1
NSG 3850/ NSG3850 Exam 4 – (New 2026/ 2027 Update)
Pathophysiology for Nurses II Review | Questions & Answers |
Grade A| 100% Correct (Verified Solutions)- Galen
1. A patient with long-standing hypertension is at greatest risk for which complication due to
increased afterload?
• A) Right-sided heart failure
• B) Left ventricular hypertrophy and heart failure
• C) Aortic regurgitation
• D) Mitral valve prolapse
Correct Answer: B) Left ventricular hypertrophy and heart failure
Rationale: Chronic hypertension increases systemic vascular resistance (afterload). The left
ventricle compensates by hypertrophy, but eventually this leads to diastolic dysfunction and
heart failure with preserved or reduced ejection fraction.
2. The primary pathophysiological event in a myocardial infarction (MI) is:
• A) Coronary artery vasospasm without plaque rupture
• B) Rupture of an atherosclerotic plaque leading to thrombus formation and coronary
occlusion
• C) Embolism from a vegetation on the aortic valve
• D) Dissection of the coronary artery
Correct Answer: B) Rupture of an atherosclerotic plaque leading to thrombus formation and
coronary occlusion
Rationale: Most MIs are caused by the rupture of an unstable atherosclerotic plaque, exposing
subendothelial collagen, which triggers platelet aggregation and thrombus formation, occluding
the vessel.
3. Serum troponin I is elevated. What does this indicate?
• A) Skeletal muscle injury
• B) Cardiac myocyte necrosis
• C) Liver failure
• D) Renal insufficiency
pg. 1
,2
Correct Answer: B) Cardiac myocyte necrosis
Rationale: Troponin I and T are highly specific cardiac biomarkers released into the blood when
myocardial cells are irreversibly damaged.
4. Right-sided heart failure typically leads to which set of clinical findings?
• A) Pulmonary crackles and pink frothy sputum
• B) Jugular venous distention, hepatomegaly, and peripheral edema
• C) Hypotension and weak peripheral pulses
• D) Orthopnea and paroxysmal nocturnal dyspnea
Correct Answer: B) Jugular venous distention, hepatomegaly, and peripheral edema
Rationale: Right ventricular failure causes systemic venous congestion, leading to increased JVP,
hepatic congestion, and dependent edema. Pulmonary findings are characteristic of left-sided
failure.
5. The hallmark pathophysiologic defect in dilated cardiomyopathy is:
• A) Severe diastolic dysfunction with normal cavity size
• B) Impaired systolic function and ventricular dilation
• C) Asymmetric septal hypertrophy
• D) Restrictive filling due to infiltrative disease
Correct Answer: B) Impaired systolic function and ventricular dilation
Rationale: Dilated cardiomyopathy is characterized by ventricular chamber enlargement and
reduced contractility, leading to low ejection fraction and symptoms of pump failure.
6. A patient develops sudden, sharp chest pain radiating to the back, with a widened
mediastinum on chest X-ray. The most likely condition is:
• A) Pericarditis
• B) Aortic dissection
• C) Pulmonary embolism
• D) Myocardial infarction
Correct Answer: B) Aortic dissection
Rationale: Aortic dissection presents with tearing chest pain radiating to the back, often with
pulse deficits, and a widened mediastinum on imaging. It is a surgical emergency.
7. The pathophysiological mechanism of stable angina is:
pg. 2
,3
• A) Complete thrombotic occlusion of a coronary artery
• B) Fixed atherosclerotic narrowing causing ischemia during increased oxygen demand
• C) Coronary artery spasm
• D) Microvascular endothelial dysfunction only
Correct Answer: B) Fixed atherosclerotic narrowing causing ischemia during increased oxygen
demand
Rationale: Stable angina occurs when myocardial oxygen demand exceeds the supply through a
stenotic but not totally occluded artery. Pain is predictable and relieved by rest or nitroglycerin.
8. Cardiac tamponade causes hypotension primarily by:
• A) Reducing systemic vascular resistance
• B) Decreasing venous return due to compression of the heart chambers
• C) Causing severe bradycardia
• D) Inducing a massive inflammatory response
Correct Answer: B) Decreasing venous return due to compression of the heart chambers
Rationale: Fluid accumulation in the pericardial sac compresses the right atrium and ventricle,
limiting diastolic filling, reducing stroke volume, and causing obstructive shock (Beck's triad).
9. Chronic mitral regurgitation leads to which compensatory cardiac change?
• A) Right ventricular atrophy
• B) Left atrial dilation and eventual left ventricular volume overload
• C) Hypertrophy of the tricuspid valve
• D) Decreased left ventricular preload
Correct Answer: B) Left atrial dilation and eventual left ventricular volume overload
Rationale: In mitral regurgitation, blood backflows into the left atrium during systole, causing
volume overload. The left atrium dilates, and the left ventricle eventually fails from chronic
volume overload.
10. The primary pathogenetic mechanism in rheumatic heart disease involves:
• A) Direct bacterial invasion of valve tissue
• B) Autoimmune cross-reactivity between streptococcal antigens and cardiac tissue
(molecular mimicry)
• C) Deposition of cholesterol in valve cusps
pg. 3
, 4
• D) Calcification of the valve annulus
Correct Answer: B) Autoimmune cross-reactivity between streptococcal antigens and cardiac
tissue (molecular mimicry)
Rationale: Acute rheumatic fever follows group A streptococcal pharyngitis; antibodies against
M protein cross-react with cardiac myosin and valve tissue, leading to inflammation and
scarring, especially of the mitral valve.
11. A patient with decompensated heart failure has elevated brain natriuretic peptide (BNP).
What stimulates BNP release?
• A) Increased atrial pressure and stretch
• B) Decreased cardiac afterload
• C) Hypovolemia
• D) Bradycardia
Correct Answer: A) Increased atrial pressure and stretch (primarily ventricular stretch)
Rationale: BNP is released from ventricular myocytes in response to increased wall tension and
volume overload. It promotes natriuresis, diuresis, and vasodilation as a compensatory
mechanism.
12. The most common form of shock in the ICU is:
• A) Hypovolemic shock
• B) Cardiogenic shock
• C) Distributive shock (septic shock)
• D) Obstructive shock
Correct Answer: C) Distributive shock (septic shock)
Rationale: Sepsis-induced vasodilation and increased capillary permeability are the most
frequent causes of shock in critical care settings.
13. Prinzmetal (variant) angina is caused by:
• A) Atherosclerotic plaque rupture
• B) Coronary artery vasospasm
• C) Severe anemia
• D) Aortic stenosis
Correct Answer: B) Coronary artery vasospasm
Rationale: Prinzmetal angina results from transient vasospasm of a coronary artery, often at
pg. 4
NSG 3850/ NSG3850 Exam 4 – (New 2026/ 2027 Update)
Pathophysiology for Nurses II Review | Questions & Answers |
Grade A| 100% Correct (Verified Solutions)- Galen
1. A patient with long-standing hypertension is at greatest risk for which complication due to
increased afterload?
• A) Right-sided heart failure
• B) Left ventricular hypertrophy and heart failure
• C) Aortic regurgitation
• D) Mitral valve prolapse
Correct Answer: B) Left ventricular hypertrophy and heart failure
Rationale: Chronic hypertension increases systemic vascular resistance (afterload). The left
ventricle compensates by hypertrophy, but eventually this leads to diastolic dysfunction and
heart failure with preserved or reduced ejection fraction.
2. The primary pathophysiological event in a myocardial infarction (MI) is:
• A) Coronary artery vasospasm without plaque rupture
• B) Rupture of an atherosclerotic plaque leading to thrombus formation and coronary
occlusion
• C) Embolism from a vegetation on the aortic valve
• D) Dissection of the coronary artery
Correct Answer: B) Rupture of an atherosclerotic plaque leading to thrombus formation and
coronary occlusion
Rationale: Most MIs are caused by the rupture of an unstable atherosclerotic plaque, exposing
subendothelial collagen, which triggers platelet aggregation and thrombus formation, occluding
the vessel.
3. Serum troponin I is elevated. What does this indicate?
• A) Skeletal muscle injury
• B) Cardiac myocyte necrosis
• C) Liver failure
• D) Renal insufficiency
pg. 1
,2
Correct Answer: B) Cardiac myocyte necrosis
Rationale: Troponin I and T are highly specific cardiac biomarkers released into the blood when
myocardial cells are irreversibly damaged.
4. Right-sided heart failure typically leads to which set of clinical findings?
• A) Pulmonary crackles and pink frothy sputum
• B) Jugular venous distention, hepatomegaly, and peripheral edema
• C) Hypotension and weak peripheral pulses
• D) Orthopnea and paroxysmal nocturnal dyspnea
Correct Answer: B) Jugular venous distention, hepatomegaly, and peripheral edema
Rationale: Right ventricular failure causes systemic venous congestion, leading to increased JVP,
hepatic congestion, and dependent edema. Pulmonary findings are characteristic of left-sided
failure.
5. The hallmark pathophysiologic defect in dilated cardiomyopathy is:
• A) Severe diastolic dysfunction with normal cavity size
• B) Impaired systolic function and ventricular dilation
• C) Asymmetric septal hypertrophy
• D) Restrictive filling due to infiltrative disease
Correct Answer: B) Impaired systolic function and ventricular dilation
Rationale: Dilated cardiomyopathy is characterized by ventricular chamber enlargement and
reduced contractility, leading to low ejection fraction and symptoms of pump failure.
6. A patient develops sudden, sharp chest pain radiating to the back, with a widened
mediastinum on chest X-ray. The most likely condition is:
• A) Pericarditis
• B) Aortic dissection
• C) Pulmonary embolism
• D) Myocardial infarction
Correct Answer: B) Aortic dissection
Rationale: Aortic dissection presents with tearing chest pain radiating to the back, often with
pulse deficits, and a widened mediastinum on imaging. It is a surgical emergency.
7. The pathophysiological mechanism of stable angina is:
pg. 2
,3
• A) Complete thrombotic occlusion of a coronary artery
• B) Fixed atherosclerotic narrowing causing ischemia during increased oxygen demand
• C) Coronary artery spasm
• D) Microvascular endothelial dysfunction only
Correct Answer: B) Fixed atherosclerotic narrowing causing ischemia during increased oxygen
demand
Rationale: Stable angina occurs when myocardial oxygen demand exceeds the supply through a
stenotic but not totally occluded artery. Pain is predictable and relieved by rest or nitroglycerin.
8. Cardiac tamponade causes hypotension primarily by:
• A) Reducing systemic vascular resistance
• B) Decreasing venous return due to compression of the heart chambers
• C) Causing severe bradycardia
• D) Inducing a massive inflammatory response
Correct Answer: B) Decreasing venous return due to compression of the heart chambers
Rationale: Fluid accumulation in the pericardial sac compresses the right atrium and ventricle,
limiting diastolic filling, reducing stroke volume, and causing obstructive shock (Beck's triad).
9. Chronic mitral regurgitation leads to which compensatory cardiac change?
• A) Right ventricular atrophy
• B) Left atrial dilation and eventual left ventricular volume overload
• C) Hypertrophy of the tricuspid valve
• D) Decreased left ventricular preload
Correct Answer: B) Left atrial dilation and eventual left ventricular volume overload
Rationale: In mitral regurgitation, blood backflows into the left atrium during systole, causing
volume overload. The left atrium dilates, and the left ventricle eventually fails from chronic
volume overload.
10. The primary pathogenetic mechanism in rheumatic heart disease involves:
• A) Direct bacterial invasion of valve tissue
• B) Autoimmune cross-reactivity between streptococcal antigens and cardiac tissue
(molecular mimicry)
• C) Deposition of cholesterol in valve cusps
pg. 3
, 4
• D) Calcification of the valve annulus
Correct Answer: B) Autoimmune cross-reactivity between streptococcal antigens and cardiac
tissue (molecular mimicry)
Rationale: Acute rheumatic fever follows group A streptococcal pharyngitis; antibodies against
M protein cross-react with cardiac myosin and valve tissue, leading to inflammation and
scarring, especially of the mitral valve.
11. A patient with decompensated heart failure has elevated brain natriuretic peptide (BNP).
What stimulates BNP release?
• A) Increased atrial pressure and stretch
• B) Decreased cardiac afterload
• C) Hypovolemia
• D) Bradycardia
Correct Answer: A) Increased atrial pressure and stretch (primarily ventricular stretch)
Rationale: BNP is released from ventricular myocytes in response to increased wall tension and
volume overload. It promotes natriuresis, diuresis, and vasodilation as a compensatory
mechanism.
12. The most common form of shock in the ICU is:
• A) Hypovolemic shock
• B) Cardiogenic shock
• C) Distributive shock (septic shock)
• D) Obstructive shock
Correct Answer: C) Distributive shock (septic shock)
Rationale: Sepsis-induced vasodilation and increased capillary permeability are the most
frequent causes of shock in critical care settings.
13. Prinzmetal (variant) angina is caused by:
• A) Atherosclerotic plaque rupture
• B) Coronary artery vasospasm
• C) Severe anemia
• D) Aortic stenosis
Correct Answer: B) Coronary artery vasospasm
Rationale: Prinzmetal angina results from transient vasospasm of a coronary artery, often at
pg. 4
