NSG 520 Nursing pathophysiology and pharmacology
Assessment 2 Solved 100%
Q1
A patient with chronic kidney disease develops metabolic acidosis. Which
compensatory mechanism is most likely to occur?
A. Increased renal bicarbonate reabsorption
B. Increased respiratory rate
C. Decreased hydrogen ion secretion
D. Decreased respiratory rate
Rationale: In metabolic acidosis, the body compensates by increasing ventilation to
blow off CO₂, reducing hydrogen ion concentration. Renal compensation is impaired in
CKD, so respiratory compensation predominates.
Q2
Which of the following best explains why beta-blockers are contraindicated in patients
with severe asthma?
A. They increase bronchial secretions
B. They block beta-2 receptors causing bronchoconstriction
C. They stimulate alpha-1 receptors leading to vasoconstriction
D. They reduce cardiac output excessively
Rationale: Non-selective beta-blockers inhibit beta-2 receptors in bronchial smooth
muscle, leading to bronchoconstriction and worsening asthma symptoms.
Q3
A patient taking warfarin presents with an INR of 6.0 but no active bleeding. What is the
most appropriate management?
A. Administer vitamin K orally
B. Administer fresh frozen plasma
C. Continue warfarin at the same dose
D. Administer protamine sulfate
Rationale: Elevated INR without bleeding is managed with oral vitamin K to reverse
anticoagulation gradually. Fresh frozen plasma is reserved for active bleeding.
Protamine sulfate reverses heparin, not warfarin.
Q4
Which pathophysiological change occurs in systolic heart failure?
A. Decreased preload
B. Increased contractility
C. Decreased ejection fraction
D. Increased afterload
,Rationale: Systolic heart failure is characterized by impaired ventricular contractility,
leading to reduced ejection fraction (<40%). Preload may increase due to fluid retention,
but contractility is diminished.
Q5
A patient with type 2 diabetes is prescribed metformin. Which adverse effect requires
immediate discontinuation of the drug?
A. Nausea and vomiting
B. Metallic taste
C. Lactic acidosis
D. Diarrhea
Rationale: Metformin can rarely cause lactic acidosis, a life-threatening condition.
Gastrointestinal side effects are common but not dangerous. Lactic acidosis requires
immediate discontinuation.
Q6
Which of the following best describes the mechanism of ACE inhibitors in hypertension?
A. Block calcium channels in vascular smooth muscle
B. Inhibit conversion of angiotensin I to angiotensin II
C. Increase aldosterone secretion
D. Stimulate beta-1 receptors in the heart
Rationale: ACE inhibitors reduce angiotensin II formation, leading to vasodilation and
decreased aldosterone secretion, lowering blood pressure.
Q7
In rheumatoid arthritis, pannus formation leads to joint destruction. What is pannus?
A. Fibrous scar tissue replacing cartilage
B. Granulation tissue with inflammatory cells
C. Synovial fluid accumulation
D. Calcified deposits in the joint
Rationale: Pannus is abnormal granulation tissue that invades cartilage and bone,
causing joint destruction in rheumatoid arthritis.
Q8
Which antibiotic is contraindicated in pregnancy due to risk of tooth discoloration in the
fetus?
A. Penicillin
B. Tetracycline
C. Cephalosporin
D. Erythromycin
Rationale: Tetracyclines deposit in developing bones and teeth, causing discoloration
, and growth inhibition. Penicillins and cephalosporins are generally safe in pregnancy.
Q9
Which electrolyte imbalance is most commonly associated with loop diuretics?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Rationale: Loop diuretics increase urinary potassium excretion, leading to hypokalemia.
Q10
In myocardial infarction, which biomarker rises first?
A. CK-MB
B. Troponin I
C. Myoglobin
D. LDH
Rationale: Myoglobin rises within 1–2 hours but is nonspecific. Troponin is more specific
and remains elevated longer.
Q11
Which drug is the antidote for opioid overdose?
A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Atropine
Rationale: Naloxone is a competitive opioid receptor antagonist, reversing respiratory
depression.
Q12
Which of the following is a hallmark of Graves’ disease?
A. Bradycardia
B. Exophthalmos
C. Hypothermia
D. Weight gain
Rationale: Graves’ disease is an autoimmune hyperthyroidism with characteristic eye
involvement.
Q13
Which antibiotic class carries a risk of tendon rupture?
A. Macrolides
B. Fluoroquinolones
C. Aminoglycosides
Assessment 2 Solved 100%
Q1
A patient with chronic kidney disease develops metabolic acidosis. Which
compensatory mechanism is most likely to occur?
A. Increased renal bicarbonate reabsorption
B. Increased respiratory rate
C. Decreased hydrogen ion secretion
D. Decreased respiratory rate
Rationale: In metabolic acidosis, the body compensates by increasing ventilation to
blow off CO₂, reducing hydrogen ion concentration. Renal compensation is impaired in
CKD, so respiratory compensation predominates.
Q2
Which of the following best explains why beta-blockers are contraindicated in patients
with severe asthma?
A. They increase bronchial secretions
B. They block beta-2 receptors causing bronchoconstriction
C. They stimulate alpha-1 receptors leading to vasoconstriction
D. They reduce cardiac output excessively
Rationale: Non-selective beta-blockers inhibit beta-2 receptors in bronchial smooth
muscle, leading to bronchoconstriction and worsening asthma symptoms.
Q3
A patient taking warfarin presents with an INR of 6.0 but no active bleeding. What is the
most appropriate management?
A. Administer vitamin K orally
B. Administer fresh frozen plasma
C. Continue warfarin at the same dose
D. Administer protamine sulfate
Rationale: Elevated INR without bleeding is managed with oral vitamin K to reverse
anticoagulation gradually. Fresh frozen plasma is reserved for active bleeding.
Protamine sulfate reverses heparin, not warfarin.
Q4
Which pathophysiological change occurs in systolic heart failure?
A. Decreased preload
B. Increased contractility
C. Decreased ejection fraction
D. Increased afterload
,Rationale: Systolic heart failure is characterized by impaired ventricular contractility,
leading to reduced ejection fraction (<40%). Preload may increase due to fluid retention,
but contractility is diminished.
Q5
A patient with type 2 diabetes is prescribed metformin. Which adverse effect requires
immediate discontinuation of the drug?
A. Nausea and vomiting
B. Metallic taste
C. Lactic acidosis
D. Diarrhea
Rationale: Metformin can rarely cause lactic acidosis, a life-threatening condition.
Gastrointestinal side effects are common but not dangerous. Lactic acidosis requires
immediate discontinuation.
Q6
Which of the following best describes the mechanism of ACE inhibitors in hypertension?
A. Block calcium channels in vascular smooth muscle
B. Inhibit conversion of angiotensin I to angiotensin II
C. Increase aldosterone secretion
D. Stimulate beta-1 receptors in the heart
Rationale: ACE inhibitors reduce angiotensin II formation, leading to vasodilation and
decreased aldosterone secretion, lowering blood pressure.
Q7
In rheumatoid arthritis, pannus formation leads to joint destruction. What is pannus?
A. Fibrous scar tissue replacing cartilage
B. Granulation tissue with inflammatory cells
C. Synovial fluid accumulation
D. Calcified deposits in the joint
Rationale: Pannus is abnormal granulation tissue that invades cartilage and bone,
causing joint destruction in rheumatoid arthritis.
Q8
Which antibiotic is contraindicated in pregnancy due to risk of tooth discoloration in the
fetus?
A. Penicillin
B. Tetracycline
C. Cephalosporin
D. Erythromycin
Rationale: Tetracyclines deposit in developing bones and teeth, causing discoloration
, and growth inhibition. Penicillins and cephalosporins are generally safe in pregnancy.
Q9
Which electrolyte imbalance is most commonly associated with loop diuretics?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Rationale: Loop diuretics increase urinary potassium excretion, leading to hypokalemia.
Q10
In myocardial infarction, which biomarker rises first?
A. CK-MB
B. Troponin I
C. Myoglobin
D. LDH
Rationale: Myoglobin rises within 1–2 hours but is nonspecific. Troponin is more specific
and remains elevated longer.
Q11
Which drug is the antidote for opioid overdose?
A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Atropine
Rationale: Naloxone is a competitive opioid receptor antagonist, reversing respiratory
depression.
Q12
Which of the following is a hallmark of Graves’ disease?
A. Bradycardia
B. Exophthalmos
C. Hypothermia
D. Weight gain
Rationale: Graves’ disease is an autoimmune hyperthyroidism with characteristic eye
involvement.
Q13
Which antibiotic class carries a risk of tendon rupture?
A. Macrolides
B. Fluoroquinolones
C. Aminoglycosides
