Advanced Pathopharmacological Foundations
Celiac disease is suspected. Which follow-up tissue test, the gold standard for this suspected diagnosis,
should be ordered? - (correct Answer) - Endoscopy with small intestine biopsy
A 44-year-old woman has recently been diagnosed with advanced metastatic non-small-cell lung cancer.
Genetic testing is ordered to determine if the patient's tumor has any genomic alterations and to guide
treatment decisions. A few weeks later, the patient's test results come back positive for a genetic
mutation. The APN starts osimertinib (Tagrisso). Based on this information, what type of genetic
mutation does this patient have? - (correct Answer) - EGFR mutation
A 20-year-old male meets with an advanced professional nurse (APN) to discuss symptoms that have
been slowly progressing over the past several years. He is mainly concerned because he has been falling
frequently. Since childhood, his gait has consisted of walking on his toes. During middle school, he was
able to participate in sports but was unable to participate in high school sports due to difficulty with
running and jumping. Lately, he has noticed it takes longer and is more difficult to change positions from
sitting to standing than it used to in the past. He has also been waking up with muscle and joint stiffness.
The APRN notes that his family history is not significant for any chronic or genetic diseases. Which
condition is likely to be the cause of these symptoms? - (correct Answer) - Becker muscular dystrophy
A patient with systemic lupus erythematosus (SLE) is diagnosed with idiopathic thrombocytopenic
purpura (ITP). Which statement should the provider give the patient regarding the pathophysiology of
SLE and its relation to thrombocytopenia? - (correct Answer) - SLE disrupts immune homeostasis and
promotes development of self-reactive antibodies.
A female patient presents to an office to establish care. Her previous primary care provider told her to
follow up regarding an elevated ferritin level. She has no previous medical history and is currently
asymptomatic. She is concerned about the elevated ferritin and would like to know if she should be
worried. What should the provider do next for this patient? - (correct Answer) - Order a liver function
test
A 75-year-old female presents to the emergency department with an irregular heart rate of 130. What
can be ascertained about this patient's findings given the limited information? - (correct Answer) - She is
diagnosed with atrial fibrillation and needs her heart rate controlled with metoprolol (Lopressor).
A 75-year-old male presents with a history of transient ischemic attack, acute myocardial infarction,
angina, and atrial fibrillation. The patient's echocardiogram shows low cardiac output and loss of
contractility. Which condition from this patient's medical history is contributing to the loss of
contractility? - (correct Answer) - Acute myocardial infarction
A patient presents to an emergency room with blurred vision, fatigue, shortness of breath, and
disorientation. Some of the preliminary lab results reveal the following: glucose >400 mg/dL, sodium 150
mEq/L, potassium 7 mEq/L, serum bicarbonate 12 mEq/L, serum creatinine 3 mg/dL. Which condition is
this patient suffering from? - (correct Answer) - Diabetic ketoacidosis
,A 45-year-old female fears that she is having a stroke and takes herself to an emergency room. After
several diagnostic and laboratory tests, the patient is diagnosed with Cushing disease. Which lab
abnormality would be present in this patient? - (correct Answer) - Increased cortisol
A 16-year-old female presents to the clinic with complaints of coughing and wheezing. The symptoms
have been going on for several months, and she reports that her coughing and wheezing becomes worse
during soccer practice. Occasionally, she wakes up at night and feels short of breath. She has a history of
seasonal allergies but has no personal or family history of respiratory diseases. Based on the patient's
presentation, which disease process is the patient likely exhibiting? - (correct Answer) - Asthma
A two-year-old child presents with a clear runny nose and cough which has lasted 3 days. The child's
mother reports the cough sounds like a barking noise. The child is sleeping in the mother's arms and
appears to have stridor. The child's mother also reports an axillary temperature of 101°F last night.
Which management technique is appropriate for this child's symptoms? - (correct Answer) - Oral steroids
and breathing treatments
A patient who is elderly presents with recent memory loss, urinary incontinence, and hallucinations. The
patient's family also states she is having daytime sleepiness and impaired judgment. Which lab and
diagnostic tests should be ordered as part of the patient's assessment? - (correct Answer) - Complete
blood count, complete metabolic profile, and urinalysis
An 18-year-old male is involved in a motorcycle crash while not wearing a helmet. He is brought into an
emergency room and is immediately taken for a CT scan. The provider tells the patient's parents he has
bleeding between the dura mater and the skull. What is this patient's condition called? - (correct
Answer) - Epidural hematoma
A 40-year-old female comes to a clinic with abdominal pain and diarrhea. She reports that every time
she eats, her diarrhea gets worse. Her labs and stool studies are normal, and a colonoscopy is
performed. The colonoscopy reveals the patient has skip lesions throughout her colon. What is the
appropriate diagnosis for this patient? - (correct Answer) - Crohn's disease
A 15-year-old male comes into an office with pain in his scrotum. He states his pain started this morning
and has been increasing. He reports feeling very nauseated. Which diagnostic test is appropriate to order
for this patient? - (correct Answer) - Ultrasound
A 45-year-old male is being seen in the clinic for a yearly check-up and lab work. His history includes
hypertension and hyperlipidemia for which he currently takes Norvasc 5 mg daily and Lipitor 20 mg
nightly. Patient has a family history of diabetes, hypertension, heart disease, and hyperlipidemia. After
obtaining lab work, the provider notices the patient's hgbA1c is elevated at 7.5. The patient is already on
a DASH diet and watching the amount of sweets and carbohydrates he eats daily. The patient is not
overweight and participates in moderate physical activity at least 4-5 days a week. He was started on
Metformin three months ago, and his hemoglobin A1c is now 6.9. The nurse expects to see a class of
medication prescribed which is proven to reduce the risk of cardiovascular events.Considering the
treatment guidelines from the American College of Cardiology, which medication should be
recommended for this patient - (correct Answer) - Invokana 100 mg daily
A 78-year-old female presents to the clinic for a checkup and refills on her medications. She is currently
taking lisinopril (Zestril), metformin (Glucophage), and levothyroxine (Synthroid). The patient has a
history of hypertension, type 2 diabetes, hypothyroidism, GERD, and gastric ulcers. The patient is
, concerned about heart disease and wants to start taking a low-dose aspirin. Which aspirin regimen
recommendation should the advanced professional nurse (APN) give to the patient? - (correct Answer) -
Low-dose enteric coated aspirin 81 mg daily
After testing is completed, the patient is diagnosed with Hashimoto's thyroiditis. The patient is currently
in a hypothyroid state.In reviewing the patient's thyroid-stimulating hormone (TSH) level, which result
correlates with her hypothyroid symptoms? - (correct Answer) - 5.31 mIU/L
A 74- year-old male with Cushing syndrome presents to the emergency department (ED) with pain in his
left leg, and is diagnosed with a deep vein thrombosis (DVT).What is this patient's symptoms related to? -
(correct Answer) - Elevated Von Willebrand factor
A 42-year-old asthmatic who has been using beta-adrenergic agonists for several years began to
experience premature atrial contractions (PACs). To treat the PACs, metoprolol (Toprol XL) therapy was
started.What is a likely consequence of this patient taking metoprolol (Toprol XL)? - (correct Answer) -
Metoprolol (Toprol XL) worsened asthma symptoms, but improved the PACs.
Which inhaler prescription would support long-acting treatment for twice-daily use in controlled asthma
management? - (correct Answer) - Fluticasone propionate/salmeterol (Advair Diskus)
A 65-year-old male presents for a visit regarding his type 2 diabetes. He has been dealing with diabetes
for the last 15 years. He has a history of diabetic neuropathy in his feet. Six months ago his symptoms
were mild to almost nonexistent. He currently describes the neuropathy as painful, and it wakes him up
at night.Which medication would be the first line treatment for this patient? - (correct Answer) -
Pregabalin (Lyrica)
A 55-year-old male presents for a new diagnosis of Parkinson's Disease. He has experienced gait
disorders and a pill rolling tremor. The patient was a former boxer with a history of multiple concussions.
He was started on carbidopa-levodopa (Sinemet), which has decreased his symptoms.How would an
antipsychotic medication such as haloperidol (Haldol) cause an interaction with this patient? - (correct
Answer) - By antagonizing dopamine
A 25-year-old female is 35 weeks pregnant and presents for lower back pain. She has a history of
moderate lower back pain that she normally controls with stretching, yoga, and ice. The patient reports
not being able to engage in stretching and yoga because of the state of her pregnancy. Ice use has been
ineffective. After a benign exam and a negative urinalysis, the provider is convinced that the pain is
musculoskeletal. The patient inquires if there are any medications she can take for the pain.Which
medication does the provider tell the patient she can safely take? - (correct Answer) - Acetaminophen
(Tylenol)
A nurse is administering medication to a 67-year-old patient in liver failure, secondary to end-stage
cirrhosis. Liver dysfunction can influence drug pharmacokinetics and pharmacodynamics. Which
pharmacokinetic phase is affected in this patient? - (correct Answer) - Metabolism
A 40-year-old Trinidadian male comes into a clinic complaining of burning chest pain, indigestion,
nausea, and belching after eating certain foods. He is a single father living and working in New York City.
He recently obtained his green card after living in the United States for more than 10 years. He has a GED
and works as an IT help desk technician earning $42,000 a year. He has health insurance through the
New York health marketplace because it is cheaper than his employer's plan. Because of the high cost of
Celiac disease is suspected. Which follow-up tissue test, the gold standard for this suspected diagnosis,
should be ordered? - (correct Answer) - Endoscopy with small intestine biopsy
A 44-year-old woman has recently been diagnosed with advanced metastatic non-small-cell lung cancer.
Genetic testing is ordered to determine if the patient's tumor has any genomic alterations and to guide
treatment decisions. A few weeks later, the patient's test results come back positive for a genetic
mutation. The APN starts osimertinib (Tagrisso). Based on this information, what type of genetic
mutation does this patient have? - (correct Answer) - EGFR mutation
A 20-year-old male meets with an advanced professional nurse (APN) to discuss symptoms that have
been slowly progressing over the past several years. He is mainly concerned because he has been falling
frequently. Since childhood, his gait has consisted of walking on his toes. During middle school, he was
able to participate in sports but was unable to participate in high school sports due to difficulty with
running and jumping. Lately, he has noticed it takes longer and is more difficult to change positions from
sitting to standing than it used to in the past. He has also been waking up with muscle and joint stiffness.
The APRN notes that his family history is not significant for any chronic or genetic diseases. Which
condition is likely to be the cause of these symptoms? - (correct Answer) - Becker muscular dystrophy
A patient with systemic lupus erythematosus (SLE) is diagnosed with idiopathic thrombocytopenic
purpura (ITP). Which statement should the provider give the patient regarding the pathophysiology of
SLE and its relation to thrombocytopenia? - (correct Answer) - SLE disrupts immune homeostasis and
promotes development of self-reactive antibodies.
A female patient presents to an office to establish care. Her previous primary care provider told her to
follow up regarding an elevated ferritin level. She has no previous medical history and is currently
asymptomatic. She is concerned about the elevated ferritin and would like to know if she should be
worried. What should the provider do next for this patient? - (correct Answer) - Order a liver function
test
A 75-year-old female presents to the emergency department with an irregular heart rate of 130. What
can be ascertained about this patient's findings given the limited information? - (correct Answer) - She is
diagnosed with atrial fibrillation and needs her heart rate controlled with metoprolol (Lopressor).
A 75-year-old male presents with a history of transient ischemic attack, acute myocardial infarction,
angina, and atrial fibrillation. The patient's echocardiogram shows low cardiac output and loss of
contractility. Which condition from this patient's medical history is contributing to the loss of
contractility? - (correct Answer) - Acute myocardial infarction
A patient presents to an emergency room with blurred vision, fatigue, shortness of breath, and
disorientation. Some of the preliminary lab results reveal the following: glucose >400 mg/dL, sodium 150
mEq/L, potassium 7 mEq/L, serum bicarbonate 12 mEq/L, serum creatinine 3 mg/dL. Which condition is
this patient suffering from? - (correct Answer) - Diabetic ketoacidosis
,A 45-year-old female fears that she is having a stroke and takes herself to an emergency room. After
several diagnostic and laboratory tests, the patient is diagnosed with Cushing disease. Which lab
abnormality would be present in this patient? - (correct Answer) - Increased cortisol
A 16-year-old female presents to the clinic with complaints of coughing and wheezing. The symptoms
have been going on for several months, and she reports that her coughing and wheezing becomes worse
during soccer practice. Occasionally, she wakes up at night and feels short of breath. She has a history of
seasonal allergies but has no personal or family history of respiratory diseases. Based on the patient's
presentation, which disease process is the patient likely exhibiting? - (correct Answer) - Asthma
A two-year-old child presents with a clear runny nose and cough which has lasted 3 days. The child's
mother reports the cough sounds like a barking noise. The child is sleeping in the mother's arms and
appears to have stridor. The child's mother also reports an axillary temperature of 101°F last night.
Which management technique is appropriate for this child's symptoms? - (correct Answer) - Oral steroids
and breathing treatments
A patient who is elderly presents with recent memory loss, urinary incontinence, and hallucinations. The
patient's family also states she is having daytime sleepiness and impaired judgment. Which lab and
diagnostic tests should be ordered as part of the patient's assessment? - (correct Answer) - Complete
blood count, complete metabolic profile, and urinalysis
An 18-year-old male is involved in a motorcycle crash while not wearing a helmet. He is brought into an
emergency room and is immediately taken for a CT scan. The provider tells the patient's parents he has
bleeding between the dura mater and the skull. What is this patient's condition called? - (correct
Answer) - Epidural hematoma
A 40-year-old female comes to a clinic with abdominal pain and diarrhea. She reports that every time
she eats, her diarrhea gets worse. Her labs and stool studies are normal, and a colonoscopy is
performed. The colonoscopy reveals the patient has skip lesions throughout her colon. What is the
appropriate diagnosis for this patient? - (correct Answer) - Crohn's disease
A 15-year-old male comes into an office with pain in his scrotum. He states his pain started this morning
and has been increasing. He reports feeling very nauseated. Which diagnostic test is appropriate to order
for this patient? - (correct Answer) - Ultrasound
A 45-year-old male is being seen in the clinic for a yearly check-up and lab work. His history includes
hypertension and hyperlipidemia for which he currently takes Norvasc 5 mg daily and Lipitor 20 mg
nightly. Patient has a family history of diabetes, hypertension, heart disease, and hyperlipidemia. After
obtaining lab work, the provider notices the patient's hgbA1c is elevated at 7.5. The patient is already on
a DASH diet and watching the amount of sweets and carbohydrates he eats daily. The patient is not
overweight and participates in moderate physical activity at least 4-5 days a week. He was started on
Metformin three months ago, and his hemoglobin A1c is now 6.9. The nurse expects to see a class of
medication prescribed which is proven to reduce the risk of cardiovascular events.Considering the
treatment guidelines from the American College of Cardiology, which medication should be
recommended for this patient - (correct Answer) - Invokana 100 mg daily
A 78-year-old female presents to the clinic for a checkup and refills on her medications. She is currently
taking lisinopril (Zestril), metformin (Glucophage), and levothyroxine (Synthroid). The patient has a
history of hypertension, type 2 diabetes, hypothyroidism, GERD, and gastric ulcers. The patient is
, concerned about heart disease and wants to start taking a low-dose aspirin. Which aspirin regimen
recommendation should the advanced professional nurse (APN) give to the patient? - (correct Answer) -
Low-dose enteric coated aspirin 81 mg daily
After testing is completed, the patient is diagnosed with Hashimoto's thyroiditis. The patient is currently
in a hypothyroid state.In reviewing the patient's thyroid-stimulating hormone (TSH) level, which result
correlates with her hypothyroid symptoms? - (correct Answer) - 5.31 mIU/L
A 74- year-old male with Cushing syndrome presents to the emergency department (ED) with pain in his
left leg, and is diagnosed with a deep vein thrombosis (DVT).What is this patient's symptoms related to? -
(correct Answer) - Elevated Von Willebrand factor
A 42-year-old asthmatic who has been using beta-adrenergic agonists for several years began to
experience premature atrial contractions (PACs). To treat the PACs, metoprolol (Toprol XL) therapy was
started.What is a likely consequence of this patient taking metoprolol (Toprol XL)? - (correct Answer) -
Metoprolol (Toprol XL) worsened asthma symptoms, but improved the PACs.
Which inhaler prescription would support long-acting treatment for twice-daily use in controlled asthma
management? - (correct Answer) - Fluticasone propionate/salmeterol (Advair Diskus)
A 65-year-old male presents for a visit regarding his type 2 diabetes. He has been dealing with diabetes
for the last 15 years. He has a history of diabetic neuropathy in his feet. Six months ago his symptoms
were mild to almost nonexistent. He currently describes the neuropathy as painful, and it wakes him up
at night.Which medication would be the first line treatment for this patient? - (correct Answer) -
Pregabalin (Lyrica)
A 55-year-old male presents for a new diagnosis of Parkinson's Disease. He has experienced gait
disorders and a pill rolling tremor. The patient was a former boxer with a history of multiple concussions.
He was started on carbidopa-levodopa (Sinemet), which has decreased his symptoms.How would an
antipsychotic medication such as haloperidol (Haldol) cause an interaction with this patient? - (correct
Answer) - By antagonizing dopamine
A 25-year-old female is 35 weeks pregnant and presents for lower back pain. She has a history of
moderate lower back pain that she normally controls with stretching, yoga, and ice. The patient reports
not being able to engage in stretching and yoga because of the state of her pregnancy. Ice use has been
ineffective. After a benign exam and a negative urinalysis, the provider is convinced that the pain is
musculoskeletal. The patient inquires if there are any medications she can take for the pain.Which
medication does the provider tell the patient she can safely take? - (correct Answer) - Acetaminophen
(Tylenol)
A nurse is administering medication to a 67-year-old patient in liver failure, secondary to end-stage
cirrhosis. Liver dysfunction can influence drug pharmacokinetics and pharmacodynamics. Which
pharmacokinetic phase is affected in this patient? - (correct Answer) - Metabolism
A 40-year-old Trinidadian male comes into a clinic complaining of burning chest pain, indigestion,
nausea, and belching after eating certain foods. He is a single father living and working in New York City.
He recently obtained his green card after living in the United States for more than 10 years. He has a GED
and works as an IT help desk technician earning $42,000 a year. He has health insurance through the
New York health marketplace because it is cheaper than his employer's plan. Because of the high cost of
