NURS 335 Exam 4 (2026/2027) | NEWEST QUESTIONS AND CORRECT ANSWERS |
GRADED A+
Nursing Pathophysiology/Pharmacology Comprehensive Examination | Core Domains: Advanced
Cardiovascular Pathophysiology & Pharmacology, Complex Respiratory Disorders & Management,
Neurological Conditions & Pharmacotherapeutics, Endocrine Disorders & Hormonal Therapies, Renal &
Electrolyte Imbalances, Multisystem Disorders, and Integrative Case Management | Nursing Program
Assessment Focus | Advanced Clinical Exam Format
Exam Structure
The NURS 335 Exam 4 for the 2026/2027 academic cycle is an 80-question, multiple-choice examination.
Introduction
This NURS 335 Exam 4 guide for the 2026/2027 academic year focuses on the integration of advanced
pathophysiology with pharmacological management. The content emphasizes clinical decision-making,
prioritizing nursing interventions, and applying evidence-based pharmacotherapeutics to complex patient
scenarios across major body systems.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green, followed
by detailed rationales that connect disease pathophysiology to drug mechanisms of action, therapeutic
outcomes, side effect monitoring, and patient education priorities.
1.
A client with heart failure (HF) is prescribed furosemide 40 mg IV twice daily and enalapril
10 mg orally daily. Which laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
B. Serum potassium
Rationale (Cardiovascular Pharmacology): Furosemide is a loop diuretic that causes potassium wasting,
leading to hypokalemia. Enalapril, an ACE inhibitor, can cause hyperkalemia by reducing aldosterone.
However, the diuretic effect typically dominates, making hypokalemia the primary concern. The nurse
must monitor potassium closely and watch for arrhythmias, muscle weakness, and ECG changes (e.g., U
waves). Patient education includes potassium-rich foods (if not contraindicated) and signs of imbalance.
2.
A client with chronic obstructive pulmonary disease (COPD) has a new prescription for
tiotropium. What is the primary mechanism of action of this medication?
,A. Beta-2 adrenergic agonist
B. Leukotriene receptor antagonist
C. Long-acting muscarinic antagonist (LAMA)
D. Phosphodiesterase-4 inhibitor
C. Long-acting muscarinic antagonist (LAMA)
Rationale (Respiratory Pharmacology): Tiotropium blocks muscarinic receptors in the airways, reducing
bronchoconstriction and mucus secretion. As a LAMA, it provides sustained bronchodilation for 24 hours
and is a cornerstone of maintenance therapy in COPD. Unlike beta-agonists, it does not cause tachycardia.
Nursing priorities include teaching proper inhaler technique (HandiHaler) and monitoring for dry mouth
or urinary retention.
3.
A client with Parkinson’s disease is prescribed carbidopa-levodopa. Which statement by
the client indicates understanding of the teaching?
A. “I will take this medication with a high-protein meal to avoid nausea.”
B. “I can stop taking it if my tremors improve.”
C. “I should report any new hallucinations or confusion.”
D. “This medication cures Parkinson’s disease.”
C. “I should report any new hallucinations or confusion.”
Rationale (Neurological Pharmacology): Levodopa can cause neuropsychiatric side effects, including
hallucinations, psychosis, and confusion, especially in older adults. Carbidopa reduces peripheral side
effects (e.g., nausea) but not central effects. The medication manages symptoms but does not cure the
disease. High-protein meals interfere with absorption; doses should be taken 30–60 min before or 1 hr
after meals. Abrupt discontinuation can cause neuroleptic malignant-like syndrome.
4.
A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Which
intervention is the highest priority?
A. Administer subcutaneous insulin glargine
B. Begin intravenous insulin infusion after initial fluid resuscitation
C. Provide oral carbohydrates to prevent hypoglycemia
,D. Encourage ambulation to improve circulation
B. Begin intravenous insulin infusion after initial fluid resuscitation
Rationale (Endocrine Pathophysiology): DKA is caused by insulin deficiency, leading to hyperglycemia,
ketogenesis, and metabolic acidosis. Initial treatment focuses on fluid resuscitation (0.9% NaCl) to restore
perfusion and correct hypovolemia, followed by a continuous IV insulin infusion to suppress ketogenesis
and lower glucose. Subcutaneous insulin is ineffective in DKA due to poor perfusion. Oral intake is
contraindicated in acute DKA due to ileus risk.
5.
A client with acute kidney injury (AKI) has a serum potassium of 6.2 mEq/L. What is the
priority nursing action?
A. Administer oral potassium-binding resin
B. Place the client on continuous ECG monitoring
C. Increase IV fluids with potassium chloride
D. Encourage potassium-rich foods
B. Place the client on continuous ECG monitoring
Rationale (Renal/Electrolyte Emergency): Hyperkalemia (K+ > 5.5 mEq/L) is life-threatening due to risk
of cardiac arrhythmias. ECG changes include peaked T waves, PR prolongation, QRS widening, and sine
wave pattern. Continuous monitoring allows immediate detection of dysrhythmias. While Kayexalate
(potassium-binding resin) may be ordered, ECG monitoring is the immediate priority. IV potassium and
high-potassium foods are contraindicated.
6.
A client with atrial fibrillation is prescribed warfarin. Which laboratory value is most
important to monitor?
A. Hemoglobin
B. Platelet count
C. International Normalized Ratio (INR)
D. Activated partial thromboplastin time (aPTT)
C. International Normalized Ratio (INR)
Rationale (Cardiovascular Pharmacology): Warfarin, a vitamin K antagonist, is monitored using the
INR. The therapeutic range for atrial fibrillation is typically 2.0–3.0. INR > 4.0 increases bleeding risk; <
, 2.0 increases clot risk. aPTT is used for heparin monitoring. The nurse must educate the client on
consistent vitamin K intake, signs of bleeding, and the need for regular INR checks.
7.
A client with myasthenia gravis is diagnosed with a cholinergic crisis. Which medication
should the nurse anticipate administering?
A. Neostigmine
B. Atropine
C. Pyridostigmine
D. Edrophonium
B. Atropine
Rationale (Neurological Pharmacology): Cholinergic crisis results from excessive acetylcholine due to
overdose of acetylcholinesterase inhibitors (e.g., pyridostigmine). Symptoms mimic myasthenic crisis
(weakness) but include SLUDGE (salivation, lacrimation, urination, etc.). Atropine, an anticholinergic,
blocks muscarinic effects and is given to counteract bradycardia and secretions. Edrophonium (Tensilon
test) is contraindicated as it worsens the crisis.
8.
A client with heart failure has a serum digoxin level of 2.5 ng/mL (therapeutic range:
0.5–2.0 ng/mL). Which finding should the nurse report immediately?
A. Heart rate of 78 bpm
B. Visual disturbances (e.g., yellow-green halos)
C. Blood pressure of 120/80 mmHg
D. Mild nausea
B. Visual disturbances (e.g., yellow-green halos)
Rationale (Cardiovascular Pharmacology): Digoxin toxicity presents with cardiac (bradycardia, heart
block), GI (nausea), and neurological (visual disturbances) symptoms. Visual changes are hallmark signs
of toxicity and require immediate action (hold dose, notify provider, check potassium). Hypokalemia
exacerbates toxicity. The nurse must monitor apical pulse before administration and hold if <60 bpm.
9.
A client with asthma is prescribed albuterol via metered-dose inhaler (MDI). What
instruction should the nurse provide?
A. “Use a spacer to improve drug delivery to the lungs.”
GRADED A+
Nursing Pathophysiology/Pharmacology Comprehensive Examination | Core Domains: Advanced
Cardiovascular Pathophysiology & Pharmacology, Complex Respiratory Disorders & Management,
Neurological Conditions & Pharmacotherapeutics, Endocrine Disorders & Hormonal Therapies, Renal &
Electrolyte Imbalances, Multisystem Disorders, and Integrative Case Management | Nursing Program
Assessment Focus | Advanced Clinical Exam Format
Exam Structure
The NURS 335 Exam 4 for the 2026/2027 academic cycle is an 80-question, multiple-choice examination.
Introduction
This NURS 335 Exam 4 guide for the 2026/2027 academic year focuses on the integration of advanced
pathophysiology with pharmacological management. The content emphasizes clinical decision-making,
prioritizing nursing interventions, and applying evidence-based pharmacotherapeutics to complex patient
scenarios across major body systems.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green, followed
by detailed rationales that connect disease pathophysiology to drug mechanisms of action, therapeutic
outcomes, side effect monitoring, and patient education priorities.
1.
A client with heart failure (HF) is prescribed furosemide 40 mg IV twice daily and enalapril
10 mg orally daily. Which laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
B. Serum potassium
Rationale (Cardiovascular Pharmacology): Furosemide is a loop diuretic that causes potassium wasting,
leading to hypokalemia. Enalapril, an ACE inhibitor, can cause hyperkalemia by reducing aldosterone.
However, the diuretic effect typically dominates, making hypokalemia the primary concern. The nurse
must monitor potassium closely and watch for arrhythmias, muscle weakness, and ECG changes (e.g., U
waves). Patient education includes potassium-rich foods (if not contraindicated) and signs of imbalance.
2.
A client with chronic obstructive pulmonary disease (COPD) has a new prescription for
tiotropium. What is the primary mechanism of action of this medication?
,A. Beta-2 adrenergic agonist
B. Leukotriene receptor antagonist
C. Long-acting muscarinic antagonist (LAMA)
D. Phosphodiesterase-4 inhibitor
C. Long-acting muscarinic antagonist (LAMA)
Rationale (Respiratory Pharmacology): Tiotropium blocks muscarinic receptors in the airways, reducing
bronchoconstriction and mucus secretion. As a LAMA, it provides sustained bronchodilation for 24 hours
and is a cornerstone of maintenance therapy in COPD. Unlike beta-agonists, it does not cause tachycardia.
Nursing priorities include teaching proper inhaler technique (HandiHaler) and monitoring for dry mouth
or urinary retention.
3.
A client with Parkinson’s disease is prescribed carbidopa-levodopa. Which statement by
the client indicates understanding of the teaching?
A. “I will take this medication with a high-protein meal to avoid nausea.”
B. “I can stop taking it if my tremors improve.”
C. “I should report any new hallucinations or confusion.”
D. “This medication cures Parkinson’s disease.”
C. “I should report any new hallucinations or confusion.”
Rationale (Neurological Pharmacology): Levodopa can cause neuropsychiatric side effects, including
hallucinations, psychosis, and confusion, especially in older adults. Carbidopa reduces peripheral side
effects (e.g., nausea) but not central effects. The medication manages symptoms but does not cure the
disease. High-protein meals interfere with absorption; doses should be taken 30–60 min before or 1 hr
after meals. Abrupt discontinuation can cause neuroleptic malignant-like syndrome.
4.
A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Which
intervention is the highest priority?
A. Administer subcutaneous insulin glargine
B. Begin intravenous insulin infusion after initial fluid resuscitation
C. Provide oral carbohydrates to prevent hypoglycemia
,D. Encourage ambulation to improve circulation
B. Begin intravenous insulin infusion after initial fluid resuscitation
Rationale (Endocrine Pathophysiology): DKA is caused by insulin deficiency, leading to hyperglycemia,
ketogenesis, and metabolic acidosis. Initial treatment focuses on fluid resuscitation (0.9% NaCl) to restore
perfusion and correct hypovolemia, followed by a continuous IV insulin infusion to suppress ketogenesis
and lower glucose. Subcutaneous insulin is ineffective in DKA due to poor perfusion. Oral intake is
contraindicated in acute DKA due to ileus risk.
5.
A client with acute kidney injury (AKI) has a serum potassium of 6.2 mEq/L. What is the
priority nursing action?
A. Administer oral potassium-binding resin
B. Place the client on continuous ECG monitoring
C. Increase IV fluids with potassium chloride
D. Encourage potassium-rich foods
B. Place the client on continuous ECG monitoring
Rationale (Renal/Electrolyte Emergency): Hyperkalemia (K+ > 5.5 mEq/L) is life-threatening due to risk
of cardiac arrhythmias. ECG changes include peaked T waves, PR prolongation, QRS widening, and sine
wave pattern. Continuous monitoring allows immediate detection of dysrhythmias. While Kayexalate
(potassium-binding resin) may be ordered, ECG monitoring is the immediate priority. IV potassium and
high-potassium foods are contraindicated.
6.
A client with atrial fibrillation is prescribed warfarin. Which laboratory value is most
important to monitor?
A. Hemoglobin
B. Platelet count
C. International Normalized Ratio (INR)
D. Activated partial thromboplastin time (aPTT)
C. International Normalized Ratio (INR)
Rationale (Cardiovascular Pharmacology): Warfarin, a vitamin K antagonist, is monitored using the
INR. The therapeutic range for atrial fibrillation is typically 2.0–3.0. INR > 4.0 increases bleeding risk; <
, 2.0 increases clot risk. aPTT is used for heparin monitoring. The nurse must educate the client on
consistent vitamin K intake, signs of bleeding, and the need for regular INR checks.
7.
A client with myasthenia gravis is diagnosed with a cholinergic crisis. Which medication
should the nurse anticipate administering?
A. Neostigmine
B. Atropine
C. Pyridostigmine
D. Edrophonium
B. Atropine
Rationale (Neurological Pharmacology): Cholinergic crisis results from excessive acetylcholine due to
overdose of acetylcholinesterase inhibitors (e.g., pyridostigmine). Symptoms mimic myasthenic crisis
(weakness) but include SLUDGE (salivation, lacrimation, urination, etc.). Atropine, an anticholinergic,
blocks muscarinic effects and is given to counteract bradycardia and secretions. Edrophonium (Tensilon
test) is contraindicated as it worsens the crisis.
8.
A client with heart failure has a serum digoxin level of 2.5 ng/mL (therapeutic range:
0.5–2.0 ng/mL). Which finding should the nurse report immediately?
A. Heart rate of 78 bpm
B. Visual disturbances (e.g., yellow-green halos)
C. Blood pressure of 120/80 mmHg
D. Mild nausea
B. Visual disturbances (e.g., yellow-green halos)
Rationale (Cardiovascular Pharmacology): Digoxin toxicity presents with cardiac (bradycardia, heart
block), GI (nausea), and neurological (visual disturbances) symptoms. Visual changes are hallmark signs
of toxicity and require immediate action (hold dose, notify provider, check potassium). Hypokalemia
exacerbates toxicity. The nurse must monitor apical pulse before administration and hold if <60 bpm.
9.
A client with asthma is prescribed albuterol via metered-dose inhaler (MDI). What
instruction should the nurse provide?
A. “Use a spacer to improve drug delivery to the lungs.”
