**Title:** **Pathophysiology & Pharmacology Fusion: A
Comprehensive NCLEX-RN Med-Surg Review**
---
### Question 1
A nurse is caring for a client who has a new diagnosis of Addison’s disease. Which of the following
findings should the nurse expect?
A) Hyperpigmentation of the skin
B) Truncal obesity and moon facies
C) Hyperglycemia
D) Hypertension
💫RATIONALE✔️✔️: Addison’s disease (primary adrenal insufficiency) causes increased ACTH secretion
due to lack of cortisol feedback. ACTH shares a precursor with melanocyte-stimulating hormone, leading
to hyperpigmentation (A). Truncal obesity, moon facies, hyperglycemia, and hypertension are seen in
Cushing’s syndrome (excess cortisol).
💫ANSWER✔️✔️: A) Hyperpigmentation of the skin
---
### Question 2 of 119
A nurse is providing discharge teaching to a client who had a myocardial infarction (MI) and has a new
prescription for metoprolol (Lopressor). Which of the following statements by the client indicates
understanding?
A) “I will stop taking this medication if my heart rate drops below 50.”
,B) “This medication will help prevent future heart attacks by lowering my blood pressure and heart
rate.”
C) “I can take this medication with my usual dose of ibuprofen for arthritis pain.”
D) “I will take this medication only when I feel chest pain.”
💫RATIONALE✔️✔️: Metoprolol is a beta-blocker that reduces myocardial oxygen demand by lowering
heart rate and blood pressure, reducing the risk of recurrent MI (B). Stopping abruptly can cause
rebound tachycardia. NSAIDs reduce efficacy. It is taken daily, not PRN.
💫ANSWER✔️✔️: B) “This medication will help prevent future heart attacks by lowering my blood
pressure and heart rate.”
---
### Question 3 of 119
**Select-All-That-Apply (SATA):** A nurse is assessing a client who has a new diagnosis of heart failure
with reduced ejection fraction (HFrEF). Which of the following findings are expected? (Select all that
apply.)
A) Dyspnea on exertion
B) Peripheral edema
C) Crackles in the lung bases
D) S3 gallop
E) Bounding pulses
💫RATIONALE✔️✔️: HFrEF presents with dyspnea (A), peripheral edema (B), crackles (C), and S3 gallop
(D). Bounding pulses (E) are not typical; weak, thready pulses may be seen in advanced failure.
💫ANSWER✔️✔️: A, B, C, D
---
, ### Question 4 of 119
A nurse is caring for a client who has a traumatic brain injury (TBI) and is exhibiting signs of increased
intracranial pressure (ICP). Which of the following nursing interventions should the nurse implement?
A) Keep the head of the bed flat.
B) Cluster all nursing care to reduce stimulation.
C) Maintain the client’s neck in a neutral, midline position.
D) Suction the airway every 2 hours.
💫RATIONALE✔️✔️: Maintaining the neck in neutral, midline position (C) promotes venous drainage from
the head, reducing ICP. HOB should be elevated 30 degrees. Clustering care increases ICP (avoid unless
necessary). Suctioning increases ICP and should be done only when needed.
💫ANSWER✔️✔️: C) Maintain the client’s neck in a neutral, midline position.
---
### Question 5 of 119
A nurse is assessing a client who is receiving a continuous heparin infusion for a pulmonary embolism.
The client’s aPTT is 110 seconds, and the control is 30 seconds. Which of the following actions should
the nurse take?
A) Continue the infusion at the same rate.
B) Decrease the infusion rate by 2 mL/hr.
C) Stop the infusion and notify the provider.
D) Administer vitamin K.
💫RATIONALE✔️✔️: Therapeutic aPTT for heparin is 1.5-2.5 times control (45-75 seconds). 110 seconds is
>3.6 times control, indicating a high bleeding risk. The nurse should stop the infusion (C) and notify the
provider. Vitamin K reverses warfarin, not heparin.
Comprehensive NCLEX-RN Med-Surg Review**
---
### Question 1
A nurse is caring for a client who has a new diagnosis of Addison’s disease. Which of the following
findings should the nurse expect?
A) Hyperpigmentation of the skin
B) Truncal obesity and moon facies
C) Hyperglycemia
D) Hypertension
💫RATIONALE✔️✔️: Addison’s disease (primary adrenal insufficiency) causes increased ACTH secretion
due to lack of cortisol feedback. ACTH shares a precursor with melanocyte-stimulating hormone, leading
to hyperpigmentation (A). Truncal obesity, moon facies, hyperglycemia, and hypertension are seen in
Cushing’s syndrome (excess cortisol).
💫ANSWER✔️✔️: A) Hyperpigmentation of the skin
---
### Question 2 of 119
A nurse is providing discharge teaching to a client who had a myocardial infarction (MI) and has a new
prescription for metoprolol (Lopressor). Which of the following statements by the client indicates
understanding?
A) “I will stop taking this medication if my heart rate drops below 50.”
,B) “This medication will help prevent future heart attacks by lowering my blood pressure and heart
rate.”
C) “I can take this medication with my usual dose of ibuprofen for arthritis pain.”
D) “I will take this medication only when I feel chest pain.”
💫RATIONALE✔️✔️: Metoprolol is a beta-blocker that reduces myocardial oxygen demand by lowering
heart rate and blood pressure, reducing the risk of recurrent MI (B). Stopping abruptly can cause
rebound tachycardia. NSAIDs reduce efficacy. It is taken daily, not PRN.
💫ANSWER✔️✔️: B) “This medication will help prevent future heart attacks by lowering my blood
pressure and heart rate.”
---
### Question 3 of 119
**Select-All-That-Apply (SATA):** A nurse is assessing a client who has a new diagnosis of heart failure
with reduced ejection fraction (HFrEF). Which of the following findings are expected? (Select all that
apply.)
A) Dyspnea on exertion
B) Peripheral edema
C) Crackles in the lung bases
D) S3 gallop
E) Bounding pulses
💫RATIONALE✔️✔️: HFrEF presents with dyspnea (A), peripheral edema (B), crackles (C), and S3 gallop
(D). Bounding pulses (E) are not typical; weak, thready pulses may be seen in advanced failure.
💫ANSWER✔️✔️: A, B, C, D
---
, ### Question 4 of 119
A nurse is caring for a client who has a traumatic brain injury (TBI) and is exhibiting signs of increased
intracranial pressure (ICP). Which of the following nursing interventions should the nurse implement?
A) Keep the head of the bed flat.
B) Cluster all nursing care to reduce stimulation.
C) Maintain the client’s neck in a neutral, midline position.
D) Suction the airway every 2 hours.
💫RATIONALE✔️✔️: Maintaining the neck in neutral, midline position (C) promotes venous drainage from
the head, reducing ICP. HOB should be elevated 30 degrees. Clustering care increases ICP (avoid unless
necessary). Suctioning increases ICP and should be done only when needed.
💫ANSWER✔️✔️: C) Maintain the client’s neck in a neutral, midline position.
---
### Question 5 of 119
A nurse is assessing a client who is receiving a continuous heparin infusion for a pulmonary embolism.
The client’s aPTT is 110 seconds, and the control is 30 seconds. Which of the following actions should
the nurse take?
A) Continue the infusion at the same rate.
B) Decrease the infusion rate by 2 mL/hr.
C) Stop the infusion and notify the provider.
D) Administer vitamin K.
💫RATIONALE✔️✔️: Therapeutic aPTT for heparin is 1.5-2.5 times control (45-75 seconds). 110 seconds is
>3.6 times control, indicating a high bleeding risk. The nurse should stop the infusion (C) and notify the
provider. Vitamin K reverses warfarin, not heparin.
