NUR 641EA Exam 4 V2 | NUR 641EA Advanced
Pathophysiology and Pharmacology for Nurse
Educators | Actual Q&A with Rationale (NUR641EA
Exam 4) | Grand Canyon University
1. A patient with Type 2 Diabetes is prescribed Metformin. Which mechanism of action
should the nurse educator emphasize when explaining this medication?
A. Decreasing hepatic glucose production and improving insulin sensitivity.
B. Increasing insulin secretion from the pancreatic beta cells.
C. Delaying the absorption of carbohydrates in the small intestine.
D. Increasing glucose excretion via the renal system.
Correct Answer: A
Explanation: Metformin is a biguanide that primary acts by decreasing hepatic glucose
production and increasing peripheral glucose uptake. It is considered a first-line therapy
for Type 2 Diabetes because it does not typically cause weight gain or hypoglycemia. Nurse
educators must emphasize the importance of monitoring renal function, as the drug is
contraindicated in patients with significant renal impairment due to the risk of lactic
acidosis.
2. A patient presents with lethargy, weight gain, cold intolerance, and a slowed heart rate.
Which lab result would most likely confirm a diagnosis of primary hypothyroidism?
A. Elevated TSH and low Free T4.
,B. Low TSH and low Free T4.
C. Elevated TSH and elevated Free T4.
D. Low TSH and elevated Free T4.
Correct Answer: A
Explanation: In primary hypothyroidism, the thyroid gland fails to produce sufficient
thyroid hormones despite stimulation. The pituitary gland responds to low circulating T4
levels by increasing the secretion of Thyroid Stimulating Hormone (TSH). This inverse
relationship is the hallmark for diagnosing primary thyroid failure in clinical practice.
3. Which of the following are clinical manifestations or complications associated with Chronic
Kidney Disease (CKD)? Select all that apply.
A. Anemia
B. Hyperkalemia
C. Metabolic Alkalosis
D. Hypertension
E. Hypophosphatemia
F. Hypocalcemia
Correct Answer: A, B, D, F
Explanation: CKD leads to decreased erythropoietin production, causing anemia, and
reduced potassium excretion, resulting in hyperkalemia. The kidneys also lose the ability to
, excrete acid and phosphate, leading to metabolic acidosis and hyperphosphatemia (not
hypo). Hypocalcemia occurs because the kidneys cannot activate Vitamin D, which is
necessary for calcium absorption in the gut.
4. A patient is diagnosed with Graves’ Disease. Which pathophysiological process is
responsible for the symptoms?
A. Autoimmune stimulation of TSH receptors by antibodies.
B. Destruction of thyroid follicular cells by T-cells.
C. Excessive secretion of TSH by a pituitary adenoma.
D. Iodine deficiency leading to goiter formation.
Correct Answer: A
Explanation: Graves’ Disease is an autoimmune disorder where thyroid-stimulating
immunoglobulins (TSI) bind to and activate TSH receptors. This leads to the autonomous
overproduction of thyroid hormones and thyroid gland enlargement. Characteristic signs
include exophthalmos, heat intolerance, and tachycardia.
5. Which assessment finding is most characteristic of Cushing’s Syndrome?
A. Hypotension and hyperkalemia.
B. Hyperpigmentation of the skin and weight loss.
C. Central obesity, buffalo hump, and purple striae.
D. Polyuria, polydipsia, and polyphagia.
Pathophysiology and Pharmacology for Nurse
Educators | Actual Q&A with Rationale (NUR641EA
Exam 4) | Grand Canyon University
1. A patient with Type 2 Diabetes is prescribed Metformin. Which mechanism of action
should the nurse educator emphasize when explaining this medication?
A. Decreasing hepatic glucose production and improving insulin sensitivity.
B. Increasing insulin secretion from the pancreatic beta cells.
C. Delaying the absorption of carbohydrates in the small intestine.
D. Increasing glucose excretion via the renal system.
Correct Answer: A
Explanation: Metformin is a biguanide that primary acts by decreasing hepatic glucose
production and increasing peripheral glucose uptake. It is considered a first-line therapy
for Type 2 Diabetes because it does not typically cause weight gain or hypoglycemia. Nurse
educators must emphasize the importance of monitoring renal function, as the drug is
contraindicated in patients with significant renal impairment due to the risk of lactic
acidosis.
2. A patient presents with lethargy, weight gain, cold intolerance, and a slowed heart rate.
Which lab result would most likely confirm a diagnosis of primary hypothyroidism?
A. Elevated TSH and low Free T4.
,B. Low TSH and low Free T4.
C. Elevated TSH and elevated Free T4.
D. Low TSH and elevated Free T4.
Correct Answer: A
Explanation: In primary hypothyroidism, the thyroid gland fails to produce sufficient
thyroid hormones despite stimulation. The pituitary gland responds to low circulating T4
levels by increasing the secretion of Thyroid Stimulating Hormone (TSH). This inverse
relationship is the hallmark for diagnosing primary thyroid failure in clinical practice.
3. Which of the following are clinical manifestations or complications associated with Chronic
Kidney Disease (CKD)? Select all that apply.
A. Anemia
B. Hyperkalemia
C. Metabolic Alkalosis
D. Hypertension
E. Hypophosphatemia
F. Hypocalcemia
Correct Answer: A, B, D, F
Explanation: CKD leads to decreased erythropoietin production, causing anemia, and
reduced potassium excretion, resulting in hyperkalemia. The kidneys also lose the ability to
, excrete acid and phosphate, leading to metabolic acidosis and hyperphosphatemia (not
hypo). Hypocalcemia occurs because the kidneys cannot activate Vitamin D, which is
necessary for calcium absorption in the gut.
4. A patient is diagnosed with Graves’ Disease. Which pathophysiological process is
responsible for the symptoms?
A. Autoimmune stimulation of TSH receptors by antibodies.
B. Destruction of thyroid follicular cells by T-cells.
C. Excessive secretion of TSH by a pituitary adenoma.
D. Iodine deficiency leading to goiter formation.
Correct Answer: A
Explanation: Graves’ Disease is an autoimmune disorder where thyroid-stimulating
immunoglobulins (TSI) bind to and activate TSH receptors. This leads to the autonomous
overproduction of thyroid hormones and thyroid gland enlargement. Characteristic signs
include exophthalmos, heat intolerance, and tachycardia.
5. Which assessment finding is most characteristic of Cushing’s Syndrome?
A. Hypotension and hyperkalemia.
B. Hyperpigmentation of the skin and weight loss.
C. Central obesity, buffalo hump, and purple striae.
D. Polyuria, polydipsia, and polyphagia.
