2026/2027
Wilkes University NSG 530
Advanced Pathophysiology Exam IV
Review Guide 2026/2027 with In-
Depth Concepts, Mock Exams, and
Clinical Application Questions
Question 1:
A patient presents to the clinic with symptoms of the common cold, including nasal
congestion and swollen nasal mucosa. Which group of upper respiratory medications
works by causing local vasoconstriction, thereby shrinking swollen membranes and
improving airflow?
A. Antihistamines
B. Antitussives
C. Decongestants
D. Expectorants
Correct Answer: C. Decongestants
Rationale: Decongestants are medications that stimulate alpha-adrenergic receptors,
causing vasoconstriction in the nasal mucosa. This decreases blood flow to swollen
tissues, reducing edema and improving nasal airflow. Antihistamines primarily block
histamine receptors and are most effective for allergic symptoms rather than
congestion. Antitussives suppress cough reflexes and do not affect nasal swelling.
Expectorants loosen mucus secretions to promote productive coughing but do not
reduce nasal congestion. Understanding the mechanism of decongestants is essential
for safe and effective respiratory care.
Question 2:
A patient calls the clinic reporting a persistent cough lasting 2 weeks and requests a
recommendation for an over-the-counter cough medication. What is the nurse’s best
response?
A. “Take a cough suppressant every 4 hours.”
B. “Increase your fluid intake and rest at home.”
C. “You should come to the clinic to be evaluated because a prolonged cough may
indicate an underlying problem.”
D. “Try an antihistamine because allergies commonly cause cough.”
,2026/2027
Correct Answer: C. “You should come to the clinic to be evaluated because a
prolonged cough may indicate an underlying problem.”
Rationale: A cough persisting longer than 1 to 2 weeks may indicate serious
conditions such as pneumonia, asthma, tuberculosis, chronic bronchitis,
gastroesophageal reflux disease, or even malignancy. The nurse should encourage
evaluation rather than simply recommending symptomatic treatment. While fluids and
cough suppressants may provide temporary relief, they do not address the underlying
cause. Antihistamines may be useful if allergies are suspected, but an unexplained
prolonged cough warrants further assessment. Nurses must prioritize patient safety
and early identification of potentially serious illnesses.
Question 3:
The nurse is caring for a patient receiving acetylcysteine (Mucomyst) via face mask
for thick respiratory secretions. Which nursing diagnosis is most appropriate?
A. Impaired gas exchange
B. Risk for impaired skin integrity
C. Activity intolerance
D. Deficient fluid volume
Correct Answer: B. Risk for impaired skin integrity
Rationale: Acetylcysteine is a mucolytic agent that can irritate the skin because of its
chemical composition and sticky residue. When administered by face mask, the
medication may contact facial skin and increase the risk of irritation or breakdown.
Therefore, the nurse should monitor skin condition and cleanse the face after
treatments. Although impaired gas exchange may exist in respiratory illnesses, the
specific concern related to acetylcysteine administration is skin irritation. Activity
intolerance and deficient fluid volume are not directly associated with this medication.
Question 4:
A 15-year-old patient with cystic fibrosis has been prescribed dornase alfa
(Pulmozyme). Which instruction should the nurse include regarding the medication?
A. Store the medication at room temperature.
B. Shake the medication vigorously before use.
C. Store the medication in the refrigerator and protect it from light.
D. Use the medication only during acute respiratory distress.
Correct Answer: C. Store the medication in the refrigerator and protect it from
light.
Rationale: Dornase alfa is a recombinant enzyme used to decrease the viscosity of
pulmonary secretions in patients with cystic fibrosis. Proper storage is essential to
,2026/2027
maintain drug stability and effectiveness. The medication must be refrigerated and
protected from light exposure. It should not be vigorously shaken because this may
damage the protein structure of the medication. Dornase alfa is intended for routine
maintenance therapy rather than only during acute episodes. Nurses play an important
role in ensuring patients understand medication handling requirements.
Question 5:
Why is it important for parents treating children with over-the-counter (OTC) cold
and flu medications to carefully read medication labels?
A. Most OTC medications are ineffective in children.
B. Children metabolize medications differently than adults.
C. Many OTC preparations contain the same active ingredients, increasing the risk of
accidental overdose.
D. Cold medications are always contraindicated in children younger than 12 years.
Correct Answer: C. Many OTC preparations contain the same active ingredients,
increasing the risk of accidental overdose.
Rationale: Many OTC cold and flu medications contain multiple active ingredients,
including acetaminophen, antihistamines, and decongestants. Parents may
unknowingly administer two products containing the same medication, increasing the
risk of overdose and toxicity. Acetaminophen overdose, for example, can lead to
severe liver damage. While children do metabolize medications differently, the major
concern addressed in this question is duplication of ingredients. Nurses should
educate caregivers about reading labels carefully and avoiding unnecessary
combination products.
Question 6:
A patient diagnosed with bronchitis has a dry, nonproductive cough. The healthcare
provider wants to thin respiratory secretions and promote productive coughing. Which
medication does the nurse expect to be prescribed?
A. Codeine
B. Loratadine
C. Guaifenesin
D. Diphenhydramine
Correct Answer: C. Guaifenesin
Rationale: Guaifenesin is an expectorant that works by thinning respiratory secretions,
making mucus easier to cough up. This helps convert a dry, nonproductive cough into
a productive cough, promoting airway clearance. Codeine is an antitussive that
suppresses coughing and would not be appropriate when secretions need to be
expelled. Loratadine and diphenhydramine are antihistamines used mainly for allergic
, 2026/2027
symptoms. Nurses should understand the distinction between suppressing coughs and
promoting secretion removal.
Question 7:
A patient prescribed a nasal corticosteroid for allergic rhinitis calls the clinic after 2
days, stating the medication is not working and requesting a different drug. What is
the nurse’s best response?
A. “Stop taking the medication immediately.”
B. “Nasal steroids usually work within 24 hours.”
C. “It may take up to 2 weeks to achieve the full therapeutic effect.”
D. “Double the dose until symptoms improve.”
Correct Answer: C. “It may take up to 2 weeks to achieve the full therapeutic
effect.”
Rationale: Nasal corticosteroids reduce inflammation gradually and may require
several days to 2 weeks before full therapeutic benefits are achieved. Patients often
become discouraged because relief is not immediate. Nurses should emphasize
adherence to the prescribed regimen. Doubling doses may increase adverse effects
without improving symptom relief. Abrupt discontinuation may prevent the
medication from becoming effective. Educating patients about expected onset of
action promotes compliance and treatment success.
Question 8:
A patient with seasonal allergic rhinitis needs immediate symptom relief before an
important presentation and wants to avoid drowsiness. Which antihistamine would be
most appropriate?
A. Diphenhydramine
B. Hydroxyzine
C. Loratadine
D. Promethazine
Correct Answer: C. Loratadine
Rationale: Loratadine is a second-generation antihistamine that effectively relieves
allergic symptoms while causing minimal sedation. This makes it ideal for patients
who must remain alert and functional. Diphenhydramine, hydroxyzine, and
promethazine are first-generation antihistamines that commonly cause drowsiness
because they cross the blood-brain barrier. Nurses should help patients select
medications that fit both therapeutic needs and lifestyle requirements.
Wilkes University NSG 530
Advanced Pathophysiology Exam IV
Review Guide 2026/2027 with In-
Depth Concepts, Mock Exams, and
Clinical Application Questions
Question 1:
A patient presents to the clinic with symptoms of the common cold, including nasal
congestion and swollen nasal mucosa. Which group of upper respiratory medications
works by causing local vasoconstriction, thereby shrinking swollen membranes and
improving airflow?
A. Antihistamines
B. Antitussives
C. Decongestants
D. Expectorants
Correct Answer: C. Decongestants
Rationale: Decongestants are medications that stimulate alpha-adrenergic receptors,
causing vasoconstriction in the nasal mucosa. This decreases blood flow to swollen
tissues, reducing edema and improving nasal airflow. Antihistamines primarily block
histamine receptors and are most effective for allergic symptoms rather than
congestion. Antitussives suppress cough reflexes and do not affect nasal swelling.
Expectorants loosen mucus secretions to promote productive coughing but do not
reduce nasal congestion. Understanding the mechanism of decongestants is essential
for safe and effective respiratory care.
Question 2:
A patient calls the clinic reporting a persistent cough lasting 2 weeks and requests a
recommendation for an over-the-counter cough medication. What is the nurse’s best
response?
A. “Take a cough suppressant every 4 hours.”
B. “Increase your fluid intake and rest at home.”
C. “You should come to the clinic to be evaluated because a prolonged cough may
indicate an underlying problem.”
D. “Try an antihistamine because allergies commonly cause cough.”
,2026/2027
Correct Answer: C. “You should come to the clinic to be evaluated because a
prolonged cough may indicate an underlying problem.”
Rationale: A cough persisting longer than 1 to 2 weeks may indicate serious
conditions such as pneumonia, asthma, tuberculosis, chronic bronchitis,
gastroesophageal reflux disease, or even malignancy. The nurse should encourage
evaluation rather than simply recommending symptomatic treatment. While fluids and
cough suppressants may provide temporary relief, they do not address the underlying
cause. Antihistamines may be useful if allergies are suspected, but an unexplained
prolonged cough warrants further assessment. Nurses must prioritize patient safety
and early identification of potentially serious illnesses.
Question 3:
The nurse is caring for a patient receiving acetylcysteine (Mucomyst) via face mask
for thick respiratory secretions. Which nursing diagnosis is most appropriate?
A. Impaired gas exchange
B. Risk for impaired skin integrity
C. Activity intolerance
D. Deficient fluid volume
Correct Answer: B. Risk for impaired skin integrity
Rationale: Acetylcysteine is a mucolytic agent that can irritate the skin because of its
chemical composition and sticky residue. When administered by face mask, the
medication may contact facial skin and increase the risk of irritation or breakdown.
Therefore, the nurse should monitor skin condition and cleanse the face after
treatments. Although impaired gas exchange may exist in respiratory illnesses, the
specific concern related to acetylcysteine administration is skin irritation. Activity
intolerance and deficient fluid volume are not directly associated with this medication.
Question 4:
A 15-year-old patient with cystic fibrosis has been prescribed dornase alfa
(Pulmozyme). Which instruction should the nurse include regarding the medication?
A. Store the medication at room temperature.
B. Shake the medication vigorously before use.
C. Store the medication in the refrigerator and protect it from light.
D. Use the medication only during acute respiratory distress.
Correct Answer: C. Store the medication in the refrigerator and protect it from
light.
Rationale: Dornase alfa is a recombinant enzyme used to decrease the viscosity of
pulmonary secretions in patients with cystic fibrosis. Proper storage is essential to
,2026/2027
maintain drug stability and effectiveness. The medication must be refrigerated and
protected from light exposure. It should not be vigorously shaken because this may
damage the protein structure of the medication. Dornase alfa is intended for routine
maintenance therapy rather than only during acute episodes. Nurses play an important
role in ensuring patients understand medication handling requirements.
Question 5:
Why is it important for parents treating children with over-the-counter (OTC) cold
and flu medications to carefully read medication labels?
A. Most OTC medications are ineffective in children.
B. Children metabolize medications differently than adults.
C. Many OTC preparations contain the same active ingredients, increasing the risk of
accidental overdose.
D. Cold medications are always contraindicated in children younger than 12 years.
Correct Answer: C. Many OTC preparations contain the same active ingredients,
increasing the risk of accidental overdose.
Rationale: Many OTC cold and flu medications contain multiple active ingredients,
including acetaminophen, antihistamines, and decongestants. Parents may
unknowingly administer two products containing the same medication, increasing the
risk of overdose and toxicity. Acetaminophen overdose, for example, can lead to
severe liver damage. While children do metabolize medications differently, the major
concern addressed in this question is duplication of ingredients. Nurses should
educate caregivers about reading labels carefully and avoiding unnecessary
combination products.
Question 6:
A patient diagnosed with bronchitis has a dry, nonproductive cough. The healthcare
provider wants to thin respiratory secretions and promote productive coughing. Which
medication does the nurse expect to be prescribed?
A. Codeine
B. Loratadine
C. Guaifenesin
D. Diphenhydramine
Correct Answer: C. Guaifenesin
Rationale: Guaifenesin is an expectorant that works by thinning respiratory secretions,
making mucus easier to cough up. This helps convert a dry, nonproductive cough into
a productive cough, promoting airway clearance. Codeine is an antitussive that
suppresses coughing and would not be appropriate when secretions need to be
expelled. Loratadine and diphenhydramine are antihistamines used mainly for allergic
, 2026/2027
symptoms. Nurses should understand the distinction between suppressing coughs and
promoting secretion removal.
Question 7:
A patient prescribed a nasal corticosteroid for allergic rhinitis calls the clinic after 2
days, stating the medication is not working and requesting a different drug. What is
the nurse’s best response?
A. “Stop taking the medication immediately.”
B. “Nasal steroids usually work within 24 hours.”
C. “It may take up to 2 weeks to achieve the full therapeutic effect.”
D. “Double the dose until symptoms improve.”
Correct Answer: C. “It may take up to 2 weeks to achieve the full therapeutic
effect.”
Rationale: Nasal corticosteroids reduce inflammation gradually and may require
several days to 2 weeks before full therapeutic benefits are achieved. Patients often
become discouraged because relief is not immediate. Nurses should emphasize
adherence to the prescribed regimen. Doubling doses may increase adverse effects
without improving symptom relief. Abrupt discontinuation may prevent the
medication from becoming effective. Educating patients about expected onset of
action promotes compliance and treatment success.
Question 8:
A patient with seasonal allergic rhinitis needs immediate symptom relief before an
important presentation and wants to avoid drowsiness. Which antihistamine would be
most appropriate?
A. Diphenhydramine
B. Hydroxyzine
C. Loratadine
D. Promethazine
Correct Answer: C. Loratadine
Rationale: Loratadine is a second-generation antihistamine that effectively relieves
allergic symptoms while causing minimal sedation. This makes it ideal for patients
who must remain alert and functional. Diphenhydramine, hydroxyzine, and
promethazine are first-generation antihistamines that commonly cause drowsiness
because they cross the blood-brain barrier. Nurses should help patients select
medications that fit both therapeutic needs and lifestyle requirements.
