NUR 521 Exam 4
Practice Questions and Answers
(2026 Updated)
THIS DOCUMENT CONTAINS:
o WELL VERIFIED Qs & ANSWERS
o LATEST 2026/2027 UPDATES
o 100% VERIFIED RATIONALES
o INSTANT PDF DOWNLOAD
o 100% PASS GUARANTEED
,Below is the complete 150-question exam for NUR 521 Exam 4 (Advanced
Pathophysiology / Advanced Pharmacology – Graduate level) based on a
typical University of Alabama blueprint.
All 150 questions are numbered consecutively, each with correct answer and
rationale. Topics covered: Endocrine, Hematologic, GI/Hepatobiliary, Renal,
Musculoskeletal/Autoimmune, and Advanced Pharmacology.
Endocrine Disorders (Questions 1–35)
1. A patient with type 1 diabetes presents with nausea, vomiting, abdominal pain,
and Kussmaul respirations. Blood glucose is 450 mg/dL. Which lab finding is most
consistent with this presentation?
A. Serum bicarbonate 22 mEq/L
B. Serum ketones positive
C. pH 7.45
D. Anion gap 8
Answer: B – Positive serum ketones.
Rationale: Diabetic ketoacidosis (DKA) presents with hyperglycemia, ketosis,
metabolic acidosis (low bicarb, low pH, elevated anion gap). Kussmaul
respirations are compensatory.
2. A patient with type 2 diabetes on metformin is scheduled for cardiac
catheterization with IV contrast. What should be done with metformin?
A. Continue as usual
B. Double the dose pre-procedure
C. Hold for 48 hours before and after procedure
D. Switch to insulin permanently
Answer: C – Hold metformin 48 hours before and after procedure.
Rationale: Metformin can increase risk of contrast-induced nephropathy and
lactic acidosis. Renal function should be reassessed before restarting.
,3. Which of the following is the most common cause of hyperthyroidism?
A. Hashimoto’s thyroiditis
B. Graves’ disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
Answer: B – Graves’ disease.
Rationale: Graves’ disease is an autoimmune disorder with TSH receptor
antibodies causing diffuse goiter and hyperthyroidism.
4. A patient with Graves’ disease develops fever, tachycardia, delirium, and
vomiting. What is the priority intervention?
A. Radioactive iodine ablation
B. IV propylthiouracil (PTU), beta-blocker, and corticosteroids
C. Levothyroxine loading dose
D. Thyroidectomy
Answer: B – IV PTU, beta-blocker, corticosteroids.
Rationale: This is thyroid storm. Treatment includes antithyroid drugs, beta-
blockade, steroids, and supportive care.
5. Which lab finding is expected in primary adrenal insufficiency (Addison’s
disease)?
A. Low ACTH, high cortisol
B. High ACTH, low cortisol
C. High ACTH, high cortisol
D. Low ACTH, low cortisol
Answer: B – High ACTH, low cortisol.
Rationale: Primary adrenal insufficiency: adrenal gland fails → low cortisol → loss
of negative feedback → high ACTH.
, 6. A patient with Cushing syndrome would most likely exhibit:
A. Hyperpigmentation
B. Hypotension
C. Truncal obesity, purple striae, hyperglycemia
D. Hyponatremia
Answer: C – Truncal obesity, purple striae, hyperglycemia.
Rationale: Glucocorticoid excess causes central obesity, easy bruising, striae,
insulin resistance.
7. Which medication is first-line for acute adrenal crisis?
A. Oral hydrocortisone
B. IV hydrocortisone
C. IV insulin
D. Oral fludrocortisone
Answer: B – IV hydrocortisone.
Rationale: Adrenal crisis requires immediate IV glucocorticoid replacement with
volume resuscitation.
8. A patient with SIADH presents with hyponatremia (Na 118). Which finding is
expected?
A. High serum osmolality
B. Low urine sodium
C. High urine osmolality (>100 mOsm/kg)
D. Hypervolemia with edema
Answer: C – High urine osmolality (>100 mOsm/kg).
Rationale: SIADH causes inappropriately concentrated urine despite low serum
osmolality.
Practice Questions and Answers
(2026 Updated)
THIS DOCUMENT CONTAINS:
o WELL VERIFIED Qs & ANSWERS
o LATEST 2026/2027 UPDATES
o 100% VERIFIED RATIONALES
o INSTANT PDF DOWNLOAD
o 100% PASS GUARANTEED
,Below is the complete 150-question exam for NUR 521 Exam 4 (Advanced
Pathophysiology / Advanced Pharmacology – Graduate level) based on a
typical University of Alabama blueprint.
All 150 questions are numbered consecutively, each with correct answer and
rationale. Topics covered: Endocrine, Hematologic, GI/Hepatobiliary, Renal,
Musculoskeletal/Autoimmune, and Advanced Pharmacology.
Endocrine Disorders (Questions 1–35)
1. A patient with type 1 diabetes presents with nausea, vomiting, abdominal pain,
and Kussmaul respirations. Blood glucose is 450 mg/dL. Which lab finding is most
consistent with this presentation?
A. Serum bicarbonate 22 mEq/L
B. Serum ketones positive
C. pH 7.45
D. Anion gap 8
Answer: B – Positive serum ketones.
Rationale: Diabetic ketoacidosis (DKA) presents with hyperglycemia, ketosis,
metabolic acidosis (low bicarb, low pH, elevated anion gap). Kussmaul
respirations are compensatory.
2. A patient with type 2 diabetes on metformin is scheduled for cardiac
catheterization with IV contrast. What should be done with metformin?
A. Continue as usual
B. Double the dose pre-procedure
C. Hold for 48 hours before and after procedure
D. Switch to insulin permanently
Answer: C – Hold metformin 48 hours before and after procedure.
Rationale: Metformin can increase risk of contrast-induced nephropathy and
lactic acidosis. Renal function should be reassessed before restarting.
,3. Which of the following is the most common cause of hyperthyroidism?
A. Hashimoto’s thyroiditis
B. Graves’ disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
Answer: B – Graves’ disease.
Rationale: Graves’ disease is an autoimmune disorder with TSH receptor
antibodies causing diffuse goiter and hyperthyroidism.
4. A patient with Graves’ disease develops fever, tachycardia, delirium, and
vomiting. What is the priority intervention?
A. Radioactive iodine ablation
B. IV propylthiouracil (PTU), beta-blocker, and corticosteroids
C. Levothyroxine loading dose
D. Thyroidectomy
Answer: B – IV PTU, beta-blocker, corticosteroids.
Rationale: This is thyroid storm. Treatment includes antithyroid drugs, beta-
blockade, steroids, and supportive care.
5. Which lab finding is expected in primary adrenal insufficiency (Addison’s
disease)?
A. Low ACTH, high cortisol
B. High ACTH, low cortisol
C. High ACTH, high cortisol
D. Low ACTH, low cortisol
Answer: B – High ACTH, low cortisol.
Rationale: Primary adrenal insufficiency: adrenal gland fails → low cortisol → loss
of negative feedback → high ACTH.
, 6. A patient with Cushing syndrome would most likely exhibit:
A. Hyperpigmentation
B. Hypotension
C. Truncal obesity, purple striae, hyperglycemia
D. Hyponatremia
Answer: C – Truncal obesity, purple striae, hyperglycemia.
Rationale: Glucocorticoid excess causes central obesity, easy bruising, striae,
insulin resistance.
7. Which medication is first-line for acute adrenal crisis?
A. Oral hydrocortisone
B. IV hydrocortisone
C. IV insulin
D. Oral fludrocortisone
Answer: B – IV hydrocortisone.
Rationale: Adrenal crisis requires immediate IV glucocorticoid replacement with
volume resuscitation.
8. A patient with SIADH presents with hyponatremia (Na 118). Which finding is
expected?
A. High serum osmolality
B. Low urine sodium
C. High urine osmolality (>100 mOsm/kg)
D. Hypervolemia with edema
Answer: C – High urine osmolality (>100 mOsm/kg).
Rationale: SIADH causes inappropriately concentrated urine despite low serum
osmolality.
