NURS 3366 EXAM 3 BLUEPRINT AND CONTENT
SUMMARY | 2026 UPDATE | WITH COMPLETE
SOLUTIONS - UTA.
NURS 3366 EXAM 3 – MEGA PRACTICE TEST (125 Questions)
1. A 62-year-old male with a 40-pack-year smoking history presents with
exertional chest pain. The earliest pathophysiological event in the development
of his coronary artery disease is:
• A) Formation of a fibrous cap over a lipid core
• B) Endothelial injury and dysfunction (Correct Answer)
• C) Smooth muscle cell migration into the tunica intima
• D) Platelet aggregation and thrombus formation
Rationale: Atherosclerosis begins with endothelial injury. This injury increases
vascular permeability, allows LDL infiltration, and triggers an inflammatory
response. All other options occur later in the disease process.
2. A patient with chronic hypertension develops left ventricular hypertrophy.
Which of the following is the primary stimulus for this myocardial remodeling?
• A) Increased preload from fluid retention
• B) Increased afterload from elevated systemic vascular resistance (Correct
Answer)
• C) Decreased cardiac output leading to ischemia
• D) Sympathetic nervous system downregulation
,Rationale: Afterload is the resistance the left ventricle must overcome to eject
blood. In chronic hypertension, systemic vascular resistance (SVR) is elevated,
increasing afterload. The LV must work harder and hypertrophies to maintain
cardiac output against this chronic pressure overload.
3. A patient with right-sided heart failure presents with jugular venous
distention, hepatomegaly, and peripheral edema. These clinical manifestations
result from:
• A) Decreased renal perfusion activating the RAAS
• B) Backward failure leading to increased systemic venous
pressure (Correct Answer)
• C) Left ventricular systolic dysfunction
• D) Pulmonary artery vasodilation
Rationale: Right-sided heart failure causes blood to back up into the systemic
venous circulation. This increased venous hydrostatic pressure forces fluid out of
the capillaries, causing peripheral edema, and distends the jugular veins and liver
capsule.
4. A 45-year-old female with a history of DVT suddenly develops pleuritic chest
pain, tachycardia, and hemoptysis. A V/Q scan confirms a pulmonary embolism.
The most common origin of this embolus is:
• A) The right atrium
• B) The deep veins of the lower extremities (Correct Answer)
• C) The left ventricular wall
• D) The carotid arteries
,Rationale: Over 90% of pulmonary emboli originate from deep vein thrombi (DVTs)
in the lower extremities. These thrombi dislodge, travel through the inferior vena
cava into the right heart, and lodge in the pulmonary arteries.
5. A patient with chronic venous insufficiency has been experiencing lower
extremity edema and skin changes. The underlying pathophysiology of this
condition is:
• A) Incompetent venous valves leading to venous reflux and
pooling (Correct Answer)
• B) Atherosclerotic narrowing of the peripheral arteries
• C) Hypercoagulability leading to microthrombi
• D) Inflammation of the venous endothelium
Rationale: Venous insufficiency is caused by damaged or incompetent one-way
valves in the veins. This allows blood to reflux backward and pool in the lower
extremities, increasing hydrostatic pressure, leading to edema, stasis dermatitis,
and potential ulceration.
6. A patient with uncontrolled hypertension has a urinalysis showing proteinuria
and microscopic hematuria. This indicates damage to which renal structure?
• A) The proximal convoluted tubule
• B) The loop of Henle
• C) The glomerulus (Correct Answer)
• D) The collecting duct
Rationale: The glomerulus is the filtration barrier. Hypertension damages the
glomerular capillaries, making them leaky. Normally, large proteins and RBCs are
retained; their presence in the urine indicates glomerular injury (hypertensive
nephrosclerosis).
, 7. A patient with heart failure is on high-dose loop diuretics. Which acid-base
disturbance is a potential complication?
• A) Respiratory acidosis
• B) Respiratory alkalosis
• C) Metabolic alkalosis (Correct Answer)
• D) Metabolic acidosis
Rationale: Loop and thiazide diuretics increase the excretion of potassium and
hydrogen ions in the distal tubule. The excessive loss of hydrogen ions (acid) results
in a relative increase in plasma bicarbonate, leading to metabolic alkalosis.
8. An arterial blood gas (ABG) reveals: pH 7.25, PaCO2 60 mmHg, HCO3 24
mEq/L. The nurse correctly interprets this as:
• A) Metabolic acidosis with full renal compensation
• B) Respiratory acidosis with no renal compensation (Correct Answer)
• C) Respiratory alkalosis with renal compensation
• D) Metabolic alkalosis with respiratory compensation
Rationale: The pH is low (acidosis). The PaCO2 is elevated (respiratory
component). The HCO3 is normal (24), indicating the kidneys have not yet had
time to compensate (renal compensation takes 3-5 days). This is acute respiratory
acidosis.
9. A 15-month-old toddler is brought in with pallor, fatigue, and pica (eating
clay). A CBC shows microcytic, hypochromic anemia. This is most consistent
with:
• A) Sickle cell anemia
SUMMARY | 2026 UPDATE | WITH COMPLETE
SOLUTIONS - UTA.
NURS 3366 EXAM 3 – MEGA PRACTICE TEST (125 Questions)
1. A 62-year-old male with a 40-pack-year smoking history presents with
exertional chest pain. The earliest pathophysiological event in the development
of his coronary artery disease is:
• A) Formation of a fibrous cap over a lipid core
• B) Endothelial injury and dysfunction (Correct Answer)
• C) Smooth muscle cell migration into the tunica intima
• D) Platelet aggregation and thrombus formation
Rationale: Atherosclerosis begins with endothelial injury. This injury increases
vascular permeability, allows LDL infiltration, and triggers an inflammatory
response. All other options occur later in the disease process.
2. A patient with chronic hypertension develops left ventricular hypertrophy.
Which of the following is the primary stimulus for this myocardial remodeling?
• A) Increased preload from fluid retention
• B) Increased afterload from elevated systemic vascular resistance (Correct
Answer)
• C) Decreased cardiac output leading to ischemia
• D) Sympathetic nervous system downregulation
,Rationale: Afterload is the resistance the left ventricle must overcome to eject
blood. In chronic hypertension, systemic vascular resistance (SVR) is elevated,
increasing afterload. The LV must work harder and hypertrophies to maintain
cardiac output against this chronic pressure overload.
3. A patient with right-sided heart failure presents with jugular venous
distention, hepatomegaly, and peripheral edema. These clinical manifestations
result from:
• A) Decreased renal perfusion activating the RAAS
• B) Backward failure leading to increased systemic venous
pressure (Correct Answer)
• C) Left ventricular systolic dysfunction
• D) Pulmonary artery vasodilation
Rationale: Right-sided heart failure causes blood to back up into the systemic
venous circulation. This increased venous hydrostatic pressure forces fluid out of
the capillaries, causing peripheral edema, and distends the jugular veins and liver
capsule.
4. A 45-year-old female with a history of DVT suddenly develops pleuritic chest
pain, tachycardia, and hemoptysis. A V/Q scan confirms a pulmonary embolism.
The most common origin of this embolus is:
• A) The right atrium
• B) The deep veins of the lower extremities (Correct Answer)
• C) The left ventricular wall
• D) The carotid arteries
,Rationale: Over 90% of pulmonary emboli originate from deep vein thrombi (DVTs)
in the lower extremities. These thrombi dislodge, travel through the inferior vena
cava into the right heart, and lodge in the pulmonary arteries.
5. A patient with chronic venous insufficiency has been experiencing lower
extremity edema and skin changes. The underlying pathophysiology of this
condition is:
• A) Incompetent venous valves leading to venous reflux and
pooling (Correct Answer)
• B) Atherosclerotic narrowing of the peripheral arteries
• C) Hypercoagulability leading to microthrombi
• D) Inflammation of the venous endothelium
Rationale: Venous insufficiency is caused by damaged or incompetent one-way
valves in the veins. This allows blood to reflux backward and pool in the lower
extremities, increasing hydrostatic pressure, leading to edema, stasis dermatitis,
and potential ulceration.
6. A patient with uncontrolled hypertension has a urinalysis showing proteinuria
and microscopic hematuria. This indicates damage to which renal structure?
• A) The proximal convoluted tubule
• B) The loop of Henle
• C) The glomerulus (Correct Answer)
• D) The collecting duct
Rationale: The glomerulus is the filtration barrier. Hypertension damages the
glomerular capillaries, making them leaky. Normally, large proteins and RBCs are
retained; their presence in the urine indicates glomerular injury (hypertensive
nephrosclerosis).
, 7. A patient with heart failure is on high-dose loop diuretics. Which acid-base
disturbance is a potential complication?
• A) Respiratory acidosis
• B) Respiratory alkalosis
• C) Metabolic alkalosis (Correct Answer)
• D) Metabolic acidosis
Rationale: Loop and thiazide diuretics increase the excretion of potassium and
hydrogen ions in the distal tubule. The excessive loss of hydrogen ions (acid) results
in a relative increase in plasma bicarbonate, leading to metabolic alkalosis.
8. An arterial blood gas (ABG) reveals: pH 7.25, PaCO2 60 mmHg, HCO3 24
mEq/L. The nurse correctly interprets this as:
• A) Metabolic acidosis with full renal compensation
• B) Respiratory acidosis with no renal compensation (Correct Answer)
• C) Respiratory alkalosis with renal compensation
• D) Metabolic alkalosis with respiratory compensation
Rationale: The pH is low (acidosis). The PaCO2 is elevated (respiratory
component). The HCO3 is normal (24), indicating the kidneys have not yet had
time to compensate (renal compensation takes 3-5 days). This is acute respiratory
acidosis.
9. A 15-month-old toddler is brought in with pallor, fatigue, and pica (eating
clay). A CBC shows microcytic, hypochromic anemia. This is most consistent
with:
• A) Sickle cell anemia
