NUR 641EA Exam 3 V2 | NUR 641EA Advanced
Pathophysiology and Pharmacology for Nurse
Educators | Actual Q&A with Rationale (NUR641EA
Exam 3) | Grand Canyon University
1. A nurse educator is instructing a group of graduate students on the pharmacokinetics of
phenytoin (Dilantin). Which of the following adverse effects should the nurse emphasize as
potential complications for a patient on long-term therapy? (Select all that apply)
A. Gingival hyperplasia
B. Nystagmus
C. Stevens-Johnson syndrome
D. Hypoglycemia
E. Hirsutism
Correct Answer: A, B, C, E
Explanation: Phenytoin is an antiepileptic drug that works by selectively inhibiting
sodium channels to prevent repetitive firing of neurons. Gingival hyperplasia is a frequent
complication occurring in approximately 20 percent of patients, requiring meticulous
dental care. Hirsutism and nystagmus are also common, while Stevens-Johnson syndrome
represents a rare but severe hypersensitivity reaction that requires immediate medical
intervention.
,2. A patient presents to the emergency department with a blood glucose level of 850 mg/dL,
profound dehydration, and a pH of 7.35. Which characteristic most likely distinguishes this
condition as Hyperglycemic Hyperosmolar State (HHS) rather than Diabetic Ketoacidosis
(DKA)?
A. The level of hyperglycemia exceeds 600 mg/dL
B. The absence of significant metabolic acidosis
C. The presence of significant ketosis and fruity breath
D. The occurrence only in Type 1 Diabetes Mellitus
Correct Answer: B
Explanation: HHS is typically characterized by extreme hyperglycemia and dehydration
without the significant ketoacidosis seen in DKA. In HHS, the body produces enough insulin
to prevent the breakdown of fats into ketones, maintaining a near-normal pH. This
condition is more commonly associated with Type 2 Diabetes Mellitus and carries a higher
mortality rate due to the severity of fluid loss and electrolyte imbalance.
3. A nurse educator is explaining the pathophysiology of Graves’ disease. Which finding is the
result of the stimulatory effects of TSH-receptor antibodies on the thyroid gland?
A. Bradycardia and cold intolerance
B. Exophthalmos and pretibial myxedema
C. Weight gain and lethargy
D. Hypotension and decreased appetite
,Correct Answer: B
Explanation: Graves’ disease is an autoimmune disorder where Type II hypersensitivity
leads to the production of thyroid-stimulating immunoglobulins. These antibodies bind to
the TSH receptor, causing excessive production of thyroid hormones and thyroid
enlargement. Exophthalmos, or bulging eyes, and pretibial myxedema are unique clinical
manifestations caused by inflammation and accumulation of connective tissue behind the
eyes and on the skin.
4. A patient with a history of gastrectomy is diagnosed with pernicious anemia. Which
underlying cause should the nurse educator explain to the students?
A. Iron deficiency due to chronic blood loss
B. Inadequate dietary intake of folic acid
C. Failure of the gastric mucosa to secrete intrinsic factor
D. Destruction of red blood cells by the spleen
Correct Answer: C
Explanation: Pernicious anemia is a macrocytic-normochromic anemia caused by a
deficiency in Vitamin B12. Intrinsic factor is required for the absorption of B12 in the
terminal ileum, and its absence—often due to gastric atrophy or surgery—prevents this
process. Without B12, DNA synthesis in red blood cells is impaired, leading to the
production of large, immature megaloblasts.
, 5. When teaching about the mechanism of action for carbidopa-levodopa in Parkinson’s
disease, what is the primary role of carbidopa?
A. To act as a dopamine agonist in the brain
B. To prevent the peripheral metabolism of levodopa
C. To inhibit the enzyme COMT in the synaptic cleft
D. To directly increase the release of stored dopamine
Correct Answer: B
Explanation: Levodopa is the metabolic precursor to dopamine and can cross the blood-
brain barrier, whereas dopamine itself cannot. Carbidopa is a decarboxylase inhibitor that
does not cross the blood-brain barrier, preventing the conversion of levodopa to dopamine
in the periphery. This ensures that a higher concentration of levodopa reaches the central
nervous system, reducing peripheral side effects like nausea and cardiac arrhythmias.
6. A patient is being evaluated for Myasthenia Gravis using the Tensilon (edrophonium) test.
Which result would confirm the diagnosis?
A. A significant increase in muscle strength after administration
B. A rapid decrease in muscle tone and respiratory effort
C. The presence of acetylcholine receptor antibodies in the blood
D. A complete lack of response to the medication
Correct Answer: A
Pathophysiology and Pharmacology for Nurse
Educators | Actual Q&A with Rationale (NUR641EA
Exam 3) | Grand Canyon University
1. A nurse educator is instructing a group of graduate students on the pharmacokinetics of
phenytoin (Dilantin). Which of the following adverse effects should the nurse emphasize as
potential complications for a patient on long-term therapy? (Select all that apply)
A. Gingival hyperplasia
B. Nystagmus
C. Stevens-Johnson syndrome
D. Hypoglycemia
E. Hirsutism
Correct Answer: A, B, C, E
Explanation: Phenytoin is an antiepileptic drug that works by selectively inhibiting
sodium channels to prevent repetitive firing of neurons. Gingival hyperplasia is a frequent
complication occurring in approximately 20 percent of patients, requiring meticulous
dental care. Hirsutism and nystagmus are also common, while Stevens-Johnson syndrome
represents a rare but severe hypersensitivity reaction that requires immediate medical
intervention.
,2. A patient presents to the emergency department with a blood glucose level of 850 mg/dL,
profound dehydration, and a pH of 7.35. Which characteristic most likely distinguishes this
condition as Hyperglycemic Hyperosmolar State (HHS) rather than Diabetic Ketoacidosis
(DKA)?
A. The level of hyperglycemia exceeds 600 mg/dL
B. The absence of significant metabolic acidosis
C. The presence of significant ketosis and fruity breath
D. The occurrence only in Type 1 Diabetes Mellitus
Correct Answer: B
Explanation: HHS is typically characterized by extreme hyperglycemia and dehydration
without the significant ketoacidosis seen in DKA. In HHS, the body produces enough insulin
to prevent the breakdown of fats into ketones, maintaining a near-normal pH. This
condition is more commonly associated with Type 2 Diabetes Mellitus and carries a higher
mortality rate due to the severity of fluid loss and electrolyte imbalance.
3. A nurse educator is explaining the pathophysiology of Graves’ disease. Which finding is the
result of the stimulatory effects of TSH-receptor antibodies on the thyroid gland?
A. Bradycardia and cold intolerance
B. Exophthalmos and pretibial myxedema
C. Weight gain and lethargy
D. Hypotension and decreased appetite
,Correct Answer: B
Explanation: Graves’ disease is an autoimmune disorder where Type II hypersensitivity
leads to the production of thyroid-stimulating immunoglobulins. These antibodies bind to
the TSH receptor, causing excessive production of thyroid hormones and thyroid
enlargement. Exophthalmos, or bulging eyes, and pretibial myxedema are unique clinical
manifestations caused by inflammation and accumulation of connective tissue behind the
eyes and on the skin.
4. A patient with a history of gastrectomy is diagnosed with pernicious anemia. Which
underlying cause should the nurse educator explain to the students?
A. Iron deficiency due to chronic blood loss
B. Inadequate dietary intake of folic acid
C. Failure of the gastric mucosa to secrete intrinsic factor
D. Destruction of red blood cells by the spleen
Correct Answer: C
Explanation: Pernicious anemia is a macrocytic-normochromic anemia caused by a
deficiency in Vitamin B12. Intrinsic factor is required for the absorption of B12 in the
terminal ileum, and its absence—often due to gastric atrophy or surgery—prevents this
process. Without B12, DNA synthesis in red blood cells is impaired, leading to the
production of large, immature megaloblasts.
, 5. When teaching about the mechanism of action for carbidopa-levodopa in Parkinson’s
disease, what is the primary role of carbidopa?
A. To act as a dopamine agonist in the brain
B. To prevent the peripheral metabolism of levodopa
C. To inhibit the enzyme COMT in the synaptic cleft
D. To directly increase the release of stored dopamine
Correct Answer: B
Explanation: Levodopa is the metabolic precursor to dopamine and can cross the blood-
brain barrier, whereas dopamine itself cannot. Carbidopa is a decarboxylase inhibitor that
does not cross the blood-brain barrier, preventing the conversion of levodopa to dopamine
in the periphery. This ensures that a higher concentration of levodopa reaches the central
nervous system, reducing peripheral side effects like nausea and cardiac arrhythmias.
6. A patient is being evaluated for Myasthenia Gravis using the Tensilon (edrophonium) test.
Which result would confirm the diagnosis?
A. A significant increase in muscle strength after administration
B. A rapid decrease in muscle tone and respiratory effort
C. The presence of acetylcholine receptor antibodies in the blood
D. A complete lack of response to the medication
Correct Answer: A
