NSG 530 Advanced Pathophysiology Actual Exam 2026/2027 |
Complete Exam Guide with Verified Answers and Detailed
Rationales |Wilkes Exam 1 Latest Update, A+ Graded.
Question 1
A 68-year-old man with long-standing hypertension develops left ventricular
hypertrophy (LVH). Which cellular adaptation is primarily responsible for the
increased thickness of the ventricular wall?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B. Hypertrophy
Explanation:
Cardiac myocytes are terminally differentiated cells and cannot undergo
significant hyperplasia. In response to chronic pressure overload, such as
hypertension, they enlarge through hypertrophy by increasing protein
synthesis and the number of sarcomeres, leading to LVH.
Question 2
A patient with septic shock develops widespread endothelial injury and
hypotension. Which inflammatory mediator plays the greatest role in
producing systemic vasodilation?
A. Histamine
B. Nitric oxide
C. Dopamine
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,D. Angiotensin II
Correct Answer: B. Nitric oxide
Explanation:
Nitric oxide released from activated endothelial cells is a major mediator of
vasodilation during septic shock. Excessive nitric oxide production
contributes to profound hypotension and impaired tissue perfusion.
Question 3
Which laboratory finding is most consistent with metabolic acidosis caused by
diabetic ketoacidosis (DKA)?
A. Elevated pH and elevated bicarbonate
B. Decreased pH, decreased bicarbonate, and increased anion gap
C. Increased pH with decreased PaCO₂
D. Normal bicarbonate with respiratory alkalosis
Correct Answer: B. Decreased pH, decreased bicarbonate, and increased
anion gap
Explanation:
DKA produces high-anion-gap metabolic acidosis due to accumulation of
ketoacids. Patients typically have low pH, low serum bicarbonate, and
compensatory hyperventilation.
Question 4
Activation of the renin-angiotensin-aldosterone system (RAAS) ultimately
results in:
A. Decreased sodium reabsorption
B. Increased potassium retention
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,C. Increased sodium and water reabsorption
D. Decreased vascular resistance
Correct Answer: C. Increased sodium and water reabsorption
Explanation:
Aldosterone promotes sodium reabsorption and potassium excretion in the
distal nephron. Water follows sodium, increasing intravascular volume and
blood pressure.
Question 5
Which component of Virchow's triad is present in a patient who remains
immobilized following hip replacement surgery?
A. Hyperglycemia
B. Venous stasis
C. Hypercalcemia
D. Hypoxia
Correct Answer: B. Venous stasis
Explanation:
Virchow's triad includes endothelial injury, hypercoagulability, and venous
stasis. Immobility slows venous blood flow and increases the risk of deep vein
thrombosis.
Question 6
A patient develops acute respiratory distress syndrome (ARDS). Which
pathophysiologic mechanism is primarily responsible for severe hypoxemia?
A. Bronchospasm
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, B. Increased alveolar-capillary membrane permeability
C. Reduced surfactant production only
D. Increased pulmonary arterial pressure only
Correct Answer: B. Increased alveolar-capillary membrane permeability
Explanation:
Inflammation damages the alveolar-capillary membrane, allowing protein-
rich fluid to enter the alveoli, impairing gas exchange and causing refractory
hypoxemia.
Question 7
Which electrolyte abnormality is most likely to produce peaked T waves on an
electrocardiogram (ECG)?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypercalcemia
Correct Answer: B. Hyperkalemia
Explanation:
Hyperkalemia alters cardiac conduction and commonly produces peaked T
waves, prolonged PR intervals, widened QRS complexes, and potentially life-
threatening arrhythmias.
Question 8
Which cytokine is primarily responsible for stimulating hepatic production of
C-reactive protein (CRP)?
4|Page
Complete Exam Guide with Verified Answers and Detailed
Rationales |Wilkes Exam 1 Latest Update, A+ Graded.
Question 1
A 68-year-old man with long-standing hypertension develops left ventricular
hypertrophy (LVH). Which cellular adaptation is primarily responsible for the
increased thickness of the ventricular wall?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B. Hypertrophy
Explanation:
Cardiac myocytes are terminally differentiated cells and cannot undergo
significant hyperplasia. In response to chronic pressure overload, such as
hypertension, they enlarge through hypertrophy by increasing protein
synthesis and the number of sarcomeres, leading to LVH.
Question 2
A patient with septic shock develops widespread endothelial injury and
hypotension. Which inflammatory mediator plays the greatest role in
producing systemic vasodilation?
A. Histamine
B. Nitric oxide
C. Dopamine
1|Page
,D. Angiotensin II
Correct Answer: B. Nitric oxide
Explanation:
Nitric oxide released from activated endothelial cells is a major mediator of
vasodilation during septic shock. Excessive nitric oxide production
contributes to profound hypotension and impaired tissue perfusion.
Question 3
Which laboratory finding is most consistent with metabolic acidosis caused by
diabetic ketoacidosis (DKA)?
A. Elevated pH and elevated bicarbonate
B. Decreased pH, decreased bicarbonate, and increased anion gap
C. Increased pH with decreased PaCO₂
D. Normal bicarbonate with respiratory alkalosis
Correct Answer: B. Decreased pH, decreased bicarbonate, and increased
anion gap
Explanation:
DKA produces high-anion-gap metabolic acidosis due to accumulation of
ketoacids. Patients typically have low pH, low serum bicarbonate, and
compensatory hyperventilation.
Question 4
Activation of the renin-angiotensin-aldosterone system (RAAS) ultimately
results in:
A. Decreased sodium reabsorption
B. Increased potassium retention
2|Page
,C. Increased sodium and water reabsorption
D. Decreased vascular resistance
Correct Answer: C. Increased sodium and water reabsorption
Explanation:
Aldosterone promotes sodium reabsorption and potassium excretion in the
distal nephron. Water follows sodium, increasing intravascular volume and
blood pressure.
Question 5
Which component of Virchow's triad is present in a patient who remains
immobilized following hip replacement surgery?
A. Hyperglycemia
B. Venous stasis
C. Hypercalcemia
D. Hypoxia
Correct Answer: B. Venous stasis
Explanation:
Virchow's triad includes endothelial injury, hypercoagulability, and venous
stasis. Immobility slows venous blood flow and increases the risk of deep vein
thrombosis.
Question 6
A patient develops acute respiratory distress syndrome (ARDS). Which
pathophysiologic mechanism is primarily responsible for severe hypoxemia?
A. Bronchospasm
3|Page
, B. Increased alveolar-capillary membrane permeability
C. Reduced surfactant production only
D. Increased pulmonary arterial pressure only
Correct Answer: B. Increased alveolar-capillary membrane permeability
Explanation:
Inflammation damages the alveolar-capillary membrane, allowing protein-
rich fluid to enter the alveoli, impairing gas exchange and causing refractory
hypoxemia.
Question 7
Which electrolyte abnormality is most likely to produce peaked T waves on an
electrocardiogram (ECG)?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypercalcemia
Correct Answer: B. Hyperkalemia
Explanation:
Hyperkalemia alters cardiac conduction and commonly produces peaked T
waves, prolonged PR intervals, widened QRS complexes, and potentially life-
threatening arrhythmias.
Question 8
Which cytokine is primarily responsible for stimulating hepatic production of
C-reactive protein (CRP)?
4|Page
