NRS 455 Exam 2 V1 | NRS 455
Pathophysiology | Actual Q&A with
Rationale (NRS455 Exam 2) | Grand
Canyon University
1. A patient presents to the emergency department with a sudden decrease in urine output,
an elevated serum creatinine, and a history of severe dehydration. The nurse recognizes this
as the ‘Oliguric Phase’ of Acute Kidney Injury (AKI). Which of the following pathophysiological
mechanisms is primarily responsible for the decrease in glomerular filtration rate (GFR)
during this phase?
A. Hypertrophy of the remaining nephrons
B. Reduced renal blood flow and tubular obstruction
C. Dilation of the afferent arteriole
D. Increased oncotic pressure in the Bowman capsule
Correct Answer: B
Rationale: During the oliguric phase of AKI, reduced renal blood flow leads to ischemic
injury of the tubular epithelial cells. These damaged cells slough off and create obstructions
within the tubules, further reducing the GFR. This process is often exacerbated by local
inflammatory responses and intrarenal vasoconstriction.
,2. A 55-year-old male with Chronic Kidney Disease (CKD) is diagnosed with secondary
hyperparathyroidism. What is the primary underlying cause of this endocrine complication in
CKD patients?
A. Excessive intake of dietary calcium
B. Hypernatremia-induced hormonal shifts
C. Direct stimulation of the parathyroid gland by urea
D. Inability of the kidneys to activate Vitamin D
Correct Answer: D
Rationale: In CKD, the kidneys fail to convert Vitamin D into its active form, calcitriol,
which is necessary for calcium absorption. This results in hypocalcemia, which
subsequently triggers the parathyroid glands to release excess parathyroid hormone (PTH)
to mobilize calcium from the bones. Over time, this chronic stimulation leads to secondary
hyperparathyroidism and renal osteodystrophy.
3. The nurse is caring for a patient suspected of having Cushing’s Syndrome. Which of the
following clinical manifestations should the nurse expect to find during the assessment?
A. Weight loss and hypotension
B. Hypoglycemia and hyperkalemia
C. Thinning of the skin and increased melanin pigmentation
D. Moon face, buffalo hump, and truncal obesity
,Correct Answer: D
Rationale: Cushing’s Syndrome is characterized by an excess of cortisol, which leads to
distinct physical changes including the redistribution of fat to the face (moon face) and the
upper back (buffalo hump). Truncal obesity is a hallmark sign due to the metabolic effects
of glucocorticoids on adipose tissue. These patients also frequently present with
hypertension and hyperglycemia.
4. Select all the clinical manifestations that are commonly associated with Hypothyroidism.
(Select All That Apply)
A. Weight gain despite poor appetite
B. Heat intolerance
C. Bradycardia
D. Constipation
E. Exophthalmos
F. Cold intolerance
G. Lethargy and fatigue
Correct Answer: A,C,D,F,G
Rationale: Hypothyroidism results from a deficiency in thyroid hormones, which slows the
metabolic rate of nearly all body systems. Common symptoms include cold intolerance,
bradycardia, weight gain, and significant fatigue or lethargy. Constipation is also frequent
, due to decreased gastrointestinal motility, while exophthalmos and heat intolerance are
characteristic of hyperthyroidism.
5. A patient with Type 1 Diabetes Mellitus is admitted with Diabetic Ketoacidosis (DKA).
Which of the following laboratory findings is most consistent with this diagnosis?
A. Serum glucose of 450 mg/dL and presence of ketones in the urine
B. Serum glucose of 150 mg/dL and pH of 7.45
C. Serum bicarbonate level of 28 mEq/L
D. Low serum osmolality and hypernatremia
Correct Answer: A
Rationale: DKA is characterized by extreme hyperglycemia, typically above 250 mg/dL,
along with metabolic acidosis and ketonuria. The lack of insulin leads the body to break
down fats for energy, resulting in the production of acidic ketone bodies. This leads to a
decrease in serum pH and an accumulation of ketones in both the blood and urine.
6. Which pathophysiological process occurs in the brain during an ischemic stroke?
A. Rupture of a cerebral artery leading to intracranial hemorrhage
B. Excessive production of cerebrospinal fluid causing pressure
C. Global demyelination of the white matter in the cerebral cortex
D. Occlusion of a cerebral artery resulting in focal neurological deficits
Correct Answer: D
Pathophysiology | Actual Q&A with
Rationale (NRS455 Exam 2) | Grand
Canyon University
1. A patient presents to the emergency department with a sudden decrease in urine output,
an elevated serum creatinine, and a history of severe dehydration. The nurse recognizes this
as the ‘Oliguric Phase’ of Acute Kidney Injury (AKI). Which of the following pathophysiological
mechanisms is primarily responsible for the decrease in glomerular filtration rate (GFR)
during this phase?
A. Hypertrophy of the remaining nephrons
B. Reduced renal blood flow and tubular obstruction
C. Dilation of the afferent arteriole
D. Increased oncotic pressure in the Bowman capsule
Correct Answer: B
Rationale: During the oliguric phase of AKI, reduced renal blood flow leads to ischemic
injury of the tubular epithelial cells. These damaged cells slough off and create obstructions
within the tubules, further reducing the GFR. This process is often exacerbated by local
inflammatory responses and intrarenal vasoconstriction.
,2. A 55-year-old male with Chronic Kidney Disease (CKD) is diagnosed with secondary
hyperparathyroidism. What is the primary underlying cause of this endocrine complication in
CKD patients?
A. Excessive intake of dietary calcium
B. Hypernatremia-induced hormonal shifts
C. Direct stimulation of the parathyroid gland by urea
D. Inability of the kidneys to activate Vitamin D
Correct Answer: D
Rationale: In CKD, the kidneys fail to convert Vitamin D into its active form, calcitriol,
which is necessary for calcium absorption. This results in hypocalcemia, which
subsequently triggers the parathyroid glands to release excess parathyroid hormone (PTH)
to mobilize calcium from the bones. Over time, this chronic stimulation leads to secondary
hyperparathyroidism and renal osteodystrophy.
3. The nurse is caring for a patient suspected of having Cushing’s Syndrome. Which of the
following clinical manifestations should the nurse expect to find during the assessment?
A. Weight loss and hypotension
B. Hypoglycemia and hyperkalemia
C. Thinning of the skin and increased melanin pigmentation
D. Moon face, buffalo hump, and truncal obesity
,Correct Answer: D
Rationale: Cushing’s Syndrome is characterized by an excess of cortisol, which leads to
distinct physical changes including the redistribution of fat to the face (moon face) and the
upper back (buffalo hump). Truncal obesity is a hallmark sign due to the metabolic effects
of glucocorticoids on adipose tissue. These patients also frequently present with
hypertension and hyperglycemia.
4. Select all the clinical manifestations that are commonly associated with Hypothyroidism.
(Select All That Apply)
A. Weight gain despite poor appetite
B. Heat intolerance
C. Bradycardia
D. Constipation
E. Exophthalmos
F. Cold intolerance
G. Lethargy and fatigue
Correct Answer: A,C,D,F,G
Rationale: Hypothyroidism results from a deficiency in thyroid hormones, which slows the
metabolic rate of nearly all body systems. Common symptoms include cold intolerance,
bradycardia, weight gain, and significant fatigue or lethargy. Constipation is also frequent
, due to decreased gastrointestinal motility, while exophthalmos and heat intolerance are
characteristic of hyperthyroidism.
5. A patient with Type 1 Diabetes Mellitus is admitted with Diabetic Ketoacidosis (DKA).
Which of the following laboratory findings is most consistent with this diagnosis?
A. Serum glucose of 450 mg/dL and presence of ketones in the urine
B. Serum glucose of 150 mg/dL and pH of 7.45
C. Serum bicarbonate level of 28 mEq/L
D. Low serum osmolality and hypernatremia
Correct Answer: A
Rationale: DKA is characterized by extreme hyperglycemia, typically above 250 mg/dL,
along with metabolic acidosis and ketonuria. The lack of insulin leads the body to break
down fats for energy, resulting in the production of acidic ketone bodies. This leads to a
decrease in serum pH and an accumulation of ketones in both the blood and urine.
6. Which pathophysiological process occurs in the brain during an ischemic stroke?
A. Rupture of a cerebral artery leading to intracranial hemorrhage
B. Excessive production of cerebrospinal fluid causing pressure
C. Global demyelination of the white matter in the cerebral cortex
D. Occlusion of a cerebral artery resulting in focal neurological deficits
Correct Answer: D
