NR283 Exam 2 Actual Exam Style V3 | NR
283 Pathophysiology | Chamberlain
1. A patient’s EKG shows peaked T-waves and a widened QRS complex. Which electrolyte
imbalance should the nurse suspect?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypercalcemia
Answer: B
Rationale: Hyperkalemia leads to a more positive resting membrane potential, which
increases cardiac excitability initially. The characteristic EKG change is a peaked T-wave
followed by a widened QRS as levels rise further. This condition is dangerous because it can
progress rapidly to ventricular fibrillation or cardiac arrest.
2. A patient presents with a pH of 7.30, a PaCO2 of 52 mmHg, and an HCO3 of 26 mEq/L.
Which acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Respiratory Alkalosis
,D. Metabolic Alkalosis
Answer: B
Rationale: The pH is below 7.35, which indicates an acidotic state within the body. Since
the PaCO2 is elevated above the normal range of 45 mmHg, the primary cause is
respiratory retention of carbon dioxide. The bicarbonate level is currently normal,
suggesting that compensation has not yet significantly occurred.
3. Which clinical manifestation is most characteristic of right-sided heart failure?
A. Pulmonary edema
B. Crackles in the lungs
C. Jugular venous distention
D. Orthopnea
Answer: C
Rationale: Right-sided heart failure causes blood to back up into the systemic venous
circulation rather than the lungs. This results in increased hydrostatic pressure in the
peripheral veins, leading to jugular venous distention and peripheral edema. Pulmonary
symptoms like crackles are typically associated with left-sided failure where blood backs
up into the lungs.
4. What is the primary pathophysiological mechanism behind Type 1 Diabetes Mellitus?
A. Insulin resistance in peripheral tissues
, B. Excessive glucagon production by alpha cells
C. Autoimmune destruction of pancreatic beta cells
D. Obesity-induced downregulation of insulin receptors
Answer: C
Rationale: Type 1 Diabetes Mellitus is characterized by an absolute insulin deficiency due
to the destruction of the insulin-producing beta cells in the pancreas. This is usually caused
by a T-cell mediated autoimmune attack often triggered by environmental factors in
genetically susceptible individuals. Without insulin, glucose cannot enter the cells for
energy, leading to hyperglycemia and ketosis.
5. A patient has a serum sodium level of 120 mEq/L and is experiencing seizures. What is the
most likely cause of these neurological symptoms?
A. Shrinkage of brain cells due to hypertonicity
B. Cerebral edema due to water moving into cells
C. Increased action potential threshold in neurons
D. Dehydration of the myelin sheath
Answer: B
Rationale: In severe hyponatremia, the extracellular fluid becomes hypotonic compared to
the intracellular environment. This osmotic gradient causes water to move into the brain
cells, leading to significant cellular swelling and cerebral edema. The resulting increase in
283 Pathophysiology | Chamberlain
1. A patient’s EKG shows peaked T-waves and a widened QRS complex. Which electrolyte
imbalance should the nurse suspect?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypercalcemia
Answer: B
Rationale: Hyperkalemia leads to a more positive resting membrane potential, which
increases cardiac excitability initially. The characteristic EKG change is a peaked T-wave
followed by a widened QRS as levels rise further. This condition is dangerous because it can
progress rapidly to ventricular fibrillation or cardiac arrest.
2. A patient presents with a pH of 7.30, a PaCO2 of 52 mmHg, and an HCO3 of 26 mEq/L.
Which acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Respiratory Alkalosis
,D. Metabolic Alkalosis
Answer: B
Rationale: The pH is below 7.35, which indicates an acidotic state within the body. Since
the PaCO2 is elevated above the normal range of 45 mmHg, the primary cause is
respiratory retention of carbon dioxide. The bicarbonate level is currently normal,
suggesting that compensation has not yet significantly occurred.
3. Which clinical manifestation is most characteristic of right-sided heart failure?
A. Pulmonary edema
B. Crackles in the lungs
C. Jugular venous distention
D. Orthopnea
Answer: C
Rationale: Right-sided heart failure causes blood to back up into the systemic venous
circulation rather than the lungs. This results in increased hydrostatic pressure in the
peripheral veins, leading to jugular venous distention and peripheral edema. Pulmonary
symptoms like crackles are typically associated with left-sided failure where blood backs
up into the lungs.
4. What is the primary pathophysiological mechanism behind Type 1 Diabetes Mellitus?
A. Insulin resistance in peripheral tissues
, B. Excessive glucagon production by alpha cells
C. Autoimmune destruction of pancreatic beta cells
D. Obesity-induced downregulation of insulin receptors
Answer: C
Rationale: Type 1 Diabetes Mellitus is characterized by an absolute insulin deficiency due
to the destruction of the insulin-producing beta cells in the pancreas. This is usually caused
by a T-cell mediated autoimmune attack often triggered by environmental factors in
genetically susceptible individuals. Without insulin, glucose cannot enter the cells for
energy, leading to hyperglycemia and ketosis.
5. A patient has a serum sodium level of 120 mEq/L and is experiencing seizures. What is the
most likely cause of these neurological symptoms?
A. Shrinkage of brain cells due to hypertonicity
B. Cerebral edema due to water moving into cells
C. Increased action potential threshold in neurons
D. Dehydration of the myelin sheath
Answer: B
Rationale: In severe hyponatremia, the extracellular fluid becomes hypotonic compared to
the intracellular environment. This osmotic gradient causes water to move into the brain
cells, leading to significant cellular swelling and cerebral edema. The resulting increase in
