Nsg554 Advanced Pathophysiology And Pharmacology 250 Master Q&A (Full Rationales)

NSG554 ADVANCED PATHOPHYSIOLOGY
AND PHARMACOLOGY 250 MASTER Q&A
(FULL RATIONALES)



NSG554 Exam 3 Practice Questions
A patient with Type 2 Diabetes is prescribed Metformin. What
is the primary mechanism of action for this drug?
A) Increasing insulin secretion from the pancreas
B) Decreasing hepatic glucose production and increasing
insulin sensitivity
C) Slowing gastric emptying
D) Increasing glucose excretion via the kidneys
Rationale: Metformin is a biguanide that reduces the amount of sugar
the liver produces and helps muscles use insulin more effectively; it
does not cause hypoglycemia because it doesn't stimulate insulin
release. [1]
1. Which thyroid disorder is characterized by an
autoimmune destruction of the thyroid gland, leading to
high TSH and low T4 levels?
A) Grave’s Disease
B) Hashimoto’s Thyroiditis
C) Myxedema Coma
D) Toxic Multinodular Goiter
Rationale: Hashimoto’s is the most common cause of primary
hypothyroidism in the U.S., where the body attacks the thyroid,
resulting in a compensatory rise in TSH. [2]
2. A patient presents with "Moon face," "Buffalo hump,"
and central obesity. The provider suspects Cushing’s
Syndrome. What is the underlying pathophysiology?
A) Cortisol deficiency
B) Excessive circulating cortisol (hypercortisolism)
C) High levels of Aldosterone
D) Low ACTH only
Rationale: Cushing’s results from prolonged exposure to high

, levels of glucocorticoids, whether from internal overproduction or
external steroid use. [3]
3. Which electrolyte imbalance is a hallmark of Primary
Hyperaldosteronism (Conn’s Syndrome)?
A) Hyperkalemia and Hypotension
B) Hypokalemia and Hypertension
C) Hyponatremia and Weight loss
D) Hypercalcemia
Rationale: Excess aldosterone causes the kidneys to retain sodium
and water (leading to hypertension) and excrete excessive
potassium (leading to hypokalemia). [4]
4. A patient with Diabetes Insipidus (DI) has a deficiency in
which hormone?
A) Insulin
B) Antidiuretic Hormone (ADH/Vasopressin)
C) Oxytocin
D) Aldosterone
Rationale: DI is characterized by the inability to concentrate
urine due to a lack of ADH (Central) or kidney resistance to it
(Nephrogenic), leading to polyuria. [5]
5. In the treatment of Hyperthyroidism, Propylthiouracil
(PTU) works by:
A) Destroying thyroid tissue with radiation
B) Inhibiting the synthesis of thyroid hormones and
blocking peripheral conversion of T4 to T3
C) Increasing iodine uptake
D) Stimulating TSH receptors
Rationale: PTU is an antithyroid medication used to lower
hormone levels, particularly useful in thyroid storm due to its
peripheral blocking effect. [6]
6. What is the most common cause of Acute Pyelonephritis?
A) Viral infection
B) Ascending urinary tract infection (usually E. coli)
C) Kidney stones only
D) Autoimmune reaction
Rationale: Most kidney infections start as a bladder infection that
travels up the ureters to the renal pelvis. [7]

,7. A patient with Chronic Kidney Disease (CKD) has a low
hemoglobin level. Why is this common in CKD?
A) Chronic blood loss in urine
B) Decreased production of Erythropoietin by the kidneys
C) Iron deficiency from diet
D) High white blood cell count
Rationale: The kidneys produce erythropoietin to stimulate red
blood cell production; as renal function fails, this hormone
production drops. [8]
8. Which acid-base imbalance is most likely in a patient
with end-stage renal failure?
A) Metabolic Alkalosis
B) Metabolic Acidosis
C) Respiratory Acidosis
D) Respiratory Alkalosis
Rationale: Failing kidneys cannot excrete hydrogen ions or
reabsorb bicarbonate effectively, leading to an accumulation of
acid in the blood. [9]
9. The "Gold Standard" for measuring overall kidney
function and staging CKD is:
A) BUN level
B) Glomerular Filtration Rate (GFR)
C) Urine output per hour
D) Serum Potassium
Rationale: GFR provides the most accurate assessment of how
well the glomeruli are filtering waste from the blood. [10]
10. A patient with Nephrotic Syndrome presents with
severe generalized edema. This is primarily due to:
A) High blood pressure
B) Massive proteinuria leading to low serum albumin
(hypoalbuminemia)
C) Sodium wasting
D) Increased capillary permeability from infection
Rationale: The loss of albumin in the urine decreases plasma
oncotic pressure, allowing fluid to leak into the interstitial
spaces. [11]
11. Which medication is the first-line "rescue" treatment for
Hyperkalemia with EKG changes (peaked T-waves)?

, A) Insulin and Dextrose
B) Calcium Gluconate
C) Kayexalate
D) Furosemide
Rationale: Calcium gluconate does not lower potassium, but it
"stabilizes the cardiac membrane" to prevent lethal arrhythmias
while other drugs work to lower the K+ level. [12]
12.Prerenal Acute Kidney Injury (AKI) is most often caused
by:
A) Bladder obstruction
B) Decreased renal perfusion (e.g., dehydration, shock,
heart failure)
C) Nephrotoxic drugs
D) Glomerunonephritis
Rationale: Prerenal AKI occurs when the "input" to the kidney is
compromised, rather than damage to the kidney tissue itself. [13]
13.A patient with a history of kidney stones (urolithiasis) is
found to have a Calcium Oxalate stone. Which dietary
advice is best?
A) Avoid all calcium-rich foods
B) Maintain adequate calcium intake but limit high-
oxalate foods (like spinach and rhubarb)
C) Drink less water to avoid flushing the kidneys
D) Increase sodium intake
Rationale: Dietary calcium binds with oxalate in the gut,
preventing its absorption and subsequent stone formation in the
kidneys. [14]
14.What is the hallmark of "Goodpasture Syndrome"?
A) Liver and kidney failure
B) Pulmonary hemorrhage and Glomerulonephritis (Anti-
GBM antibodies)
C) Brittle bones and stones
D) Skin rash and joint pain
Rationale: This is a rare autoimmune disease where antibodies
attack the basement membranes in both the lungs and the
kidneys. [15]
15. In Gastroesophageal Reflux Disease (GERD), what is the
primary structural defect?