NUR 283 PATHOPHYSIOLOGY AND
PHARMACOLOGY ADVANCED
NURSING EXAM
1. A patient with Diabetic Ketoacidosis (DKA) has a blood glucose of 450 mg/dL, arterial pH of
7.20, and a serum potassium of 3.2 mEq/L. Which provider order should the nurse implement
first?
A. Administer an intravenous bolus of regular insulin 0.1 units/kg.
B. Initiate a potassium chloride infusion at 10 mEq/hr.
C. Infuse 0.9% Normal Saline at 500 mL/hr.
D. Obtain an electrocardiogram (ECG).
Answer: C
Conceptual Explanation: Fluid resuscitation with Normal Saline is the absolute priority in
DKA to restore circulatory volume. While potassium is low and insulin is needed, initial
volume expansion is the first step in the ACLS and ADA protocols.
2. A client is receiving Digoxin 0.125 mg daily. Which assessment finding would most concern
the nurse regarding potential toxicity?
A. Heart rate of 62 beats per minute.
,B. Blood pressure of 110/70 mmHg.
C. Daily weight gain of 1 lb.
D. A serum potassium level of 3.1 mEq/L.
Answer: D
Conceptual Explanation: Hypokalemia (3.1 mEq/L) significantly increases the risk of
Digoxin toxicity because potassium and digoxin compete for binding sites on the Na+/K+
ATPase pump. Low potassium allows more digoxin to bind.
3. Which clinical manifestation is a hallmark sign of a Tension Pneumothorax?
A. Dullness on percussion of the affected side.
B. Tracheal deviation toward the affected side.
C. Presence of inspiratory wheezing.
D. Tracheal deviation toward the unaffected side.
Answer: D
Conceptual Explanation: In a tension pneumothorax, air buildup in the pleural space
increases intrathoracic pressure, shifting the mediastinum and trachea toward the opposite
(unaffected) side.
4. A patient with a T6 spinal cord injury reports a sudden severe headache and has a blood
pressure of 190/100 mmHg. What is the nurse’s priority action?
A. Administer prescribed PRN hydralazine.
, B. Place the patient in a high-Fowler’s position.
C. Check the patient’s bladder for distension.
D. Dim the lights and decrease environmental stimuli.
Answer: B
Conceptual Explanation: The symptoms suggest Autonomic Dysreflexia. The first priority
is to sit the patient upright (High-Fowler’s) to lower blood pressure via orthostatic effect
before investigating the cause (like bladder distension).
5. In Acute Respiratory Distress Syndrome (ARDS), what is the primary pathophysiological
mechanism for refractory hypoxemia?
A. Increased compliance of the lung tissue.
B. Decreased pulmonary capillary permeability.
C. Excessive surfactant production.
D. Intrapulmonary shunting due to alveolar collapse.
Answer: D
Conceptual Explanation: ARDS involves damaged alveolar-capillary membranes leading
to fluid-filled alveoli and collapse. This causes blood to flow past non-ventilated alveoli
(shunting), leading to hypoxemia that does not respond to increased oxygen.
PHARMACOLOGY ADVANCED
NURSING EXAM
1. A patient with Diabetic Ketoacidosis (DKA) has a blood glucose of 450 mg/dL, arterial pH of
7.20, and a serum potassium of 3.2 mEq/L. Which provider order should the nurse implement
first?
A. Administer an intravenous bolus of regular insulin 0.1 units/kg.
B. Initiate a potassium chloride infusion at 10 mEq/hr.
C. Infuse 0.9% Normal Saline at 500 mL/hr.
D. Obtain an electrocardiogram (ECG).
Answer: C
Conceptual Explanation: Fluid resuscitation with Normal Saline is the absolute priority in
DKA to restore circulatory volume. While potassium is low and insulin is needed, initial
volume expansion is the first step in the ACLS and ADA protocols.
2. A client is receiving Digoxin 0.125 mg daily. Which assessment finding would most concern
the nurse regarding potential toxicity?
A. Heart rate of 62 beats per minute.
,B. Blood pressure of 110/70 mmHg.
C. Daily weight gain of 1 lb.
D. A serum potassium level of 3.1 mEq/L.
Answer: D
Conceptual Explanation: Hypokalemia (3.1 mEq/L) significantly increases the risk of
Digoxin toxicity because potassium and digoxin compete for binding sites on the Na+/K+
ATPase pump. Low potassium allows more digoxin to bind.
3. Which clinical manifestation is a hallmark sign of a Tension Pneumothorax?
A. Dullness on percussion of the affected side.
B. Tracheal deviation toward the affected side.
C. Presence of inspiratory wheezing.
D. Tracheal deviation toward the unaffected side.
Answer: D
Conceptual Explanation: In a tension pneumothorax, air buildup in the pleural space
increases intrathoracic pressure, shifting the mediastinum and trachea toward the opposite
(unaffected) side.
4. A patient with a T6 spinal cord injury reports a sudden severe headache and has a blood
pressure of 190/100 mmHg. What is the nurse’s priority action?
A. Administer prescribed PRN hydralazine.
, B. Place the patient in a high-Fowler’s position.
C. Check the patient’s bladder for distension.
D. Dim the lights and decrease environmental stimuli.
Answer: B
Conceptual Explanation: The symptoms suggest Autonomic Dysreflexia. The first priority
is to sit the patient upright (High-Fowler’s) to lower blood pressure via orthostatic effect
before investigating the cause (like bladder distension).
5. In Acute Respiratory Distress Syndrome (ARDS), what is the primary pathophysiological
mechanism for refractory hypoxemia?
A. Increased compliance of the lung tissue.
B. Decreased pulmonary capillary permeability.
C. Excessive surfactant production.
D. Intrapulmonary shunting due to alveolar collapse.
Answer: D
Conceptual Explanation: ARDS involves damaged alveolar-capillary membranes leading
to fluid-filled alveoli and collapse. This causes blood to flow past non-ventilated alveoli
(shunting), leading to hypoxemia that does not respond to increased oxygen.
