NURS 6501 Advanced Pathophysiology Week 11
Final Exam - Walden University MSN 2026-2027
Walden University MSN Capstone | 100 items | 100 % integrative synthesis | 3 h
SECTION 1 Systemic Homeostasis Collapse & Shock (Q 1 – 25)
Q1
72-y/o F, urosepsis, day 3 on abx/pressors → new bilateral crackles, PaO₂/FiO₂ < 200,
diffuse infiltrates, PCWP 10 mmHg. Primary mechanism of lung injury?
A. Cardiogenic pulmonary edema
B. Hydrostatic overload from fluids
C. Diffuse alveolar damage (neutrophil-mediated leak)
D. New HAP
Answer: C – systemic inflammatory mediators → capillary leak → ARDS; PCWP rules
out cardiogenic.
Q2
STEMI → cardiogenic shock → AST/ALT > 3000 U/L. Explanation?
A. Toxic metabolites from heart
B. Ischaemic hepatitis (shock liver)
C. Right-heart congestion
,D. Autoimmune hepatitis
Answer: B – ↓ cardiac output → hepatic hypoperfusion → centrilobular necrosis;
transaminase surge mirrors ischemia.
Q3
Which cytokine principally initiates capillary leak in early septic shock?
A. IL-10
B. TNF-α
C. TGF-β
D. IL-4
Answer: B – TNF-α ↑ endothelial permeability.
Q4
Which acid-base pattern in septic shock on mechanical ventilation?
A. Respiratory acidosis + metabolic alkalosis
B. Respiratory alkalosis + metabolic acidosis
C. Metabolic acidosis + respiratory acidosis
D. Metabolic alkalosis + respiratory alkalosis
Answer: B – hyperventilation (respiratory) + lactic acidosis (metabolic).
Q5
Which finding signals transition to MODS in cardiogenic shock on dobutamine?
,A. UOP 40 mL/h
B. Platelets 80 k/µL
C. CVP 8 mmHg
D. Lactate 1.5 mmol/L
Answer: B – thrombocytopenia = hematologic organ dysfunction.
Q6
Hepatorenal syndrome type 1 mechanism?
A. Glomerulonephritis
B. Renal vasoconstriction + portal hypertension
C. ATN
D. Nephrotoxic drugs
Answer: B – splanchnic vasodilation → effective hypovolemia → renal vasoconstriction.
Q7
Post-renal AKI biochemical hallmark?
A. FENa < 1 %
B. Urine Na 10 mmol/L
C. BUN/Cr < 10
D. FeUrea < 35 %
, Answer: C – back-pressure → disproportionate BUN rise.
Q8
Which compensatory response is MOST immediate in hemorrhagic shock?
A. Renin release
B. Baroreflex tachycardia
C. Cortisol surge
D. ADH secretion
Answer: B – neural reflex < 1 s.
Q9
Which blood gas in aspirin overdose?
A. Respiratory acidosis only
B. Metabolic acidosis + respiratory alkalosis
C. Metabolic alkalosis
D. Normal anion gap acidosis
Answer: B – central hyperventilation + lactic acidosis.
Q10
Which ECG change reflects hyperkalemia-induced cardiac toxicity?
A. Prolonged PR
Final Exam - Walden University MSN 2026-2027
Walden University MSN Capstone | 100 items | 100 % integrative synthesis | 3 h
SECTION 1 Systemic Homeostasis Collapse & Shock (Q 1 – 25)
Q1
72-y/o F, urosepsis, day 3 on abx/pressors → new bilateral crackles, PaO₂/FiO₂ < 200,
diffuse infiltrates, PCWP 10 mmHg. Primary mechanism of lung injury?
A. Cardiogenic pulmonary edema
B. Hydrostatic overload from fluids
C. Diffuse alveolar damage (neutrophil-mediated leak)
D. New HAP
Answer: C – systemic inflammatory mediators → capillary leak → ARDS; PCWP rules
out cardiogenic.
Q2
STEMI → cardiogenic shock → AST/ALT > 3000 U/L. Explanation?
A. Toxic metabolites from heart
B. Ischaemic hepatitis (shock liver)
C. Right-heart congestion
,D. Autoimmune hepatitis
Answer: B – ↓ cardiac output → hepatic hypoperfusion → centrilobular necrosis;
transaminase surge mirrors ischemia.
Q3
Which cytokine principally initiates capillary leak in early septic shock?
A. IL-10
B. TNF-α
C. TGF-β
D. IL-4
Answer: B – TNF-α ↑ endothelial permeability.
Q4
Which acid-base pattern in septic shock on mechanical ventilation?
A. Respiratory acidosis + metabolic alkalosis
B. Respiratory alkalosis + metabolic acidosis
C. Metabolic acidosis + respiratory acidosis
D. Metabolic alkalosis + respiratory alkalosis
Answer: B – hyperventilation (respiratory) + lactic acidosis (metabolic).
Q5
Which finding signals transition to MODS in cardiogenic shock on dobutamine?
,A. UOP 40 mL/h
B. Platelets 80 k/µL
C. CVP 8 mmHg
D. Lactate 1.5 mmol/L
Answer: B – thrombocytopenia = hematologic organ dysfunction.
Q6
Hepatorenal syndrome type 1 mechanism?
A. Glomerulonephritis
B. Renal vasoconstriction + portal hypertension
C. ATN
D. Nephrotoxic drugs
Answer: B – splanchnic vasodilation → effective hypovolemia → renal vasoconstriction.
Q7
Post-renal AKI biochemical hallmark?
A. FENa < 1 %
B. Urine Na 10 mmol/L
C. BUN/Cr < 10
D. FeUrea < 35 %
, Answer: C – back-pressure → disproportionate BUN rise.
Q8
Which compensatory response is MOST immediate in hemorrhagic shock?
A. Renin release
B. Baroreflex tachycardia
C. Cortisol surge
D. ADH secretion
Answer: B – neural reflex < 1 s.
Q9
Which blood gas in aspirin overdose?
A. Respiratory acidosis only
B. Metabolic acidosis + respiratory alkalosis
C. Metabolic alkalosis
D. Normal anion gap acidosis
Answer: B – central hyperventilation + lactic acidosis.
Q10
Which ECG change reflects hyperkalemia-induced cardiac toxicity?
A. Prolonged PR
