Cephalexin is a first-generation cephalosporin. Cephalosporins
share a beta-lactam ring structure with penicillins, and there is a risk of
cross-reactivity in patients with true penicillin allergies (approximately 5-
10%).
, 8. A patient is prescribed ciprofloxacin for a complicated urinary tract
infection. Which serious adverse effect should the patient be counseled
about?
A) Tendon rupture
B) Hepatotoxicity
C) Cardiotoxicity
D) Nephrotoxicity
Correct Answer: Tendon rupture
Rationale: Fluoroquinolones, such as ciprofloxacin, are associated with an
increased risk of tendonitis and tendon rupture, particularly of the Achilles
tendon. This risk is higher in patients over 60, those taking corticosteroids,
and organ transplant recipients.
9. The nurse is caring for a patient with benign prostatic hyperplasia (BPH)
who is prescribed tamsulosin. What is the primary mechanism of action of
this medication?
A) Inhibition of 5-alpha reductase
B) Alpha-1 adrenergic receptor blockade
C) Phosphodiesterase-5 inhibition
D) Muscarinic receptor antagonism
Correct Answer: Alpha-1 adrenergic receptor blockade
Rationale: Tamsulosin is a selective alpha-1a adrenergic receptor blocker that
relaxes smooth muscle in the prostate and bladder neck, improving urine
flow. This provides symptomatic relief of BPH without significantly affecting
blood pressure.
10. A patient with an overactive bladder is prescribed oxybutynin. What is
the mechanism of action of this medication?
A) Alpha-1 adrenergic receptor blockade
